The Pituitary
Growth hormone disorders:
(Gigantism)
Acromegaly, GH excess - IGF1 raised Acromegaly may be caused by a pituitary adenoma secreting multiple hormones, ?Acromegaly and hyperpigmentation
Somatostatin (octreotide analogue) to reduce GH release.
Prolactin disorders:
Prolactinoma with galactorrhea and secondary amenorrhea (decreased GnRH in females) with occasional bitemporal hemianopia in males (macroadenoma)
Cabergoline upregulates dopamine production and inhibits prolactin secretion. It can have strange psychiatric effects.
Secretory FSH/LH tumours do not occur, but non-secretory tumours may cause secondary problems, typically hypopituitarism.
TSH disorders are rare.
ACTH disorders:
Cushing’s syndrome:
DXM suppression test, 1mg nocte. Or 24h urinary-free cortisol. Or evening cortisol level.
Cushing’s disease (70%) - primary pituitary ACTH hyperproduction, petrosal sinus sample ration >2:1.
Adrenal adenoma (15%) - primary cortisol hyperproduction, with ACTH suppression.
Ectopic Cushing’s (15%) - primary ectopic ACTH hyperproduction, petrosal sinus sample ratio ~1:1.
The Adrenals
Zona glomerulosa produces aldosterone. Zona fasciculata produces cortisol. Zona reticularis produces dehydroepiandrosterone.
Hyperaldostreronism: bilateral (spironolactone) or unilateral (adrenenalectomy)?
Addisons disease: Fatigue, pigmentations, prodromal glomerulosal failure. Abnormal synacthen test, high ACTH.
Phaeo: hypertension with other symptoms (palpitations, headache, etc). Test with plasma metanephrines
The Thyroid
Hashimoto’s thyroiditis: progressive painless destruction of the thyroid with anti-TPO antibodies. Primary hypothyroidism. Treat with thyroxine to normalise TSH.
Grave’s disease: anti-TSHr antibodies leading to elevated T3/T4, suppressed TSH.
Toxic (multi)nodular goitre: nodular uptake present on a scan. Anti-TSHr negative.
Thyroiditis (subacute, or silent): Inflammation of the thyroid leads to inappropriate release from follicular colloid into circulation. Anti-TSHR negative.
Carbimazole can cause agranulocytosis 1:1000 incidence.
Age: = round((date(now) - this.file.ctime).days) days