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Questions and Answers
What is the term for a deficiency of most or all hormones secreted by the pituitary gland?
What is the term for a deficiency of most or all hormones secreted by the pituitary gland?
- Pituitary insufficiency
- Hypopituitarism
- Panhypopituitarism (correct)
- Anterior pituitary deficiency
What effect may a gonadotroph adenoma have in very rare situations?
What effect may a gonadotroph adenoma have in very rare situations?
- Hyperthyroidism
- Premature puberty (correct)
- Cushing's syndrome
- Diabetes insipidus
Which hormone deficiency is primarily associated with hypocortisolism?
Which hormone deficiency is primarily associated with hypocortisolism?
- Prolactin
- TSH
- ACTH (correct)
- Growth Hormone
Which of the following conditions is characterized by ischemic necrosis of the pituitary gland due to postpartum hemorrhage?
Which of the following conditions is characterized by ischemic necrosis of the pituitary gland due to postpartum hemorrhage?
Which hormone deficiency results in decreased lactation?
Which hormone deficiency results in decreased lactation?
What can pituitary macroadenomas commonly cause?
What can pituitary macroadenomas commonly cause?
Which of the following deficiencies can lead to secondary hypothyroidism?
Which of the following deficiencies can lead to secondary hypothyroidism?
What is a possible consequence of deficient Growth Hormone prior to epiphyseal closure?
What is a possible consequence of deficient Growth Hormone prior to epiphyseal closure?
What hormone is likely excessively secreted in the presented case of the 24-year-old woman with amenorrhea?
What hormone is likely excessively secreted in the presented case of the 24-year-old woman with amenorrhea?
Which of the following symptoms is NOT commonly associated with pituitary hormone deficiency?
Which of the following symptoms is NOT commonly associated with pituitary hormone deficiency?
How does damage to the pituitary gland typically manifest over time?
How does damage to the pituitary gland typically manifest over time?
Which of the following could be a differential diagnosis for the patient's symptoms?
Which of the following could be a differential diagnosis for the patient's symptoms?
What is a possible underlying issue for the milky discharge observed in the patient?
What is a possible underlying issue for the milky discharge observed in the patient?
Which pituitary hormone is responsible for lactation?
Which pituitary hormone is responsible for lactation?
Which of these conditions is most associated with pituitary adenomas?
Which of these conditions is most associated with pituitary adenomas?
What primary factor influences the clinical presentation of pituitary disorders?
What primary factor influences the clinical presentation of pituitary disorders?
What is the primary consequence of ACTH deficiency?
What is the primary consequence of ACTH deficiency?
Which of the following is NOT a symptom of low cortisol levels due to ACTH deficiency?
Which of the following is NOT a symptom of low cortisol levels due to ACTH deficiency?
What life-threatening complication is associated with adrenal insufficiency?
What life-threatening complication is associated with adrenal insufficiency?
Which symptom is commonly associated with gonadotrophin deficiency?
Which symptom is commonly associated with gonadotrophin deficiency?
Which of the following can lead to secondary adrenal insufficiency?
Which of the following can lead to secondary adrenal insufficiency?
What condition is most closely associated with hypogonadotropic hypogonadism?
What condition is most closely associated with hypogonadotropic hypogonadism?
What is the primary indicator of an adrenal crisis?
What is the primary indicator of an adrenal crisis?
Which of the following is a common symptom of ACTH deficiency in adults?
Which of the following is a common symptom of ACTH deficiency in adults?
What is a common treatment for prolactinomas?
What is a common treatment for prolactinomas?
Which condition is associated with excess ACTH production?
Which condition is associated with excess ACTH production?
What is the primary therapy for acromegaly?
What is the primary therapy for acromegaly?
Which hormone is primarily elevated in conditions like Graves’ disease?
Which hormone is primarily elevated in conditions like Graves’ disease?
What is a potential cause of secondary hypothyroidism?
What is a potential cause of secondary hypothyroidism?
Which syndrome is listed as a cause of growth hormone excess?
Which syndrome is listed as a cause of growth hormone excess?
What may happen if Cushing’s syndrome is left untreated?
