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
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Source: Kevin, M.D. - Medical Weblog - Category: Family Physicians Tags: Conditions Endocrinology Source Type: blogs
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