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Hypopituitarism (Anterior pituitary (Diagnosis (Examination Signs of…

- - - - History
        Polyuria, poyldipsia, dehydration
        Previous head surgery, head injury, strokes
        Known autoimmune or metabolic disease
        Meds (Li)
      - Examination
        Signs of dehydration
      - Investigations
        Bedside: obs, ECG
        Urine: urine Osm (low)
        Bloods: FBC, CRP, U+E (low Na), Ca (normal) LFT,
        hormones (low ADH if cranial, high if nephrogenic)
        serum Osm (high)
        Imaging: MRI head (suspected SOL)
        Special tests: water deprivation (stage 1 deprive of water and weigh and test serum and urine Osm to see if urine conc; stage 2 give desmopressin, measure serum and urine Osm, if responsive then its central)
    - - Cranial DI
        Vascular: haemorrhage, ischemia
        Infection: meningitis, encephalitis
        Idiopathic: unclear cause
        Trauma: head trauma
        Autoimmune: autoimmune hypophysitis, sarcoidosis, amyloidosis
        Iatrogenic: CNS surgery, RT
        Neoplastic: pituitary tumour, craniopharyngoma
        Congenital/Genetic: Wolframs syndrome
      - Nephrogenic
        Trauma: post-obstruction
        Metabolic: hypo-K, hyper-Ca, CKD
        Congenital/genetic
        Drugs: Li
    - - Medical
        ADH replacement (desmopressin) if cranial
        Diuretics (thiazides) and NSAIDs if nephrogenic
      - Conservative
        Information, advice, support