Please enable JavaScript.

Coggle requires JavaScript to display documents.

Anterior Pituitary (Overview: pretty goddamn obvious (Hypothalamus…

- - - - ACTH
        
        TSH
        
        GH
        
        FSH/LH
        
        hormone goes to Target organ, secretes something else
        
        (Adrenal)Cortisol
        
        (Thyroid)T4
        
        (Liver)ILGF-1
        
        (repro) Testosterone/estrogen
        
        notice theres neg feedback
        
        that has final metabolic effect
        
        Stress
        
        Met activity
        
        Growth
        
        Reproduction
        
        Things that keep you alive (order of importance)
- - - - Path: PRL secreting tumor (benign)
        
        Pt: :female_sign:
        
        amenorrhea
        
        galactorrhea :glass_of_milk:
        
        microadenomas (they present early, tumors detected at small stage)
        
        no field cuts (bitemporal hemi)
        
        Pt: :male_sign: (no breasts or periods)
        
        decreased libido (NBD, not worrisome)
        
        Macroadenomas
        
        visual field cuts :eyes:
        
        Dx:
        
        Rx list : PRL raising?
        
        suspicion: Antipsychotic DA antagonists disinhibit PRL)
        
        :green_cross: 2. TSH level (suspicion: hypothyroidism causes hyperprolactinemia)
        
        :green_cross: Normal TSH
        
        1 more item...
        
        :check: Abnormal TSH = hypothyroidism
        
        1 more item...
        
        :check: antipsychotic cause: readjust dose
    - - :warning:GH grows all cells, increases risk of Ca in other tissues
        
        Path: GH secreting tumor (benign)
        Pt: :boy::skin-tone-2: kids get long bone growth, gigantism
        Pt: :man::skin-tone-4: adults get
        
        hand, feet, face, visceral organ growth,
        
        glucose stimulation (diabetes)
        
        cause of :skull: - visceral growth, diastolic LVHF :broken_heart:HF is so common: look for
        
        :tophat: hats/gloves that don't fit
        
        coarse face/teeth :japanese_ogre:
        :!:Pt won't notice since its over long time course
        
        Dx: ILGF-1 (somatomedin)
        
        :warning: Not GH! Do not test that GH, dont do it!
        
        :check: elevated ILGF-1
        
        Glucose suppression test
        :pencil2: insulin competes w/ Epi, Cortisol, GH to lower Glucose
        :pencil2:Unchanged GH under a glucose load is :check:positive test. I.e. Glucose Suppression test is the GH test
        
        :check: pos Glucose suppression test
        
        1 more item...
        
        :green_cross: neg Glucose suppression :forbidden: stop
- - - - Path:
        
        Infxn
        
        Infarction
        
        Iatrogenic
        
        Pt: catastrophic loss of all of hormones
        
        Cortisol loss
        
        Hypotensive :open_mouth:
        
        Tachycardic :heartpulse:
        
        T4 loss
        
        Lethargy & coma :sleeping_accommodation:
        
        Dx: Cortisol & T4 test
        
        :pencil2: Recognize rare ones
        
        Sheehan's:
        
        Prolonged pregnancy/blood loss, infarct, then coma
        
        Apoplexy:
        
        Tumor leading to obtunded, nuchal rigidity, headache :face_with_head_bandage:
        
        Tx: replace hormones
    - - Dx: Insulin Stimulation test
        
        or Vasopressin stim test
        
        Confirm: Get MRI
        
        :check: Pos MRI :checkered_flag:
        
        Tx: replace lost hormones
        
        and fix underlying disease
        Tumor (sx), Autoimmune (prednisone), Sarcoid/amyloid (??)
        
        :pencil2: insulin load lowers blood glucose.
        
        Epi, Cortisol, GH should increase to correct low Glucose.
        
        Failure to stimulate is :check:positive test
        
        Again, this stimulation test is the GH test , and also cortisol
    - - Path: anterior and posterior pituitary are still present, just not in the Sella.
        
        incidental MRI finding, but Pt is totally alive :smiley: :checkered_flag: Dx: Empty Sella
        
        Tx: absolutely nothing
        
        aka: reassure pt