mbbs first year syllabus

1. Case Study : Dysfunction of
anterior pituitary gland
Dr Nurul Akmal Jamaludin

2. Case Study 1
• A 28-year-old woman complains to her obstetrician of her periods became
irregular and then ceased altogether (amenorrhea) and milk discharge from
her nipples (galactorrhea).
• The patient was involved in a motorcycle accident 3 months ago. Injuries were
mostly superficial, but the impact was sufficient to break her helmet.
• The patient indicated she just has not “felt right since the accident.” She is
constantly tired, has gained 5 pounds, and drinks and urinates more than
before the accident.

3. Laboratory studies :
• Pregnancy test: Negative
FSH levels: 2 mIU/mL (normal: 4-30 mIU/mL)
LH levels: 2 mIU/mL (normal: 5-30 mIU/mL)
• Cortisol level: 2 μg/dL (normal: 3-15 μg/dL)
• Thyroxine (T4): 3 μg/dL (normal: 5-12 ug/dL)
• Triiodothyronine (T3): 60 ng/dL (normal: 115-190 (ng/dL)
Prolactin levels: 70 ng/mL (normal: < 20 ng/mL)

4. Questions?
• From all the laboratory examination, explain what is the possible
reason that cause the anterior pituitary hormones secretion are not
at their normal range?
• Why the patient experienced milk discharge from her breast even
though she is not breastfeeding?
• How is prolactin secretion regulated?
• Why did the patient have galactorrhoea (increased milk production)?

5. Back to the case study
The patient complains to her obstetrician of her periods became
irregular and then ceased altogether (amenorrhea).
• Why were her menstrual cycles irregular? What was the significance
of her follicle stimulating hormone (FSH) level?

6. What other symptoms?
The patient indicated she just has not “felt right since the accident.”
She is constantly tired, has gained 5 pounds, and drinks and urinates
more than before the accident.
• Why is she experience all the symptoms above?

7. Case Study 2 :
• A 33-year-old woman comes to her primary care physician complaining
of joint pains associated with changes in the sizes of her hands and feet.
The patient reports massive growth of her hands and feet as well as protrusion of
her lower jaw.
• She believes the shape of her face has changed, becoming sharper. She also
complains of sudden weakness, even when just “carrying the clothes hamper
upstairs.”
• She first noticed these changes about 6 months ago when she was home for the
holidays and saw some high school and early college pictures of herself.
• Her mother brought to her attention how her features seemed much larger. After
that she says she became more aware of her bodily changes. She came in
because she says she knows something is wrong and that there is a definite
distinction from how she looks now from how she used to look.
• An MRI scan revealed an 11–12 mm pituitary tumor.
• Labarotary examination showed elevated level of IGF1

9. Questions?
• Based on the symptoms what is the diagnosis for the patient?
• How is the growth hormone regulated in normal person?
• Why did the patient experienced changes in the sizes of her hands and feet?

10. Back to the case study
The patient laboratory examination showed elevated level of IGF1
For suspected acromegaly patient, doctor will check their IGF-1 level.
Explain why the doctor need to test the patient IGF-1 Level?