What may happen if Cushing’s syndrome is left untreated?
Which condition is not typically treated with radiation therapy as the first-line treatment?
Which condition is not typically treated with radiation therapy as the first-line treatment?
What is a common symptom of excess growth hormone?
What is a common symptom of excess growth hormone?
Which treatment option is not indicated for managing Cushing's syndrome?
Which treatment option is not indicated for managing Cushing's syndrome?
What primarily causes hypersecretion of hormones in the pituitary gland?
What primarily causes hypersecretion of hormones in the pituitary gland?
Which condition is characterized by excess Growth Hormone (GH) in adults?
Which condition is characterized by excess Growth Hormone (GH) in adults?
What is a symptom indicative of excess Growth Hormone (GH)?
What is a symptom indicative of excess Growth Hormone (GH)?
In which population is hyperprolactinemia most likely to present as amenorrhea or oligomenorrhea?
In which population is hyperprolactinemia most likely to present as amenorrhea or oligomenorrhea?
What is one of the key laboratory findings used to confirm a somatotroph adenoma diagnosis?
What is one of the key laboratory findings used to confirm a somatotroph adenoma diagnosis?
What is a potential complication of acromegaly?
What is a potential complication of acromegaly?
What is the role of dopamine in prolactin secretion?
What is the role of dopamine in prolactin secretion?
What is the primary hormonal consequence caused by a corticotroph adenoma?
What is the primary hormonal consequence caused by a corticotroph adenoma?
Which condition might lead to low prolactin levels in the context of pituitary disease?
Which condition might lead to low prolactin levels in the context of pituitary disease?
Which of the following is a rare condition related to excess Thyroid Stimulating Hormone (TSH)?
Which of the following is a rare condition related to excess Thyroid Stimulating Hormone (TSH)?
What is a common consequence of prolonged hyperprolactinemia in men?
What is a common consequence of prolonged hyperprolactinemia in men?
Which of the following is NOT a common symptom of acromegaly?
Which of the following is NOT a common symptom of acromegaly?
What psychological or physical stressors can physiologically cause hyperprolactinemia?
What psychological or physical stressors can physiologically cause hyperprolactinemia?
What is a primary symptom associated with ACTH deficiency due to low cortisol levels?
What is a primary symptom associated with ACTH deficiency due to low cortisol levels?
Which condition is characterized by severe cardiovascular collapse as a main sign?
Which condition is characterized by severe cardiovascular collapse as a main sign?
Which of the following symptoms is specifically indicative of gonadotrophin deficiency?
Which of the following symptoms is specifically indicative of gonadotrophin deficiency?
What is a common differential diagnosis for adrenal insufficiency?
What is a common differential diagnosis for adrenal insufficiency?
What effect does gonadotrophin deficiency have on muscle mass?
What effect does gonadotrophin deficiency have on muscle mass?
What psychological symptom may arise from low cortisol levels due to ACTH deficiency?
What psychological symptom may arise from low cortisol levels due to ACTH deficiency?
What is a potential effect of prolonged hyperprolactinemia on reproductive health?
What is a potential effect of prolonged hyperprolactinemia on reproductive health?
Which symptom is likely to occur when there is an acute deficiency of pituitary hormones?
Which symptom is likely to occur when there is an acute deficiency of pituitary hormones?
Which event is often responsible for precipitating an adrenal crisis in secondary adrenal insufficiency?
Which event is often responsible for precipitating an adrenal crisis in secondary adrenal insufficiency?
What nonspecific symptom may be experienced by adults with growth hormone deficiency?
What nonspecific symptom may be experienced by adults with growth hormone deficiency?
In the case of a prolactin-secreting adenoma, which of the following signs is most likely?
In the case of a prolactin-secreting adenoma, which of the following signs is most likely?
What differentiates a pituitary tumor from a non-secretory adenoma?
What differentiates a pituitary tumor from a non-secretory adenoma?
How can chronic pituitary hormone excess potentially affect metabolism?
How can chronic pituitary hormone excess potentially affect metabolism?
What is a common diagnostic finding associated with corticotroph adenomas?
What is a common diagnostic finding associated with corticotroph adenomas?
