HY USMLE Neuro/Endocrine -

[@danieldonascimentoaraujo3221]

Fabulous question! Amazing Clarification, Mike!!!!

[@Mehlmanmedical]

Thanks Daniel

[@iknoordhami5604]

3:23 AM exactly today , what a coincidence!!!!

[@maryamnour8801]

#313- Detroit B)
Thank you~

[@jeneenkhrais7699]

amazing amazing, thank you for taking the time to do this, I really appreciate all of your efforts

[@archangel80303]

Thanks so much.I blindly thought it was prolactinoma.

[@Mehlmanmedical]

Thanks Anne-Marie

[@OthmanMatar]

Thank you ❤

[@ibrahimzuraik]

Thanks Mike💪

[@prashanthkuraku5119]

thanks mike

[@fadilsahar7914]

Thanks bro!

[@Mehlmanmedical]

Gatorrr

[@VAISHNAVAM]

Good question and explanation 👍🏽

[@preethi7751]

Thanks Mike!

[@Mehlmanmedical]

Preethi thank you ;)

[@tsharma120]

Wow, thank you!

[@Mehlmanmedical]

Thanks Tina!

[@sourabharora3768]

Thank 😊 you so much

[@Mehlmanmedical]

Thanks Sourabh

[@dilansarmad3385]

Great explanation.

[@Mehlmanmedical]

Thanks Dilan

[@aliharisman]

Thank you

[@Mehlmanmedical]

Thanks Shahzz

[@muhammadashurov697]

Liked it! Cool question

[@MahnoorWaqas-u6e]

It took me a while to get to it. Need to step up my game to solve the question in time

[@Hellastorytella]

A new way of thinking about this image, which has been historically (and incorrectly) correlated with PROLACTINOMA, especially when a pt presents with these symptoms.

[@theclinicalist6401]

what about the prolactin gnrh relation ? just solved a question on amboss with the exact same presentation and prolactin was the ans, just need clarification on this because prolactin can indeed cause osteoporosis, plus whats up with the vision problems? thanks.

[@etniasdeguatemala4689]

share the question stem and options to see how is it that differ

[@hanszimmer6529]

There is also a huge weight gain here due to excess cortisol, this can't be explained by prolactin effect, the visual finding is bitemporal hemianopsia due to compression of the optic chiasm by the tumor mass

[@dr.poornaprajna]

Thanks Mike
I have a Q. What's with the "diminished lateral vision bilaterally"?

[@hanszimmer6529]

Bitemporal hemianopsia due to compression of the optic chiasm

[@sanjaykarki8533]

wow its a clever one mike? association of prolactinoma with osteoporosis in premenopausal women is tested everywhere. so students can get easily tripped. 👍 brilliant one.

[@Mehlmanmedical]

Never seen prolactinoma causing osteoporosis on NBME material. There's a question specifically on the Step 1 NBME where prolactinoma is wrong answer in this case.

[@NandhiniIyer]

Hiii,can't prolactin suppress gnrh which will eventually cause low estrogen leading to osteoporosis?

[@jyotidave488]

I also have the same question.

[@OliviaH0920]

Yes, but there’s no further supporting symptoms for a possible suppression of sex hormones. Both LH and FSH would be suppressed with a prolactinoma where in a male we would see impotence from low testosterone and/or galactorrhea from high prolactin levels. In a woman we would see amenorrhea from an imbalance of estrogen/progesterone, galactorrhea from high prolactin, and sure, maybe a compression fracture from the low estrogen specifically. This vignette talks about 1. a male with no galactorrhea or impotence 2. He presents with weight gain (supports excess steroids), a compression fracture indicative of osteoporosis and osteoporosis is an adverse effect of prolonged steroid use 3. Compression of optic chiasm causing bitemporal hemianopsia which can also support Cushing’s Disease (ACTH pituitary tumor)

[@mycobacteriumtuberculosis6913]

Doctor, could you make a topic in neuroscience sensory and reflex exam

[@abdullahmouhammed4912]

hyperthyroidism can cause osteoporosis and the patient will present with the same presentation , why the question didn't contain any thing to differentiate between hyperthyroidism and caushing syndrome as a cause of osteoporosis??!

[@Mehlmanmedical]

ACTH secretion leading to Cushing way more likely to cause osteoporosis. And it's on the NBME. Not my opinion, take it up with NBME.

[@Mehlmanmedical]

And I also gave weight gain in the vignette btw. That reflects Cushing. You'd have weight loss if anything in hyperthyroidism.

[@abdullahmouhammed4912]

Thanks DR.Mike ... you are the best 🎆