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Hypercalcemia & Hypophosphatemia - does it have to do with increased PTH?
Hypercalcemia & Hypophosphatemia - does it have to do with increased PTH?
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
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
1 - 12 of 12 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
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
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
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
Great Question!
i wouldn't have thought of MEN at all!
Wowwwww!
Thanks for sharing a question and explanation that leads to the answer...
good for practice
good for practice
You welcome smile135Thanks for sharing a question and explanation that leads to the answer...
good for practice
Can you help me solve this problem please
http://www.usmle-forums.com/usmle-step-1-forum/609-type-ii-type-iii-hypersensitivity.html
This is seriously the most difficult question that I've ever seen so far
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 had no idea this was a MEN I related question!
thanks for the awesome question and explanations guys.
I THOUGHT THAT TOOi 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
