ENDOCRINE DISORDERS Flashcards
Master Gland of the body
Pituitary Gland
Pituitary Gland is divided into the:
Anterior Pituitary Gland
Posterior Pituitary Gland
Other term for pituitary gland is
Hypophysis
Adenohypophysis
Anterior PG
Neurohypophysis
Posterior PG
Controlled by the hypothalamus
Pituitary Gland
Where is the pituitary gland located?
Inside the head (Sella Turcica)
What are the pituitary hormone in Anterior?
-Prolactin
-Growth Hormone (GH)
-Follicle Stimulating Hormone (FSH)
-Luteinizing Hormone (LH)
-Adrenocorticotropic hormone (ACTH)
- Thyroid-stimulating hormone (TSH)
What are the pituitary hormone in posterior?
-Antidiuretic Hormone
- Oxytocin
An excessive secretion or production of one or more of the hormone produced by the pituitary gland
Hyperpituitarism
What inhibits prolactin production?
Dopamine
What stimulates prolactin production?
Estrogen
Occurs in isolation or together with GH excess
Prolactinoma
Most common pituitary tumor (40%)
Prolactinoma
Clinical Manifestations of Prolactinoma
-Erectile dysfunction
- Loss of Libido
- Galactorrhea
-Amenorrhea
-Gynecomastia
-Unable to Reproduce
What are the management of Prolactinoma?
-Bromocriptine (dopamine agonist)
-Hypophysectomy (surgical removal of pituitary)
Also known as somatotropin
Growth Hormone
It stimulates tissue growth
Growth Hormone Excess
Antagonizes insulin
Growth Hormone Excess
Growth Hormone excess in children
Gigantism
Growth Hormone excess in adult
Acromegaly
This results from excessive GH production before the fusion of epiphyseal plates in long bones
Gigantism
Cause of Gigantism
Somatotropinas: GH- producing pituitary adenomas
What are the clinical manifestations of Gigantism?
-Towering height
- Overgrowth of face, extremities
-Headaches
-Maxilla/Mandible protrusion
Complications of Gigantism
-CV: Hypertension in children
- Ortho: Osteoarthritis
- Metabolic: Diabetes mellitus
A rare condition characterized by overproduction of growth hormone (GH) after the appearance of the epiphyseal line in long bones
Acromegaly
Cause of Acromegaly
Somatotropinomas: GH-producing pituitary adenomas
Clinical Manifestations of Acromegaly
-Enlarged hands and feet
- Skull enlargement
-Macrognathia- jaw protrusion and enlargement
- Increased spacing of teeth
- Forehead protrusion
-Organomegaly
-Cardiomegaly
- Nephromegaly
- Vocal cord enlargement- slow, deep voice
-Joint pain, thickened skin, vision problems
-Excessive sweating, hirsutism
Diagnostic Tests of Growth Hormone Excess
-Insulin-like Growth Factor-1(IGF-1)
- Oral Glucose Tolerance Test (OGTT)
Normal level of Insulin
135-449 ng/ml
Oral Glucose Tolerance Test (OGTT)
-Baseline GH levels are obtained before ingestion of 75-or 100-gm oral glucose
-GH levels are then measured at 30, 60, 90, and 120 minutes
-Acromegaly: GH > 0.4 mcg/L
Medical Management of Growth Hormone Excess
-Ocreotide acetate
-Sandostatine agonist
- Reduces GH and IGF-1 to normal by stopping GH production
-Bromocriptine
-Dopamine agonist
- Used if unresponsive to octreotide or if tumor affects prolactin level
Surgical Management of Growth Hormone Excess
-Transsphenoidal Hypophysectomy
-Removal of the pituitary gland
-Treatment of choice for small pituitary tumors
Post-Operative Care for Patients S/P Transsphenoidal Hypophysectomy
-Position: Low- fowlers position (30- degrees) at all times to reduce pressure on sella turcica and decrease headaches
-Provide mouth care q4H to keep surgical area clean and free of debris
-Avoid toothbrushing for at least 10 days to protect suture line
-Instruct patient to avoid vigorous coughing, sneezing, and straining at stool to prevent cerebrospinal fluid leakage
-WOF CSF Leak: clear nasal discharge, persistent and severe generalized or supraorbital headache
-Resolves within 72 hours
A rare disorder that involves a decrease in or more of the pituitary hormones
Hypopituitarism
-Deficiency of one pituitary hormone
- Most common cause: pituitary adenoma
Selective hypopituitarism
-Total failure of the pituitary gland that results to deficiency of all pituitary hormones
-Most common cause: pituitary adenoma
Panhypopituitarism (Simmond’s disease)
-Hypopituitarism caused by postpartum pituitary necrosis
-Cause: postpartum hemorrhage
Sheehan’s syndrome
If the cause is pituitary adenoma
Go Look For The Adenoma
Sequence of Loss
-Growth Hormone
-Luteinizing Hormone
-Follicle- stimulating Hormone
-Thyroid-stimulating Hormone
-Adrenocorticotropic Hormone
Management of Hypopituitarism
-Hormone Replacement
- Transsphenoidal hypophysectomy for small tumors