Which pituitary hormone is most likely to be inappropriately secreted in the case of a silent pituitary adenoma?
Which pituitary hormone is most likely to be inappropriately secreted in the case of a silent pituitary adenoma?
Which factor most significantly influences the symptom variability in pituitary disorders?
Which factor most significantly influences the symptom variability in pituitary disorders?
What condition is characterized by a deficiency of hormones due to tumors or surgical trauma to the pituitary gland?
What condition is characterized by a deficiency of hormones due to tumors or surgical trauma to the pituitary gland?
Which condition might lead to panhypopituitarism due to ischemic necrosis?
Which condition might lead to panhypopituitarism due to ischemic necrosis?
What is the primary consequence of a deficiency in TSH?
What is the primary consequence of a deficiency in TSH?
Which hormonal deficiency is most likely to result in decreased muscle mass and increased fat mass?
Which hormonal deficiency is most likely to result in decreased muscle mass and increased fat mass?
Which of the following conditions is likely to arise from pituitary adenomas causing hormonal imbalances?
Which of the following conditions is likely to arise from pituitary adenomas causing hormonal imbalances?
What is a likely consequence of ACTH deficiency?
What is a likely consequence of ACTH deficiency?
Which condition is associated with gonadotroph adenomas that often remain clinically silent?
Which condition is associated with gonadotroph adenomas that often remain clinically silent?
What is a principal cause of damage to the pituitary gland leading to hormone deficiency?
What is a principal cause of damage to the pituitary gland leading to hormone deficiency?
Which treatment option is primarily recommended for patients with Acromegaly?
Which treatment option is primarily recommended for patients with Acromegaly?
What condition is most commonly associated with primary hypothyroidism?
What condition is most commonly associated with primary hypothyroidism?
Which syndrome is associated with excess Growth Hormone production?
Which syndrome is associated with excess Growth Hormone production?
What is the effect of Cabergoline in the treatment of Prolactinomas?
What is the effect of Cabergoline in the treatment of Prolactinomas?
What is a key complication resulting from untreated Cushing's Syndrome?
What is a key complication resulting from untreated Cushing's Syndrome?
Which of the following conditions is characterized by excessive ACTH production?
Which of the following conditions is characterized by excessive ACTH production?
What is the initial step in the management of hypercortisolism in Cushing's Syndrome when surgery is not possible?
What is the initial step in the management of hypercortisolism in Cushing's Syndrome when surgery is not possible?
Which hormone excess can be caused by an adrenal adenoma?
Which hormone excess can be caused by an adrenal adenoma?
What hormonal condition can result from chronic steroid use?
What hormonal condition can result from chronic steroid use?
What is a common treatment for chronic hyperprolactinemia?
What is a common treatment for chronic hyperprolactinemia?
Which condition is characterized by pressure symptoms in postmenopausal women due to elevated prolactin levels?
Which condition is characterized by pressure symptoms in postmenopausal women due to elevated prolactin levels?
What is the main consequence of excess Growth Hormone (GH) production in adults?
What is the main consequence of excess Growth Hormone (GH) production in adults?
Which of the following findings would indicate a lack of suppression of Growth Hormone after an oral glucose load?
Which of the following findings would indicate a lack of suppression of Growth Hormone after an oral glucose load?
Which hormone deficiency can lead to increased mortality in patients with acromegaly?
Which hormone deficiency can lead to increased mortality in patients with acromegaly?
Which of the following statement accurately describes a consequence of Cushing's disease?
Which of the following statement accurately describes a consequence of Cushing's disease?
What is a hallmark examination finding of acromegaly due to GH excess?
What is a hallmark examination finding of acromegaly due to GH excess?
What physiological effect does prolactin have under normal circumstances?
What physiological effect does prolactin have under normal circumstances?
Which condition may be suspected if a patient exhibits triad symptoms of headaches, blurred vision, and bitemporal hemianopia?
Which condition may be suspected if a patient exhibits triad symptoms of headaches, blurred vision, and bitemporal hemianopia?
Which dietary management approach is considered when diagnosing somatotroph adenoma?
Which dietary management approach is considered when diagnosing somatotroph adenoma?
