FY2 The PITUITARY Growth Hormone FSHLH ACTH TSH Prolactin ADH Oxytocin Cushings Syndrome persistent and inappropriate glucocorticoid excess with systemic symptoms and signs Disease Endogenous cause ID: 781418
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Slide1
Endocrine
Charlotte Miller
FY2
Slide2The PITUITARY
Growth Hormone
FSH/LH
ACTH TSH Prolactin ADH Oxytocin
Slide3Cushings
Syndrome – persistent and inappropriate glucocorticoid excess with systemic symptoms and signs
Disease – Endogenous cause
Pituitary adenoma secreting ACTH or hyperplasiaPseudo-Cushings Syndrome: Alcohol excess mimic
Hypothalamus
PituitaryAdrenals
GlucocorticoidsCortisol
CRH
ACTH
Slide4Presentation
Differentials
Depression
Alcohol Excess
ObesityMalnutrition
Thinned Hair‘Moon Face’
AcneHirtuism
Supraclavicular
Fat Pad
Hypertension
Obesity
Purple Straie
Thin Skin
Bruising
Proximal Myopathy
History
Lethargy
Depression/Psychosis
Muscle Aches/Pains
Peptic Ulcer
Dysmenorrhoea
Impotence
MEDICATIONS
Slide5Investigation
Bedside
Blood Pressure, ECG
BiochemistryFBC, U+E, LFTs, TFT, Lipid profile, HbA1cSerum + Salivary CortisolRadiologyCTMRISpecial Test24 hour Urinary Cortisol
Dexamethasone Suppression TestVenous SamplingDEXA
Bedside
BiochemistryRadiology
Special tests
Slide6Management : Cushing’s Disease
Biochemical
Conservative
EducationMedical: MetyraponeKetoconazoleRadiotherapySurgicalTransspenhoidal Adenectomy
Adrenalectomy PsychologicalSocial
Untreated: Survival <5 years
multidisciplinary team
biological – psychological - social approach
Slide7Addisons
Definition
Primary Adrenal Failure
Autoimmune destruction of Adrenal glandAdrenal Failure Low Sodium
High Potassium Low glucose
Adrenals
Mineralcorticoids Glucocorticoids Androgens Adrenaline/Noradrenaline
Aldosterone Cortisol DHEA/Androstenedione
Slide8Presentation
History
Insidious onset
Lethargy/FatigueDepressionAnorexia/wt lossAbdominal PainDiarrhoeaExaminationPostural Hypotension
Hyperpigmentation
Buccal
Scars
Palmar Creases
Generalised
Slide9Investigation
Bedside
Observations, BM, ECG,
BiochemistryFBC, U+E, LFT, GlucoseSputum – AFBHIVRadiologyCT ?adrenal massMRI ?Pituitary Lesion
Special TestShort Synacthen Test, Long Synacthen TestATCH level
Slide10Management
Biochemical
Conservative
EducationMedicalHydrocortisoneFludracortisoneSurgicalPsychologicalLiving with a Chronic Condition
SocialSupport Groups
Multidisciplinary team
biological – psychological - social
Slide11Complications
Auto-immune conditions
Thyroid
T1 DiabetesOvarian FailurePernicious Anaemia Addisonian CrisisVomiting
Abdominal PainProfound WeaknessHypoglycaemia
Hypovolaemic shock
IV Fluids
High Dose Hydrocortisone
Monitor U+E, Glucose
Slide12Acromegaly
Definition:
Excessive production of growth hormone
Post fusion of epiphyses of long bones
Slide13Presentation
SOL
Headache
Visual DisturbancesHypopituitarismExcessive GHBroadened ExtremitiesThickening of Soft tissues
Joint Pain/Muscle Aches
Carpal Tunnel
Increase Hand/Foot size
Facial Features
Frontal Bossing
Prognathism
Separation of Teeth
Organomegaly
Heart Failure
Hoarse Voice
Goitre
Slide14Slide15Investigation
Bedside
Photographs, BP, ECG, Peripheral Fields,
BiochemistryFBC, U+E, LFT, TFT, HbA1cOral Glucose tolerance Test, BNP, ProlactinRadiologyMRIColonoscopySpecial Tests
Echocardiogram, Sleep Apnea
Slide16Management
Biochemical
Conservative
Medical: Somatostatin Analogues Dopamine Agonists GH antagonistsRadiationSurgical: Transphenoidectomy
PsychologicalSocial
Multidisciplinary team
Biological– psychological - social approach
Slide17Summary
Cushings Disease
Significant systemic effect of cortisol
AddisonsCRISISAcromegalyFollow up: Increase risk of Colon CaEXAMS
Slide18GOOD LUCK!