Table of Contents
1.
Approach to a Patient with Pituitary Disease
2.
Presentation Mass effect Hormonal Work-up Imaging Hormonal Differential Diagnosis Treatment
3.
- Symptoms -
4.
Symptoms -
5.
Ophthalmoplegia: III , IV , VI nerves
6.
Symptoms - Hydrocephalus
7.
- Symptoms -
8.
Hypopituitarism (Simmonds’ cachexia)
9.
Workup for Hypopituitarism
10.
How to assess HPA axis?
11.
When to order a dynamic test?
12.
- Symptoms -
13.
- Symptoms -
14.
Hypercortisolism
15.
Workup – Cushing’s Syndrome
16.
Differentiate ACTH Dependent from ACTH Independent
17.
slide 17
18.
When to order IPS catheterization?
19.
Inferior Petrosal Sinus Sampling
20.
slide 20
21.
slide 21
22.
slide 22
23.
How do you assess remission?
24.
slide 24
25.
Prolactinoma
26.
Diagnosis of Prolactinoma
27.
47 yo man with hypopituitarism, headaches, visual loss, proptosis PRL=40, FT4=low
28.
Pathology: adenoma Immunostains: +++ PRL Repeat PRL = 45
29.
Normal Two-Site Immunoassay
30.
Schematic Depiction of Hook Effect
31.
What is the prevalence of the
32.
Wrong question!
33.
It depends on the assay
34.
Macroprolactinemia
35.
Macroprolactinemia: quick facts
36.
Diagnosis of macroprolactinemia
37.
Shrinkage of macroprolactinoma with Pergolide
38.
Re-expansion of macroprolactinoma
39.
slide 39
40.
28 yo woman with headaches, fatigue PRL=40, FT4=0.56 (L) AM cortisol=9
41.
Untreated Hypothyroidism:
42.
Acromegaly -Symptoms
43.
slide 43
44.
Diagnosis of Acromegaly
45.
slide 45
46.
slide 46
47.
Patients May Have Minimal Acromegalic Features
48.
Mean GH = 7.15 µg/L IGF-I = 652 ng/ml
49.
slide 49
50.
Mean GH = 4.15 µg/L IGF-I = 413 ng/ml
51.
slide 51
52.
Acromegalic Patients
53.
Acromegaly: How Low Can You Go?
54.
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