manage this - step3turn

[ArchivalUser]

C.......

[ArchivalUser]

yes this is a uw question. And the ans is A. Bromocriptine useful only in prolactinomas and GH secreting tumors (acc to uw), not in non-functional pitutary adenomas. I suppose the alpha subunit indicates it's a GnRH tumor

[ArchivalUser]

Dear step3turn, yes I still remember you. You were a super helpful person in ck forum. So why did not you make the ID as "NOWstep3turn" That would make more easier to get you. Good luck and all the best

[ArchivalUser]

Drock Thanks man for the compliments, suggestion and wish. Good luck to u as well. I hope u would have rocked CK score board. When is ur plan for STEP 3 ?

[ArchivalUser]

a subunit increase indicate pipuitary fraction so its functional and 2cm need surgery, only prolactinoma should treated with bromocriptine not all the pituipary tumor, so ans; A.

[ArchivalUser]

If its not prolactinoma , why is her prolactin levels so high and why is she amenorrhic for 8 months., please enlighten us .

[ArchivalUser]

Dr. Red explained it well on his lecture. According to him - Prolactin level between 500 - macroadenoma.
So in this case - Prolactin level is not significantly high. Now looking at the size of the pituitary mass which is more than 1cm. - falls into the criteria of macroadenoma. So basically there is mismatch between lab and clinical picture. This can be explained by the fact that - pituitary macroadenoma is likely causing mass effect - thereby decreasing the other hormones. (which also explains amenorhea). So a non functioning macroadenoma - that is causing mass effect can only be cured by trans- sphenoidal surgery.
I hope that explains.

[ArchivalUser]

so tumor mass effect is decreasing LH and FSH...understandable
then why the the same non functional/non secretary mass effect is not decreasing prolactin,
rather it is increasing it.what is causing marked increase in a-subunits.
do we get missmatch labs in exam.
please help....thanks

[ArchivalUser]

@step3turn, please give us the correct answer and explanation too. Thanks.

[ArchivalUser]

1. The initial treatment for macroadenoma is dopamine agonist ( bromocritine , cabergiline ) cabergoline is better than bromocrptine . it help to shrink the mass and PRL comes to normal with in one month .

2. large tumor with apoplexy( hemorrage ) , severely compress of visual field , who does not responce to dopamine agonist then transhenoidal surgery is next choice .