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Postgraduate Medical Journal 2004;80:185; doi:10.1136/pgmj.2003.006510a
© 2004 BMJ Publishing Group Ltd and The Fellowship of Postgraduate Medicine.
Postgraduate Medical Journal 2004;80:185
© 2004 Fellowship of Postgraduate Medicine

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Nausea and vomiting in a patient with increasing thirst

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Q1: Describe the finding on computed tomography and MRI and give a differential diagnosis

Enhanced axial computed tomography of the brain with iodine based contrast (iodine 300 mg I/ml) demonstrates a 1.5 cm diameter enhancing lesion in the suprasellar cistern involving the pituitary stalk.

The supplementary T1 weighted MRI scan with gadolinium DPTA enhancement shows this lesion to be based in the pituitary stalk with involvement of the floor of the hypothalmamus. There was preservation of the normal high signal in the posterior pituitary gland.

In a patient with known breast carcinoma this would represent a pituitary stalk metastasis. For radiological differential diagnoses see table 1Go.1


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Table 1 Radiological differential of a suprasellar mass

 

Q2: What three simple biochemical tests would you perform, and what result would you expect and why?

The simple biochemical tests would be a serum urea and electrolytes, a corrected serum calcium, and osmolality of the serum and urine. The anticipated finding on the serum urea and electrolytes would be a raised sodium, because of the dehydration of the polyuria. You may have expected the serum calcium to . . . [Full text of this article]


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Nausea and vomiting in a patient with increased thirst
J D Birchall
Postgrad. Med. J. 2004 80: 183. [Extract] [Full Text] [PDF]

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