hypopituitarism and acromegaly

Question 1

what is hypopituitarism?

Answer 1

combined deficiency of any of the anterior pituitary hormones

Question 2

which hormones mostly deficiet?

Answer 2

first growth hormone
2nd gondatrophin(LH and FSH)
3rd is ACTH

Question 3

how to differentiate acth deficieny is it from adrenal or pituitary?

Answer 3

mineralocorticoids is normal in pituitary and loss in adrenal disease because it depend on angiotensin II and normal potassium

Question 4

features?

Answer 4

in contrast to addison disease there is pallor due to lack of melanocytes stimulation
apathy and cold intolerance
frank myxoedema is uncommon because thyroid retain some autonomous function
postural hypotension

Question 5

causes?

Answer 5

pituitary adenoma
craniopharyngioma
meningioma
kallman's syndrome
head injury
sellar surgery
sheehan syndrome

Question 6

investigation?

Answer 6

T4 serum
acth stimulation test
GH test
MRI/ CT

Question 7

management?

Answer 7

in acutely ill patient treat cortisol deficieny

once specific diagnose established treat specifically

Question 8

insuline tolerance test?

Answer 8

use:
to check HPA axis
to check GH deficiency
contraindications: ishcemic heart disease
epilepsy
sever hypopituitarism
aim: to produce adequate hypoglycemia tachycardia and sweating with blood glucose
results: normal subjects GH >6.7
normal subjects cortisol >550

Question 9

acromegaly?

Answer 9

is cause by excess of GH mostly due to macroadenoma

Question 10

clinical features?

Answer 10

if occur before puberty gigantism occur
if occur after puberty acromegaly
most common complain is headache and sweating
sometime prolactin also secrete

Question 11

how GH cause diabetic?

Answer 11

growth hormon cause resistant in insulin sensitivity
in dM patient, gh does not suppress after glucose load before glucose fail to stimulate IFG-1 which inhibit the GH secretion as a negative feedback

Question 12

management of acromegaly?

Answer 12

trans-sphenoidal surgery is the first line
radiotherapy is the 2nd line
surgery along with medical therapy in which hormone secrete after surgery
somatotastin octreotide and lanreotide
dopamine agnost in which prolactin also increase
pegvisomant GH peptide antagonist