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  #1  
Old 08-26-2009
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Thyroid Difficult Question

I came across this CCS which is really challenging

Patient came with malaise, weight loss, epigastric tenderness, diarrhea, hypercalcemia, hypophosphatemia, normoglycemia, occasional headaches, high prolactin level.

What hormone will be low in this patient?
-Gastrin
-VIP
-Testosterone
-Insulin

I know the answer
let's see if you can guess
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  #2  
Old 08-26-2009
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Default ??

Hypercalcemia & Hypophosphatemia - does it have to do with increased PTH?
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  #3  
Old 08-26-2009
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Quote:
Originally Posted by hope2inspire View Post
Hypercalcemia & Hypophosphatemia - does it have to do with increased PTH?
Yes,
You are getting closer
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  #4  
Old 08-27-2009
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Default ??

You said I'm getting closer..
But what does high PTH have to do with any of the choices on the list?? Argh!
My final answer is Testosterone.
I came to that conclusion by thinking that since there is a high prolactin level, either there's a benign adenoma or the dopamine from the hypothalamus is not enough to inhibit it. If there is a problem in the hypothalamus, GnRH will be affected, which will affect secretion of LH & FSH and can decrease production of testosterone.
I'm still wondering what the link is between high PTH and the question itself. That explains the hypercalcemia and the hypophosphatemia. Maybe it's a distraction?
Gastrin & VIP - not really related to the lab values. Maybe related to the diarrhea?
Insulin - normoglycemia rules that out.
Curious to know what the answer is
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  #5  
Old 08-27-2009
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Your answer is correct

This is a case of multiple endocrine neoplasia type I

There's parathyroid tumor which explains the high calcium low phosphate
There's pancreatic tumor which explains the GIT hormones
There's pituitary tumor which explains the headaches and the high prolactin

Prolactin is inhibitory to GnRH (check it in First Aid) so it inhibits LH, FSH, and testosterone
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  #6  
Old 08-27-2009
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Default :)

Great Question!
i wouldn't have thought of MEN at all!
Wowwwww!
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  #7  
Old 10-18-2009
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Thanks for sharing a question and explanation that leads to the answer...

good for practice
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  #8  
Old 10-18-2009
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Question

Quote:
Originally Posted by smile135 View Post
Thanks for sharing a question and explanation that leads to the answer...

good for practice
You welcome smile135
Can you help me solve this problem please
Type II or Type III Hypersensitivity?
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  #9  
Old 04-19-2010
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This is seriously the most difficult question that I've ever seen so far
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  #10  
Old 04-19-2010
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When a pt presents with a constellation of heterogenous symptoms, the exam taker should always have in mind two entities: MEN syndromes (esp. type 1) & paraneoplastic syndromes. We could also add autoimmune disease (esp. mixed collagen tissue disease & the correlation between heterogenous autoimmune disease, eg diabetes & autoimmune thyroiditis).
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  #11  
Old 04-20-2010
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Default

i guessed testosterone for only one reason = high prolactin.

i had no idea this was a MEN I related question!

thanks for the awesome question and explanations guys.
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  #12  
Old 06-20-2010
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Quote:
Originally Posted by Seetal View Post
i guessed testosterone for only one reason = high prolactin.

i had no idea this was a MEN I related question!

thanks for the awesome question and explanations guys.

I THOUGHT THAT TOO
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