Pituitary Adenoma

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Primary Addison Disease S/sx

***Skin changes areas of hyperpigmentation** Chronic deficiency of cortisol and aldosterone, elevation of ACTH.

Visual field defects=

Bitemporal hemianopia it results from tumor at the optic chiasm.

Visual field defects associated with

Ocular muscle palsy and headache.

Manifestations of Pituitary Adenoma

Visual field defects, headache, and hypo/hypersecretion.

S/Sx of Cushing

Weight gain (truncal obesity and buffalo hump), skin changes, Hirsutism, glucose intolerance, psych symptoms, and infections.

Addison Disease occurs when

dysfunction of adrenal cortices

Paraganglioma secrete

Secrete norepinephrine>>hypertension

Secretory Pituitary Adenoma

Prolactinoma.

Majority of adenomas are

Benign

Dx Diabetes insipidus

24 hour urine collection.

Addison Disease percentages

70% are caused by autoimmune disorders. 90% occurs due to adrenal cortex destroyed

Cushing Syndrome is

A side effect of excessive high dose corticosteriods.

Dx of Addison Disease

ACTH challenge test, Decrease cortisol and aldosterone, elevated blood level of ACTH, CT or MRI of adrenal glands.

Acromegaly when

After closure of epiphyses

Metastases to pituitary results from

Breast or lung CA

Diabetes insipidus

Deficiency of ADH.

Dx of Cushing

Dexamethasone suppression test> decrease cortisol is NORMAL. No changes in cortisol is positive for Cushing's MRI, CT adrenals, 24 hr urinary free cortisol level.

Acro/gigantism s/sx

Hands enlarged, fingers widen, skull enlarge, mandible more prominent, macroglossia, deep, coarse voice.

Tx of Addison Disease

Hydrocortisone

Cushing disease is

Hypersecretion of ACTH by benign adenoma.

Pathway to cortisol

Hypothalamus > CRH> anterior pituitary secrete> ACTH>adrenals release cortisol

Acro/gigantism Dx

IGF-1 increased over 5 times normal MRI

Tx Diabetes insipidus

IV fluids and DDAVP.

Primary Addison Disease

Increase ACTH>> skin coloration changes

labs of Prolactinoma

Increased prolactin

Secondary Addison

Lack of ACTH>>lack skin coloration changes

Dx of Prolactinoma

MRI and prolactin level

Cortisol functions

Maintain BP, Slow immune inflame response, balance insulin in breaking down sugar for energy, regulate metabolism of proteins, CHO, and fat. Maintain proper arousal and sense of well-being.

Tx of Prolactinoma

Parlodel or Dostinex (dopamine agonist) Transsphenoidal removal of pituitary tumor

"I have acute attacks of H/A, perspiration, palpitations and anxiety."

Pheochromocytoma & paraganglioma

Dx of Pheochromocytoma & paraganglioma

Plasma fractionate free metanephrines. 24 hour urine specimen. CT without contrast.

Tx of Acro/gigantism

Surgery sandostatin decrease GH or somavert treats acro

Tx of Pheochromocytoma & paraganglioma

Surgical resection of tumor. Treat HTN prior to surgery. Alpha blocker for HTN (phenox).

Tx of Cushing

Transsphenoidal resection of pituitary adenoma

Prolactinoma sx/s

Women: Galactorrhea, reproductive dysfunction, and visual field changes, headache. Men: Sexual dysfunction, gynocomastia.

Pheochromocytoma secrete

both epinephrine (tachyarrythmias) and norepinephrine

Pheochromocytoma & paraganglioma s/sx

catastrophic htn, fatal cardiac arrythmias, and anxiety attack.

Physical Exam of prolactinoma

galactorrhea and gynocomestia

Gigantism when

in youth before closure of epiphyses

Diabetes insipidus s/sx

polyuria, polydipsia, dehydration.


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