USMLE Forums banner
1 - 12 of 12 Posts

·
Registered
Joined
·
586 Posts
Discussion Starter · #1 ·
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 :D
 

·
Registered
Joined
·
3 Posts
??

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 :)
 

·
Registered
Joined
·
586 Posts
Discussion Starter · #5 ·
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 :D
 

·
Registered
Joined
·
187 Posts
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).
 

·
Registered
Joined
·
919 Posts
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.:)
 
1 - 12 of 12 Posts
This is an older thread, you may not receive a response, and could be reviving an old thread. Please consider creating a new thread.
Top