-
-
Thomas B. Repas, DO, FACP, FACE, CDE, is an endocrinologist, lipidologist and physician nutrition specialist in clinical practice at the Regional Medical Clinic Endocrinology and Diabetes Education Center in Rapid City, SD. Dr. Repas is the former chairman of the professional diabetes advisory committees of the Wyoming and the Wisconsin Diabetes Prevention and Control Programs. He is board certified in the areas of endocrinology, diabetes and metabolism, clinical lipidology, internal medicine and nutrition, and is also a certified diabetes educator.
Friday, November 2, 2012
Thomas B. Repas, DO, FACP, FACE, CDE
In this blog post, I present three cases involving patients suspected of having possible acromegaly and discuss follow up. After reading, please share your thoughts.
Case #1
Case #1 is a 51-year-old man who was first referred to me for primary hypothyroidism. However, at our first visit, I was struck by his large hands. Upon further questioning, he reported a history of snoring, sleep apnea and excessive sweating. He no longer was able to wear his wedding ring.
Thursday, December 15, 2011
Thomas B. Repas, DO, FACP, FACE, CDE
A young woman in her 20s asked to come see me in consultation. She had been told, "An endocrinologist won't do anything for you that we aren't already doing." It was not until recently that one of her providers finally complied with her request.
Tuesday, November 10, 2009
Thomas B. Repas, DO, FACP, FACE, CDE
A 32-year-old woman had imaging to evaluate headache. The MRI incidentally found “fullness of pituitary possibly representing pituitary microadenoma but without discrete lesion seen.” Her primary care practitioner found slightly high prolactin of 32 ng/mL (3-27 ng/mL). She denied menstrual irregularity. Thyroid-stimulating hormone and other laboratory studies were normal. Nevertheless, her primary care practitioner initiated dopamine agonist which she had been receiving for three years until she came to see me.
Friday, September 4, 2009
Thomas B. Repas, DO, FACP, FACE, CDE
This week I saw two young women, a 31-year-old and a 21-year-old with galactorrhea. They were sent to me from two different gynecologist’s offices. Both had analysis of the breast discharge which confirmed breast milk. Both had normal prolactin on repeat testing. One had pituitary MRI which showed “physiologic hypertrophy” but no pituitary adenoma. The other was to have an MRI but was sent to me first.
Monday, February 16, 2009
Thomas B. Repas, DO, FACP, FACE, CDE
I saw a 44-year-old woman last week in consultation for hyperprolactinemia. The diagnosis was made several years earlier by her gynecologist. She had had menometrorrhagia resulting in iron deficiency anemia. Her prolactin was elevated and she was started on bromocriptine. An MRI per the gynecologist’s progress note revealed subtle asymmetry of the pituitary suggesting possible microadenoma. Her prolactin levels normalized on the bromocriptine but she continued to have heavy menstrual bleeding. She later underwent hysterectomy.
Friday, October 31, 2008
Thomas B. Repas, DO, FACP, FACE, CDE
I saw a fascinating new consult yesterday.
Friday, October 24, 2008
Thomas B. Repas, DO, FACP, FACE, CDE
The inspiration for this post came from a previous comment and subsequent email.
Friday, September 5, 2008
Thomas B. Repas, DO, FACP, FACE, CDE
A 58-year-old man came to see me in consultation for type 2 diabetes and dyslipidemia. He had elevated transaminases presumed to be due to nonalcoholic fatty liver disease. The question was, which oral antidiabetic and lipid-lowering agents might be options?
Tuesday, August 26, 2008
Thomas B. Repas, DO, FACP, FACE, CDE
A 54-year-old man fell off a ladder and presented to the emergency room for evaluation. An MRI of the head found an incidental pituitary macroadenoma measuring 1.8 cm. He was sent to neurosurgery for evaluation. Visual field testing was abnormal and he was scheduled for transphenoidal pituitary resection.