Pituitary Gland Disorders Flashcards
Hypopituitaryism- Eti
- Due to hypothalamic or pituitary dysfunction
- Single to multiple hormone deficiencies
- Due masse, lesions, hemorrhages & infarction, trauma, infections
Hypopituitaryism- Sx
- Symptoms are based deficiency in hormones effected
- Confusing clinical presentation
- Adrenal insufficiency is life threatening
Anterior Pituitary Hormones
- Growth hormone
- Prolactin
- Adrenocorticotropic hormone
- Thyroid stimulating hormone
- Lutenizing & Follicle Stimulating hormone
Growth Hormone deficiency
- Mild to moderate central obesity
- Decreased energy, concentration, depression
- Reduced been mass, increase LDL
- Decreased CO
Gonadotropin deficiency
- Decrease LH & FSH
- Loss of facial, axillary, pubic & body hair
- Men: libido, ED, infertility
- ## Women: Amenorrhea, infertility, osteoporosis, muscle atrophy
TSH deficiency
Hypothyroidism- fatigue, weakness, weight gain, hyerplipidemia
ACTH deficiency
Weakness, fatigue, wt loss, hypotension
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Hypopituitaryism- Dx
- Lab studies based on suspected deficiency:
- TSH + Free T4
- LH, FSH, Estrogen, testosterone & prolactin
- Cortisol & ACTH response
- Serum IGF-I
- MRI of hypothalamus & pituitary
Hypopituitaryism- Tx
- Replacement of missing hormones
- Surgical debulking if indicated
- Hydrocortisone, levothyroxine, rhGH
Diabetes Insipidus- Eti
- Deficiency or resistance of ADH/ vasopressin
- Primary due to autoimmune reaction, genetics
- Secondary due to hypothalamic or stalk damage
Diabetes Indipidus- Sx
- Intense thirst
- Polyuria- 2-20 L daily
- Hypernatremia & dehydration
Diabetes Indipidus- Dx
- No single diagnostic test
- 24hr urine creatinine & volume >2L
- Serum gluvose, urea, calcium, potasssium, sodium & uric acid
- Vasopressin challenge test with desmopressin
Diabetes Indipidus- Tx
- Desmopressin acetate
Acromegaly & gigantism- Eti
- Acromegaly = pituitary adenoma, macro, non-malignant
- GH stimulates release of IGF-I from liver & other tissue
- McCune-Albright and Carney complex
Acromegaly & gigantism- Sx
- Youth: tall stature & gigantism
- Dough, moist, enlarged hands
- Coarse facial features & voice
- Cardiomegaly & HTN
- Arthralgia, spinal stenosis
- Skin tags, acne, acanthosis nigricans
Acromegaly & gigantism- Dx
- Serum IGF-I- screening
- Fasting IGF-I, PRL, glucose and CMP to determine increased levels
- MRI indicating pituitary tumor (90% pts have)
Acromegaly & gigantism- Tx
- Pituitary transsphenoidal microsurgery- Remission in 70% patients
- Cabergoline- dopamine agonist, tumor reduction
Acromegaly & gigantism- Prog
- M & M from cardiovascular disorders
Hyperprolactinemia- Eti
- Microadenomas
- Medications (opioids, antipsych, estrogen, SSRI, tricyclics)
Hyperprolactinemia- Sx
- Reduced fertility
- Women: amenorrhea, galactorrhea, oligomenorrhea
- Men: Hypogonadism, decreased libido, ED, infertility
Hyperprolactinemia- Dx
- Eval for pregnancy, hypothyroid, kidney & liver disease, & hyperparathyroid to RO other causes
- MRI
Hyperprolactinemia- Tx
- Stop offending meds
- Dopamine agonists!- 90% effective (cabergoline, bromocriptine)
- No surgery
SIADH- Eti
- Excess of ADH leads to retention of water, hyponatremia
- Carcinomas, osmostat disorders
- Hypotonic, euvolemic hyponatremia
SIADH- Sx
- CNS symptoms- lethargy, weakness, confusion, delerium, seizures
SIADH- Dx
- Serum Na+ concentration <135
- Decreased serum osmolality with increased urine osmolality
SIADH- Tx
- Furosemide
- Restrict water intake
