Return to Scenario ListShow Learning Points most relevant to Phase 1:


Clinical Discipline(s)/Organ System(s)
Endocrinology, Neurology, Neurosurgery
Progress Test Topic(s)
A 30 year old South African man sees his GP because he is feeling very tired and has reduced libido. He recently failed his vision test when renewing his driver's licence.
Progress Test-Type Questions:   Question 1 | Question 2
Applied Science for Medicine 
   - Anatomy of the pituitary gland and hypothalamus
   - Physiology of the hypothalamic-pituitary-end organ axis; science of negative feedback loops
   - Hormones produced by the pituitary and their synthesis; pituitary hormones required for survival
   - Pathology of types of tumours and other diseases that affect the pituitary
   - Pathophysiology of visual field defects
   - Pharmacology of testosterone, oestrogen, vasopressin, hydrocortisone and thyroxine
Clinical and Communication Skills 
   - Elicit a history from a patient with visual field defects and fatigue
   - Appropriate communication with patient regarding their change in libido
   - Examination of vision and the endocrine system
   - Recognise types of visual field defects
   - Recognise clinical phenotypes of common functioning pituitary tumours and panhypopituitarism
   - Indications for pituitary function tests (including urgent prolactin, cortisol), visual field tests and MRI brain
   - Differential diagnosis for acute and chronic panhypopituitarism
   - Management of panhypopituitarism and the order in which hormone replacement should be started
   - Management of the patient on long-term adrenal replacement therapy
   - Prognosis of panhypopituitarism
   - Surgical approach to removing a pituitary mass and the complications
   - Management of visual field defects
Personal and Professional Skills 
   - Helping patients come to terms with a new disability
   - Principles underlying informed consent and valid consent
   - Maintaining confidentiality
   - Knowing the obligations of the doctor in relation to the New Zealand Transport Authority guidelines on driving
Hauora Māori 
   - Communication with patients and whānau
   - Consideration of patient and whanau support needs
   - Consideration of access to cultural/spiritual support for patient and whānau
Conditions to be considered relating to this scenario
panhypopituitarism, pituitary adenoma, post-traumatic brain injury, post-radiotherapy, post-neurosurgery, stroke
Less common but 'important not to miss'
metastases, Sheehan's syndrome, pituitary apoplexy, subarachnoid haemorrhage
craniopharyngioma, meningioma, glioma, haemochromatosis, neurosarcoidosis, empty sella syndrome, lymphocytic hypophysitis
Related Scenarios
[Adrenal crisis], [Hypothyroidism]