WBR0225

Author	[[PageAuthor::Mugilan Poongkunran M.B.B.S [1]]]
Exam Type	ExamType::USMLE Step 3
Main Category	MainCategory::Emergency Room
Sub Category	SubCategory::Endocrine
Prompt	[[Prompt::A 60 yr old woman is brought to the emergency department following a motor vehicle accident. She was hit by car from her side and claims that she did not see the car coming towards her. She had a past history of intraabdominal operation done 15 yrs ago for Cushing’s syndrome. Physical examination shows tanned female with normal vital signs. She has few abrasions on her face and chest. Her injuries are managed appropriately. What is the most likely diagnosis at this point?]]
Answer A	AnswerA::Craniopharyngioma
Answer A Explanation	[[AnswerAExp::Incorrect : Although craniopharyngioma occurs in adults, it is uncommon at this stage. They present with hypopituitarism and diabetes insipidus is common and hyperpigmentation does not occur in this.]]
Answer B	AnswerB::Prolactinoma
Answer B Explanation	[[AnswerBExp::Incorrect : Prolactinoma causes infertility, oligomenorrhea, or amenorrhea. Galactorrhea, gynecomastia, or bitemporal hemianopia maybe prominent. But hyperpigmentation does not occur.]]
Answer C	AnswerC::Brain tumour
Answer C Explanation	[[AnswerCExp::Incorrect : Only parasellar and intrasellar meningioma produce visual field defects and not other. Hyperpigmentation is not a finding.]]
Answer D	AnswerD::Nelson’s syndrome
Answer D Explanation	AnswerDExp::'''Correct''' : Pituitary enlargement and hyperpigmentation following bilateral adrenalectomy is called Nelson’s syndrome
Answer E	AnswerE::Empty sella syndrome
Answer E Explanation	[[AnswerEExp::Incorrect : Hyperpigmentation and visual field defects does not occur in empty sella syndrome]]
Right Answer	RightAnswer::D
Explanation	[[Explanation::Pituitary enlargement and hyperpigmentation following bilateral adrenalectomy is called Nelson’s syndrome. The cause of pituitary enlargement is loss of feedback by adrenal glucocorticoids following the adrenalectomy. The tumour is aggressive and is treated by surgery or pituitary radiation. Following B/L adrenalectomy prophylactic pituitary radiation is an option, but however it leads to pan hypopituitarinism. Previously treatment of Cushing’s disease is B/L adrenalectomy, but now days transphenoidal surgery is preferred. Educational Objective: References: ]]
Approved	Approved::Yes
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