1.C.M., age 20 years, was admitted to emergency with severe headache, photophobia, drowsiness, and slight neck rigidity, suggestive of meningitis. Her medical history indicated good general health. She had been treated for carpal tunnel syndrome 3 years before, and she had noted an increase in hand and foot sizes over the past several years. In the past week, she had experienced severe headaches associated with nausea and vomiting. Tests on CSF did not confirm meningitis. Blood tests indicated low levels of thyroxine, cortisol, and gonadotropins, but high levels of growth hormone. Radiographic tests showed a space-occupying lesion in the sella turcica. A diagnosis of pituitary adenoma with acromegaly was established. The acute episode had resulted from infarction of the pituitary gland (pituitary apoplexy). C.M. recovered from the infarction, and was discharged from the hospital. The infarction had reduced the GH secretion to some extent. Thyroxine and cortisol levels were low normal; no replacement therapy was recommended at this time.
1. Define adenoma and describe the location of the pituitary gland.
2. Explain the rationale for the neurologic signs and symptoms leading to admission (see Chapter 22).
3. Explain the effects of acromegaly in C.M. How long was the adenoma likely present?
4. Explain the low blood levels of thyroxine, gonadotropins, and cortisol.