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Patho

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Submitted By lafrenz25
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B.J. is a 54-year-old attorney who for several months has been experiencing generalized headaches that have responded poorly to nonnarcotic analgesics. He is also experiencing visual disturbances including blurred vision and double vision. Upon questioning, B.J. reports that he has gained 20 pounds over 2 years despite no change in activity or eating patterns. About his weight gain, B.J. jokes, “I guess its all in my feet. I had to buy new shoes, and my shoe size went from a size 10 to a size 12.” It was determined that B.J. should have a CT scan of his head to assess for pituitary adenoma.
1. What information from the above scenario would indicate a possible pituitary adenoma?
2. What other signs or symptoms might be apparent if B.J. does indeed have a pituitary adenoma?
3. B.J. is dianosed with pituitary adenoma and undergoes a trans-sphenoidal hypophysectomy to remove the tumor. After surgery, he has huge urinary outputs of 500 to 600 ml/hr. What is the most likely cause of his high urine output? What other clinical data support this diagnosis?
4. B.J. receives subcutaneous vasopressin (ADH) to manage his high urine output. What is the rationale for this therapy? How can effectiveness be assessed?
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Case 2
D.K. is a 35-year-old high school secretary who began to experience weight loss despite ravenous appetite and increased dietary intake. She has to make frequent trips to the bathroom to urinate and has difficulty concentrating on her work because of fatigue. She drinks large volumes of coffee to help with a constant dry mouth and to combat her fatigue. At a clinic appointment, it was noted that D.K.’s weight has dropped from 140 to 128 pounds. She is 5 feet 7 inches tall. Her urine is positive for sugar (2%) and ketones. A chemstick blood glucose level is 412 mg/dl. D.K. had eaten breakfast 3 hours before the…...

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