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
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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
