MKSAP: 38-year-old woman with increasing fatigue and weight gain

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 38-year-old woman reports a 3-month history of increasing fatigue and weight gain. She underwent transsphenoidal surgery 4 years ago to remove a nonfunctioning pituitary macroadenoma, followed 4 months later by radiation therapy because of residual tumor. She started taking hydrocortisone 14 months ago after adrenal insufficiency was diagnosed. The patient developed amenorrhea 1 year ago and began taking an oral contraceptive. Medications are hydrocortisone, norethindrone with ethinyl estradiol, and a multivitamin. On physical examination, blood pressure is 102/68 mm Hg, pulse rate is 64/min, and respiration rate is 12/min. Mild periorbital edema is noted. The skin is pale. Laboratory studies: Hemoglobin Normal Sodium 134 mEq/L (134 mmol/L) Prolactin 22 ng/mL (22 µg/L) Thyroid-stimulating hormone 1.1 µU/mL (1.1 mU/L) Which of the following is the most appropriate next diagnostic test? A: Morning serum cortisol measurement B: Serum free thyroxine (T4) measurement C: Serum growth hormone measurement D: Serum luteinizing hormone measurement Continue reading ... Your patients are rating you online: How to respond. Manage your online reputation: A social media guide. Find out how.
Source: Kevin, M.D. - Medical Weblog - Category: Family Physicians Tags: Conditions Endocrinology Source Type: blogs