One of your patients is a new mother, and she comes in complaining of muscle weakness, tiredness, and she says she is now unable to breastfeed.
What gland are you worried about?
What probably happened during her pregnancy?
Pituitary gland; ischemic necrosis (Sheehan syndrome)
Loss of blood to an enlarged pituitary causes panhypopituitarism (low prolactin, ACTH, FSH, TSH)
A baby is diagnosed with panhypopituitarism. What congenital cause is diagnosed with imaging studies, and what is the pathogenesis?
Empty sella syndrome
Arachnoid and CSF herniate into the sella, compressing and destroying the pituitary.
What are benign neoplasms of the pituitary?
What is the most common hormone that is secreted in excess from them?
Excess prolactin secretion is the most common
What non-endocrine symptoms might result from a pituitary adenoma?
Headaches, bitemporal hemianopsia, potentially oculomotor palsies.
Your 17 y.o patient comes in concerned because she has recently stopped getting her periods, and milk has been leaking out of her breasts. She insists that she could not, and has not, been pregnant. Before you call the Pope to report an immaculate conception, what could this be?
Prolactinoma; pituitary adenoma produces prolactin. This inhibits the LH surge necessary for ovulation, so she is also currently infertile.
How do prolactinomas present in men?
What medicine can you use to treat them?
Decrease in libido and sexual impotence
Treated with dopamine agonists (bromocriptine) to inhibit PRL secretion
Tony Bromo comes in complaining that he can’t fit into his lucky Dallas Cowboys hat anymore. He also brags that he’s been able to pick up a lot more sorority girls because they love his strong jaw and big hands.
What endocrine disorder does this bro have?
What other symptoms might he develop?
Acromegaly due to an adenoma secreting growth hormone; causes enlargement of head, hands, and jaw.
CHF due to cardiomegaly, paresthesias, muscle weakness
What do corticotrope adenomas do?
Pharm crossover: what would the results of low and high dose dexamethasone suppression tests show?
Produce excess ACTH, leading to Cushings disease
Cortisol elevation due to elevated ACTH from pituitary would be suppressed by high dose dexamethasone, but not low dose
What causes central diabetes insipidus?
How does it present?
Deficiency of ADH from the posterior pituitary
Inability to concentrate the urine, polyuria, thirst, polydipsia
Central diabetes insipidus can be associated with what kind of brain tumor?
Craniopharyngioma (above the sella turcica)
Trauma can also cause CDI.
What paraneoplastic disorder can result in decreased urine production?
SIADH, syndrome of inappropriate ADH secretion by tumor cells