Pituitary

Hyperprolactinemia:

  • Amenorrhea and galactorrhea in women, hypogonadism in men
  • Bitemproal hemianopia (more common in men; macroadenoma)
  • Need to rule out hypothyroidism
  • Rx: dopamine agonist: bromocriptine (worse S\E, preferred in pregnancy), cabergoline
  • If doesn’t work: surgery and radio (it might cause panhypopituitary)
  • Pts in child-bearing age + men (macro) -> be aggressive with treatment

 


Acromegaly:

  • If children -> giganistm
  • If adults -> acromegaly
  • Most are macroadenoma
  • MCC of death is CHF
  • Bilateral carpal tunnel (like hypothyroidism)
  • GH is counter regulatory hormone (like cortisol, epi, NE, glucagon) -> diabetes
  • Dx: measure IGF\somatomedins, glucose load\suppression test (normally it would be suppressed), MRI
  • Rx: octreotide (somatostatin), dopamine agonist

 


Hypopituitarism:

  • TB, sarcoidosis, trauma, abscess
  • In children -> craniopharyngioma
  • Hormones lost first: GH, FSH\LH (check them first), TSH, ACTH (last)
  • Dx: give insulin -> hypoglycemia (normally GH should increase)

 


Pituitary apoplexy:

  • Prior pituitary adenoma -> expands -> bleeding and necrosis at the center -> acute hypopituitarism
  • Confusion, nuchal rigidity, altered mental status, headache, meningeal signs
  • Endocrine emergency

 


Sheehan syndrome:

  • Postpartum necrosis of the gland
  • Inability to lactate

 


Empty sella syndrome:

  • Diaphragmatic membrane and meninges pushing the pituitary (it’s still there tho, can be seen by imaging)
  • No hormonal problems
  • Incidental finding
  • Present with other problems (ER)

 

 


Download the PDF version: here


References:

  • Kaplan step 2 videos and lecture notes

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