What could be a result of untreated acromegaly over time?
What could be a result of untreated acromegaly over time?
Which physiological condition can lead to elevated prolactin levels due to hypothalamic dysfunction?
Which physiological condition can lead to elevated prolactin levels due to hypothalamic dysfunction?
What is a rare consequence of excessive Gonadotroph secretion?
What is a rare consequence of excessive Gonadotroph secretion?
Which of the following symptoms might result from a lactotroph adenoma in men?
Which of the following symptoms might result from a lactotroph adenoma in men?
Flashcards
Hypopituitarism
Hypopituitarism
A condition where the pituitary gland does not produce enough of one or more hormones.
Panhypopituitarism
Panhypopituitarism
A condition where the pituitary gland is not producing enough of most or all of its hormones.
Pituitary adenomas
Pituitary adenomas
Benign tumors of the pituitary gland.
Pituitary macroadenomas
Pituitary macroadenomas
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Hypophysitis
Hypophysitis
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Sheehan's syndrome
Sheehan's syndrome
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Secondary Adrenal Insufficiency
Secondary Adrenal Insufficiency
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Secondary Hypothyroidism
Secondary Hypothyroidism
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Pituitary Hormone Excess
Pituitary Hormone Excess
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Thyroid-Stimulating Hormone (TSH)
Thyroid-Stimulating Hormone (TSH)
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Prolactin
Prolactin
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Hyperprolactinemia
Hyperprolactinemia
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Growth Hormone Deficiency
Growth Hormone Deficiency
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Acromegaly
Acromegaly
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Prolactinomas
Prolactinomas
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Corticotroph Adenomas
Corticotroph Adenomas
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Somatotroph Adenomas
Somatotroph Adenomas
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TSHomas
TSHomas
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Growth Hormone Excess
Growth Hormone Excess
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Gigantism
Gigantism
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Growth Hormone (GH)
Growth Hormone (GH)
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IGF-1 Blood Test
IGF-1 Blood Test
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Low Prolactin
Low Prolactin
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Gonadotroph Adenomas
Gonadotroph Adenomas
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Hypothyroidism
Hypothyroidism
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Hypopituitarism (Growth Hormone Deficiency)
Hypopituitarism (Growth Hormone Deficiency)
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Prader-Willi Syndrome
Prader-Willi Syndrome
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Cushing's Disease
Cushing's Disease
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Dopamine Agonists (e.g., Cabergoline, Bromocriptine)
Dopamine Agonists (e.g., Cabergoline, Bromocriptine)
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Pituitary Surgery (for Acromegaly)
Pituitary Surgery (for Acromegaly)
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Growth Hormone Receptor Blockers
Growth Hormone Receptor Blockers
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Bilateral Adrenalectomy
Bilateral Adrenalectomy
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Hypogonadotropic Hypogonadism
Hypogonadotropic Hypogonadism
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Adrenal Crisis
Adrenal Crisis
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ACTH Deficiency
ACTH Deficiency
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GH Deficiency
GH Deficiency
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Kallmann Syndrome
Kallmann Syndrome
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Constitutional Delay
Constitutional Delay
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Congenital Adrenal Disorders
Congenital Adrenal Disorders
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Postpartum Lactation Failure
Postpartum Lactation Failure
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Pituitary Apoplexy
Pituitary Apoplexy
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Adenohypophysis
Adenohypophysis
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Central Hyperthyroidism
Central Hyperthyroidism
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Hypothalamus
Hypothalamus
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Study Notes
Pituitary Hormones & Conditions
- Pituitary gland secretes distinct hormones from anterior and posterior lobes.
- Anterior pituitary controls many physiological processes.
- Pituitary damage can occur acutely or chronically and affect hormone secretion.
- Diverse clinical presentations resulting from different factors.
Learning Outcomes
- Define pituitary hormone excess/deficiency conditions.
- Explain pituitary hormone excess/deficiency pathophysiology.
- List cardinal symptoms/signs of hormone excess/deficiency.
- Explain cause of symptoms/signs.
- Develop differential diagnosis for hormone excess/deficiency.
