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A 25-year-old woman presents to a primary
care clinic complaining of galactorrhea, loss of
libido, and vision changes. Further work-up reveals
a mass in the sella turcica. Which of the
following functions will most likely be preserved
with normal functioning in this individual?
(A) Free water resorption
(B) Menstruation
© Ovulation
(D) Salt retention
(E) Thyroid hormone production
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DRONA WHATS THE ANSWER TO THIS?
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The correct answer is D. Pituitary adenomas
can lead to hypersecretion of hormones as
demonstrated by this woman’s galactorrhea
suggesting high levels of prolactin. Due to their
mass effect, an adenoma can also lead to defi -
ciencies in other pituitary hormones and
changes in vision. The key to answering this
question is to realize which of the processes
listed is not changed by a defi ciency in a pituitary
hormone. Salt retention is a primary action
of aldosterone, which acts at the renal distal
tubules to increase sodium and chloride
reabsorption as well as increase potassium secretion.
Aldosterone is produced in a multistep
pathway from cholesterol, along with cortisol
and the androgens, in response to ACTH stimulation.
ACTH is secreted by the anterior pituitary
and would likely be defi cient due to impingement
of an adenoma on this gland.
However, ACTH defi ciency does not cause saltwasting, volume contraction, and hyperkalemia,
because it does not result in clinically important
defi ciency of aldosterone.
Answer A is incorrect. Free water resorption is
mediated by ADH that is secreted from the
posterior pituitary. ADH secretion leads to insertion
of water channels in the collecting duct
of the nephron that resorb free water. In the
absence of ADH, there would be a lack of water
channels to resorb free water
