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Endocrinology Notes

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Endocrinology

Pituitary Tumours Endocrine vs local effects Local effects: CNS + visual fields (optic chiasm compression?bitemporal hemianopia)+ headache

Prolactinoma Most common pituitary tumour. Usually a microadenoma i.e. <1cm. Most are sporadic; also MEN1. Of lactotroph cells. P PC: oligo/amenorrhea, galactorrhoea, decreased libido and fertility, erectile dysfunction Ix: prolactin serum level. MRI pituitary Mx: Mainstay is medical. Ergot dopamine agonists e.g. cabergoline (need an echocardiogram with this as it leads to valve disease) Differential Dx: metaclopramide, domperidone, haloperidol, pregnancy/lactation, hypothyroidism, PCOS, CRF

Non-functioning pituitary adenoma Second commonest pituitary tumour PC: mass effects and/or hypopituitarism; rarely, pituitary apoplexy (bleed into pituitary gland, differential diagnosis of SAH) Mx: monitor with annual MRI. Replace hormones. Transphenoidal pituitary resection, radiotherapy.

Hypopituitarism PC: Weight loss/gain; lethargy; hypotension; oligo/amenorrhoea; decreased libido and fertility; thirst, polyuria, polydipsia Biochem: Often done in 1 blood test:

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IGF1

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Prolactin

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LF, FSH

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TSH, T4, T3

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9am testosterone/oestradiol

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9am cortisol

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Urine and plasma osmolalities

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U & Es (hyponatraemia in SIADH)

Mx: Replace hormones in this order: Hydrocortisone; levothyroxine; sex hormones; GH replacement. If there is posterior hypopituitarism, treat diabetes insipidus with desmopressin.

Acromegaly Anterior pituitary somatotroph cells, majority spontaneous, macroadenomas, in MEN1 or FIPA syndromes. PC:

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Musculoskeletal: increased interdental space, frontal bossing, prognathism, carpal tunnel syndrome, osteoarthritis, soft tissue swelling, macroglossia

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Respiratory: sleep apnoea

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Metabolic: diabetes mellitus/impaired glucose tolerance

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Cardio: hypertension, LVH

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Nervous: pituitary tumour effects, carpal tunnel syndrome, diabetic polyneuropathy, nerve compression elsewhere e.g. facial nerve through temporal petrous bone

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Gastrointestinal: colonic polyps?malignancy

Dx: random IGF1 level high. Random GH levels are not useful. Oral glucose tolerance test shows no suppression of GH. Mx: transphenoidal pituitary resection. If large, give somatostatin analogue or radiotherapy.

Cushing's Syndrome Microadenoma of corticotroph cells of anterior pituitary? true Cushing's Disease PC:

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Skin: acne, hirsutism, striae, thin skin?bruising

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Metabolic: centripetal obesity, interscapular and supraclavicular fat pads, 'buffalo hump', 'moon face', impaired glucose tolerance

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Cardio: hypertension

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Musculoskeletal: proximal myopathy, osteoporosis

Dx: May not see microadenoma on MRI pituitary. No suppression of cortisol on low dose dexamethasone test. Then do a high dose dexamethasone test to if CRH is inappropriately high

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