Case Study (24-Year-Old Woman)
- Presented with amenorrhea (absence of menstruation), menarche at age 13.
- Regular menses from age 15 to 22, then irregular, and stopped at 23.
- Occasional milky discharge from nipples for two months.
- Medical history includes headaches, fatigue, depression, cold intolerance, and difficulty losing weight gained during pregnancy.
- No medications.
- Physical exam: normal skin, hair, pelvic exam, mature breasts, milk expression.
Initial Evaluation (Case Study)
- Pregnancy test negative.
- Thyroid Stimulating Hormone (TSH) normal.
- Prolactin level: 6000 mIU/L (reference range 90-500 mIU/L).
Pituitary Hormones
- Distinct hormones secreted by the anterior and posterior pituitary lobes.
- Anterior pituitary primarily controls many physiological processes like stress response, growth, reproduction, and metabolism.
- Severe or widespread pituitary hormone deficiency is known as panhypopituitarism.
- Clinical presentations depend on the affected hormones and severity.
Pituitary Tumours
- Adenomas arise from anterior pituitary cells.
- They may be non-functional or secretory (prolactinomas, corticotroph adenomas, somatotroph adenomas, TSHomas).
- Rare, but possible, association with syndromes (e.g., multiple endocrine neoplasia type 1).
- Non-pituitary lesions (craniopharyngiomas, Rathke's cleft cysts) can also arise in or near the sella turcica.
- Other diseases (sarcoidosis, hemochromatosis, inflammatory lesions, infections, trauma/hemorrhage, metastases) affect the pituitary.
Hormonal Consequences
- Hypersecretion occurs when pituitary adenomas or fragments hypersecrete hormones normally made by pituitary cells.
- Hyposecretion results from pituitary or hypothalamic disease causing deficiencies in anterior pituitary hormones.
Pituitary Hormone Excess (e.g., Prolactinomas, Acromegaly)
- Prolactinomas: Excess prolactin is the main characteristic. Symptoms include amenorrhea/oligomenorrhea, galactorrhea (milk discharge), decreased libido, decreased fertility, erectile dysfunction, pressure symptoms (visual problems). These are often successfully treated with dopamine agonists.
- Acromegaly: Excess growth hormone (GH) causes gigantism (if epiphyseal plates are open) or acromegaly (if epiphyseal plates are closed) in adults. Features include facial coarsening, enlarged hands/feet, thickened skin, headaches, blurred vision, and bitemporal hemianopia (loss of vision in outer half of visual field). Treatment involves surgery, medical therapy (e.g., somatostatin analogues), and/or radiation.
Growth Hormone Excess (Acromegaly)
- Gigantism (children): excessive growth.
- Acromegaly (adults): enlargement of hands, feet, and facial bones.
Diagnosis of Growth Hormone Excess (Acromegaly)
- Clinical suspicion.
- Chemical confirmation: Elevated serum insulin-like growth factor-1 (IGF-1), lack of suppression of growth hormone to an oral glucose load.
MRI Appearance
- MRI scans can help visualize pituitary masses or tumors
Consequences of Somatotroph Adenoma (Acromegaly)
- Diabetes mellitus.
- Arthritis (osteoarthritis).
- Cancer (especially colon), preceded by polyps.
- Cardiovascular disease, hypertension, cardiomyopathy, strokes.
- Neuropathy (e.g., carpal tunnel syndrome).
- Obstructive sleep apnea, respiratory diseases.
- Increased mortality.
Pituitary Hormone Excess (Corticotroph Adenoma)
- Cushing's Disease: Excess ACTH causes Cushing's disease. Distinct features, which can be helpful in diagnosing, include skin changes (central obesity, ruddy appearance), muscle weakness, and osteoporosis. Diagnosis can require further tests; treatment often includes surgery, medical therapy, or radiation.
Pituitary Hormone Excess (Thyrotroph Adenoma)
- Central hyperthyroidism: Excess TSH causes this rare condition. Associated with characteristic symptoms of hyperthyroidism. Diagnosis relies on specific tests; treatment often includes surgery or medical therapy.
Pituitary Hormone Excess (Gonadotroph Adenomas)
- Very rare.
