Postgrad Med J 2001;77:533-534
( August )
Self assessment questions
Confusion in an elderly patient: an uncommon diagnosis for such a
common event
D Piettea, P Selvaisb, D Vanpeea, C Swinea
a Université
Catholique de Louvain, Mont-Godinne Hospital, Yvoir, Belgium: Division
of Geriatric Medicine, b Division of Endocrinology
Correspondence to: Professor Christian Swine, Department of Geriatric Medicine, University
Hospital of Mont-Godinne, B-5530 Yvoir, Belgium
swine@intr.ucl.ac.be
Submitted 10 January
2000;
Accepted 22 June 2000
| The first 100% of the full text of this article appears below. |
A 90 year old woman was admitted to
the emergency department with delirium and falls. She had a recent
history of cognitive impairment, insomnia, drowsiness, and progressive
disability. Three months before admission, in the course of a medical
check-up, an isolated increased plasma thyroid stimulating hormone (TSH 8 mIU/l, normal values 0.5-2.9) was discovered, leading to a
levothyroxine therapy (50 µg daily). This patient was previously
alert and able to live almost independently. Physical examination was
unremarkable, except for fidgeting and restlessness. Other biochemical
investigations were normal. A cranial tomographic study was obtained
and revealed no intracranial haematoma but unexpectedly showed a
pituitary macroadenoma, subsequently confirmed by magnetic resonance
imaging (fig
1).
| Figure Removed (Available Only in the Full Text) |
Questions
| (1) |
What is the initial diagnosis?
|
| (2) |
In view of the results, which diagnosis should be considered and which parameters shall be measured?
| Figure Removed (Available Only in the Full Text) |
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© 2001 by The Fellowship of Postgraduate Medicine
