A 30-year-old woman complains of headache, visual disturbances, deepening of the voice, and generalized weakness. She repos amenorrhea for the past year and states that she recently required a larger shoe size. Laboratory studies show impaired glucose tolerance. What other procedure would be useful for establishing your diagnosis?
- Given clinical features suggests the diagnosis of acromegaly which can be d/t Pituitary adenoma. Pituitary adenomas - Range from small lesions that do not enlarge gland to expansive tumors that erode sella turcica & impinge on adjacent cranial structures. Hence MRI of sella turcica can be useful to diagnose these tumors. - Adenomas < 1 cm diameter- Microadenomas (no symptoms) - > 1 cm- Macroadenomas- Mass effect : Impingement on optic chiasma causing bitemporal hemianopsia, Loss of central vision, Oculomotor palsies when tumor invades cavernous sinuses Severe headaches. - Large adenomas may invade hypothalamus -Loss of temperature regulation, hyperphagia & hormonal syndromes because they interfere with normal hypothalamic input to pituitary. - Symptoms of acromegaly- Facial changes, goiter, barrel chest, abnormal glucose tolerance, male sexual dysfunction, menstrual disorders in women, degenerative ahritis, peripheral neuropathy & thickened skin.
CBC with differential count
CT scan of the abdomen
MRI of the sella turcica
Test for serum 21-hydroxylase
Miscellaneous