- Clinical presentations usually include symptoms related to downstream hormone effects.
- Potential for premature puberty in males, enlarged testicles, or ovarian hyperstimulation.
Pituitary Hormone Deficiency
- Hypopituitarism: Deficiency of one or more hormones.
- Panhypopituitarism: Deficiency of most or all hormones.
- Deficiencies in anterior pituitary hormones can cause various clinical syndromes.
- Deficiencies in posterior pituitary hormones would also result in specific clinical syndromes.
Pathophysiology of Pituitary Hormone Deficiency
- Tumours (e.g., adenomas, cysts, metastatic cancer) can cause damage by pressure & infiltration.
- Pituitary surgery.
- Radiation therapy
- Infiltration (e.g., hypophysitis).
- Head trauma resulting in ischemic necrosis (Sheehan's syndrome).
Hypothalamic-Pituitary Hormonal Deficiencies (Symptoms)
- Growth Hormone Deficiency: Short stature, decreased muscle mass, increased fat mass, decreased bone mineral density.
- Prolactin Deficiency: Decreased lactation.
- ACTH Deficiency: Hypocortisolism.
- TSH Deficiency: Secondary hypothyroidism.
- LH/FSH Deficiency: Hypogonadism.
ACTH Deficiency
- Secondary adrenal insufficiency.
- Presentation with nonspecific symptoms.
ACTH Deficiency (Symptoms/Signs)
- Fatigue.
- Anorexia/Nausea/Vomiting.
- Abdominal pain/digestive issues.
- Myalgia/Arthralgia (muscle/joint pain).
- Amenorrhea (absence of menstruation).
- Psychiatric concerns (mood/cognition).
- Weight loss.
- Hypoglycemia (low blood glucose).
- Hyponatremia (low sodium).
Adrenal Crisis
- Life-threatening complication of adrenal insufficiency (usually secondary).
- Often precipitated by insufficient glucocorticoid replacement/non-adherence to treatment during acute illness.
Gonadotrophin Deficiency
- Hypogonadotropic hypogonadism (deficient FSH & LH)
- Fatigue, low libido, erectile dysfunction, sweating, brain fog, loss of muscle mass, absence of menses are common symptoms, but can vary depending on onset age.
Deficiency Differential Diagnosis
- Cortisol (Addison's disease, secondary adrenal insufficiency).
- Gonadotrophins (hypopituitarism, Kallmann syndrome, constitutional delay of growth and puberty, congenital disorders of hypothalamo-pituitary axis, chronic illness, malnutrition).
- T4 (primary/secondary/tertiary hypothyroidism).
- GH (hypopituitarism, syndromes, malnutrition, chronic illness).
Excess Differential Diagnosis
- ACTH/Cortisol (pituitary adenoma (Cushing's disease), ectopic ACTH production (e.g., small cell lung cancer), adrenal adenoma/carcinoma/hyperplasia, exogenous cortisol).
- TSH/T3/T4 (pituitary adenoma, Graves disease, toxic adenoma/multinodular goiter, thyroiditis, exogenous thyroid hormone use).
- Growth Hormone (pituitary adenoma (acromegaly), Carney complex, McCune-Albright syndrome, other).
- Gonadotrophins (pituitary adenomas, PCOS, ovarian/testicular tumors, other hormone-secreting tumors).
Treatment of Hormone-Active Pituitary Adenomas
- Prolactinomas: Dopamine agonists (e.g., cabergoline, bromocriptine).
- Acromegaly: Pituitary surgery (expert surgeon required), medical therapy (e.g., somatostatin analogues), radiation therapy.
- Cushing's disease: Pituitary surgery, medical therapy (e.g., metyrapone, pasireotide, mifepristone, ketoconazole), radiation therapy (in selective cases), bilateral adrenalectomy. Important to note that some treatments may have delayed onset.
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Description
Test your knowledge on pituitary hormones and related conditions. This quiz covers the secretion of hormones from the anterior and posterior lobes, the impact of pituitary damage, and clinical presentations of hormone excess or deficiency. Apply your understanding to a case study involving a 24-year-old woman with amenorrhea and other symptoms.
