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Category: Critical Care Medicine-Endocrine Disorders--->Pituitary
Page: 2

Question 6#Print Question

A 28-year-old with history of severe postpartum hemorrhage 1 month ago is sent to the ED from primary care clinic for hypotension and worsening weakness and fatigue over the last few days. On review of systems, she notes that she has been having trouble with her memory, cold intolerance, low appetite, and has been unable to breastfeed since her previous discharge from the hospital. Vitals are:

  • pulse 110
  • blood pressure 81/49
  • respiratory rate 16
  • oxygen saturation of 98% on room air

Basic metabolic panel shows:

  • sodium of 128 mEq/L
  • potassium of 5.8 mEq/L
  • chloride of 98 mEq/L
  • bicarbonate 26 mEq/L
  • urea 36 mg/dL
  • creatinine 1.6 mg/dL

Complete blood count demonstrates:

  • hemoglobin 10.2 g/dL
  • hematocrit 33%
  • WBC 4.0 × 10 3 /µL
  • platelets 120 × 10 3 /µL

Thyroid-stimulating hormone (TSH) is 0.1 mIU/L (normal 0.5-4 mIU/L). Injection of 500 µg of thyrotropin-releasing hormone elicits no increase in serum TSH or prolactin.

Which of the following hormones is most likely to have normal levels? 

A. Aldosterone
B. Cortisol
C. Follicle-stimulating hormone
D. Gonadotropin-releasing hormone


Question 7#Print Question

A 72-year-old female with history of hypertension, chronic kidney disease stage IV, and worsening headaches over the last few weeks is brought to the ICU for airway watch after falling in her bathroom and suffering multiple rib fractures and mild respiratory distress. CT head without contrast demonstrates no signs of acute cranial bleed but notes “an enlarged pituitary with concern for sellar mass.”

What is the best imaging procedure to further investigate?

A. Computed tomography
B. Magnetic resonance imaging
C. Magnetic resonance imaging with gadolinium
D. Positron emission tomography


Question 8#Print Question

A 22-year-old previously healthy female is brought to the emergency department from a rave party with a chief complaint of “dizziness.” Per her friends, the patient had taken a tablet of “ecstasy.” There was no report of other drug use or excessive water intake. Her blood pressure is 108/62 mm Hg, pulse 115 beats/min, respiration rate 18 breaths/min, pulse oximetry 98% on room air, and afebrile. Physical examination demonstrates normal skin turgor, normal cardiac examination, clear lungs, no edema, and nonfocal neurologic examination. Head CT and chest X-ray are negative. Her labs are:

  • sodium 128 mEq/L
  • potassium 3.7 mEq/L
  • chloride 87 mEq/L
  • bicarbonate 19 mEq/L
  • urea nitrogen 6 mg/dL
  • creatinine 0.7 mg/dL
  • glucose 118 mg/dL
  • Measured serum osmolality is 250 mOsm/kg
  • Urine sodium is 105 mEq/L
  • urine osmolality is 352 mOsm/L

Alcohol level is 0 and toxicology screen is negative.

What is the next best step in management?

A. Neurosurgical consult
B. Administration of hypertonic saline
C. Demeclocycline
D. Fluid restriction




Category: Critical Care Medicine-Endocrine Disorders--->Pituitary
Page: 2 of 2