Pituitary Insufficiency-no photos

Pituitary Insufficiency-no photos - Pituitary Insufficiency...

Info iconThis preview shows pages 1–17. Sign up to view the full content.

View Full Document Right Arrow Icon
Pituitary Insufficiency William Harper, MD, FRCPC Assistant Professor of Medicine McMaster University
Background image of page 1

Info iconThis preview has intentionally blurred sections. Sign up to view the full version.

View Full Document Right Arrow Icon
Pituitary Disorders Mass effect Headaches • CN II, III, IV, V 1 , V 2 , VI Pituitary hypersecretory Syndrome PRL, GH, ACTH, > > TSH Anterior Pituitary Dysfunction ACTH, TSH, LH/FSH > > GH Posterior Pituitary Dysfunction ADH
Background image of page 2
Mass Effect: H/A, CN II, EOM, V 1 , V 2 (LR 6 SO 4 ) 3 V 1 V 2
Background image of page 3

Info iconThis preview has intentionally blurred sections. Sign up to view the full version.

View Full Document Right Arrow Icon
Background image of page 4
Background image of page 5

Info iconThis preview has intentionally blurred sections. Sign up to view the full version.

View Full Document Right Arrow Icon
Background image of page 6
H-P-A Axis
Background image of page 7

Info iconThis preview has intentionally blurred sections. Sign up to view the full version.

View Full Document Right Arrow Icon
Cushing’s Disease Ectopic ACTH High ACTH Cushing’s
Background image of page 8
Establish hypercortisolism (Cushing’s syndrome) “Screening” tests 1 mg O/N DMST DXM 1 mg po 11PM 8AM plasma cortisol < 140 nM R/O Cushing’s Syndrome » SEN 98% SPEC 71-80% » < 50 nM SEN ~100% SPEC ? (Poor), still some cases missed! 24 UFC < 248 nM/d R/O Cushing’s Syndrome (SEN 95-100%) 248-840 nM/d Equivocal > 840 nM/d consistent with Cushing’s Syndrome (SPEC 98%)
Background image of page 9

Info iconThis preview has intentionally blurred sections. Sign up to view the full version.

View Full Document Right Arrow Icon
Establish hypercortisolism (Cushing’s syndrome) “Confirmatory Tests” 24 UFC > 840 nM/d Establishes Cushing’s Syndrome on 2 or more collections AND clear clinical findings of Cushing’s makes diagnosis of Cushing’s with SPEC 98% Otherwise, need an additional confirmatory test. LDDST (Liddle Test) 2 baseline 24h urine for cortisol and 17-OH steroids DXM 0.5 mg q6h x 48h (8 doses) During 2 nd day on DXM repeat 24h urine collection UFC > 100 nM/d or 17OHS > 11 uM/d indicates Cushing’s Historical gold standard but SEN 56-69%, SPEC 74-100% Plasma cortisol < 50 nM measured 2 or 6 hours after last dose has SEN 90-100% and SPEC 97-100%
Background image of page 10
Clinical Suspicion Screen Test: 24 UFC or 1mg O/N DST (+/- evening plasma/salivary cortisol) Confirmatory Testing: Repeat 24 UFC +/- CRH/DXM Test (+/- evening plasma/salivary cortisol) ACTH ACTH Independent CT abdo Adrenal Surgery ACTH dependent 1 st 8mg O/N DST or HDDST 2 nd CRH Test if above test negative CRH Test Pituitary MRI Pituitary Surgery IPSS Ectopic ACTH CT thorax, abdo Thyroid U/S Octreotide Scan Continue search for ectopic source Remove ectopic source < 1.1pM >2.2pM 1.1-2.2pM No Stim Positive Stim Conclusive (>0.8-1.0cm) Inconclusive > 2 b a s l 3 C R H <1.5 basal <2 CRH Conclusive No CRH stim No DXM suppression Stim by CRH or DXM suppresses
Background image of page 11

Info iconThis preview has intentionally blurred sections. Sign up to view the full version.

View Full Document Right Arrow Icon
Case 49 year old female Adie’s pupil x 2 years L frontoparietal H/A Neurologist ordered MRI Enlarged Pituitary! Subsequent Endo referral TSH 31.7 mU/L, FT4 6 pM Hypothyroid! FSH 63 (menopausal)
Background image of page 12
Background image of page 13

Info iconThis preview has intentionally blurred sections. Sign up to view the full version.

View Full Document Right Arrow Icon
Pituitary Hyperplasia Another cause of sellar mass! Physiological enlargement of pituitary Lactotroph Hyperplasia (pregnancy) » Pregnancy, most common Thyrotroph, Gonadotroph Hyperplasia » Primary gland failure Somatotroph, Corticotroph Hyperplasia » GHRH or CRH secreting neuroendocrine tumors
Background image of page 14
Background image of page 15

Info iconThis preview has intentionally blurred sections. Sign up to view the full version.

View Full Document Right Arrow Icon
Most common pituitary tumor Dx: elevated PRL with size/level correlation (stalk-effect!) Treatment: Dopamine Agonist
Background image of page 16
Image of page 17
This is the end of the preview. Sign up to access the rest of the document.

{[ snackBarMessage ]}

Page1 / 44

Pituitary Insufficiency-no photos - Pituitary Insufficiency...

This preview shows document pages 1 - 17. Sign up to view the full document.

View Full Document Right Arrow Icon
Ask a homework question - tutors are online