Pituitary Adenoma
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.