Endocrinology, Diabetes, and Metabolism Board Review #2 Rob ...

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• A 24-year-old woman is evaluated for a 5-week history of polyuria and
polydipsia (both of which were of sudden onset), onset) a 3-month history of
mild fatigue, a 7-month history of galactorrhea, and a 1-year history of
secondary amenorrhea. She has been drinking between 7.5 and 9.5
liters of water daily and has been awakening three to five times per
night g to urinate; ; she is always y thirsty y at these times. The ppatient
reports normal growth and development; she experienced menarche
at age 12 years. Approximately 6 months ago, her ophthalmologist
diagnosed uveitis. She takes no medications.
• Physical examination reveals a short, mildly overweight woman. Blood
pressure iis 118/74 mm Hg, H pulse l rate t is i 78/min, 78/ i and d BMI is i 27.1. 27 1
Bilateral expressible galactorrhea and axillary lymphadenopathy are
noted. Breast development and pubic hair are normal.
• Laboratory studies:
– SSodium di 146 meq/L /L (146 mmol/L) l/L)
– Osmolality: Plasma 305 mosm/kg; Urine 84 mosm/kg
– Prolactin 48.2 ng/mL (48.2 µg/L)
– Thyroxine (T4), free 1.2 ng/dL (15.5 pmol/L)
– AAn MRI shows h a normal l pituitary it it gland l d but b t a thickened thi k d pituitary it it stalk.
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