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Pituitary Case: 53-year-old Man after Transsphenoidal Resection of Pituitary Adenoma

by Michael Lazarus, MD

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    00:01 Let's go on to another case.

    00:03 A 53-year old man was recently discharged after a transsphenoidal resection of a pituitary macroadenoma that had compressed his optic nerves.

    00:13 For the last week, he has felt dizzy, weak, and has had reduced appetite.

    00:19 On discharge, he was told that his hormonal labs were all normal.

    00:24 Currently, he denies increased thirst or increased urination.

    00:28 He is on no medications, and his exam reveals normal vital signs and is otherwise unremarkable.

    00:35 His labs are significant for a sodium of 129 milliequivalents per liter.

    00:40 What is the most likely diagnosis? In this case, we have a patient who has had recently had pituitary surgery, who now has symptoms of weakness, and dizziness, and reduced appetite.

    00:55 He has no increased thirst or urination, but he is also hyponatremic.

    01:00 His serum sodium of 129 is very low.

    01:05 After a pituitary procedure, a low pituitary hormone release should be suspected.

    01:11 The clinical history suggests a decrease in ADH based on the fact that his sodium is low, and potentially also a decrease in cortisol which would fit with the dizziness and weakness as well as the hyponatremia.

    01:25 But we are told that his vital signs are normal, so he's not hypertensive.

    01:31 After pituitary surgery, always monitor for hormone deficiencies.

    01:35 His low sodium suggests either diabetes insipidus or SIADH.

    01:41 Given the absence of polyuria and thirst, SIADH is favored as the most likely diagnosis for his hyponatremia.


    About the Lecture

    The lecture Pituitary Case: 53-year-old Man after Transsphenoidal Resection of Pituitary Adenoma by Michael Lazarus, MD is from the course Pituitary and Hypothalamic Disorders.


    Included Quiz Questions

    1. Syndrome of inappropriate antidiuretic hormone secretion (SIADH)
    2. Diabetes insipidus
    3. Cushing syndrome
    4. Addison disease

    Author of lecture Pituitary Case: 53-year-old Man after Transsphenoidal Resection of Pituitary Adenoma

     Michael Lazarus, MD

    Michael Lazarus, MD


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    best one
    By S C. on 13. August 2021 for Pituitary Case: 53-year-old Man after Transsphenoidal Resection of Pituitary Adenoma

    useful case. Very good explanation and clear logical approach to a post op patient.