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NBME 18 Answers

nbme18/Block 2/Question#30

35 yo man, 4 weeks of severe midline back pain


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its best to think about pituitary adenomas as one of three big options, prolactin secreting, ACTH secreting, or GH secreting. The only pituitary tumor that causes osteoporosis and therefore the compression fractures seen in the questions could be a ACTH secreting pituitary adenoma (note: macroadenoma just means that the tumor is >10mm in size). increased ACTH leads to increased cortisol and therefore decreased osteoblastic activity (bone formation) = osteoporosis

Even though TSH producing adenomas mat also produce compression fractures they are far less common than ACTH producing tumors