Pituitary and Adrenal Gland

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Definition of Hypopituitarism

Refers to total or partial deficiency of one or more pituitary hormones

Symptoms of Corticotropin deficiency

Fatigue, weakness, no appetite, abd pain, N/V, failure to thrive in children, hyponatremia

Symptoms of Gonadotropin deficiency

/loss of libido, erectile dysfunction, amenorrhea, hot flashes, dyspareunia, infertility, anemia, gynecomastia, dec. muscle mass

Physical findings and clinical presentation of GH deficiency

Growth retardation in children, fatigue, hypoglycemia, lean mass reduction and fat increased, dec. bone mineral density, incr. LDL

Physical findings and clinical presentation of Hyperprolactemia

Galactorrhea, amenorrhea, infertility, hypogonadism, erectile dysfunction, infertility in men

Acquired cause of Hypopituitarism

Pituitary apoplexy-hemorrhage or infarction of pituitary gland. Infiltrative. Pituitary tumors. Suprasellar tumors

Clinical manifestations of ACTH

May result in cortisol deficiency, leading to hypotension, shock and cardiovascular collapse

Hypersecretory Pituitary Tumors

GH-acromegaly, ACTH-Cushing's Disease, PRL- Hyperprolactinemia, TSH-hyperthyroidism

Imaging for Pituitary Tumors

MRI more sensitive than CT. CT w/ contrast also can be used.

Signs of GH-Secreting pituitary adenoma:Acromegaly

Course facial features, oily skin, prognathism, carpal tunnel, OA, increased size, DM, visual field deficits

Treatment of Acromegaly

Surgical resection of GH-secreting ademonas is initial. Somatostatin are adjuvant for preoperative shrinkage

Definition and symptoms of Adrenocorticotropic (ACTH)

Commonly due to glucocorticoid withdrawal after treatment-associated suppression of HPA axis. Fatigue, weakness, anorexia, N/V, hypoglycemia

Treatment of Adrenocorticotropic (ACTH)

Glucocorticoid replacement therapy. Should be increased in acute illness or stress

Common causes of Cushing's Disease

Pituitary corticotrope adenomas and iatrogenic hypercortisolism is most common cause of cushinoid features

Symptoms of Cushing's Disease

Round (moon face), buffalo hump, hirsutism, HTN, striae, thin skin, acne, menstrual disorder, bruising

Diagnosis of Cushing's Disease

Measurement 24h urine free cortisol, Dexamethasone suppression test(plasma cortisol after overnight), Midnight cortisol (elevated levels +)

Treatment of Cushing's Disease

Reduce corticol secretion (somatostatin, glucocorticoid), Eradication of tumor, pituitary irradiation, adrenalectomy, cytotoxic chemo

Causes of Addison's Disease

Autoimmune destruction of the adrenal glands, TB, Adrenal hemorrhage, Carcinomatous

Physical findings and clinical presentation

Hyperpigmentation of skin and mucous membranes. prominent palmar creases, hypotension, tachy, dizziness

Lab findings of Addison's Disease

Hyponatremia, hyperkalemia, decreased glucose, increased BUN/creatinine, morning corticol level, PPD (rule out TB)