Hypopituitarism Acromegaly

Question 1

After you take out pituitary adenoma what can happen?

Answer 1

Polyuria due to diabetes insipidus
Treatment through DDAVP

Low t4- so give thyroxine

Then do a short synacthen stimulation test, poor cortisol response so give hydrocortisone

Estrogen deficiency symptoms- estrogel, mirena iud

Do a GnRH arginine stimulation test if no growth hormone response then treat with subcutaneous growth hormone daily unit q of l score 9 out of 25

Question 2

Acromegaly signs?

Answer 2

Prominent orbital and occipital ridging, increased size of hands and feet (carpal tunnel syndrome)
Overgrowth of mandible
Skin tags
Facial changes

Question 3

Skin tags in acromegaly increase risk of what?

Answer 3

Colon cancer

Question 4

Overgrowth of mandible is called?

Answer 4

Prognathism

Question 5

How to test for excessive growth hormone?

Answer 5

Glucose tolerance test and growth hormones

IGF1

Question 6

What happens in glucose growth hormone test?

Answer 6

Give glucose and normally growth hormone levels will fall. If they remain high and insulin like growth factor 1 is high then that’s a sign of acromegaly

Question 7

What else should you check for in acromegaly?

Answer 7

Co-secretion of other hormones or multiple endocrine neoplasia type 1

Question 8

How to make IGF1 in the normal range?

Answer 8

Dopamine agonist= cabergoline , because they decrease growth hormone levels

Long acting somatostatin analogue ocreotide

Radiotherapy

And GH receptor antagonist (pegvisomant)