questions 1

General Hypopituitarism

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Topic updated on 12/25/15 3:56pm

Presentation
  • Symptoms depend on specific hormone deficiency
    • ↓ FSH/LH
      • impotence (males), amenorrhea (females)
      • late-onset puberty (children)
    • ↓ GH
      • growth delay (children)
      • muscle wasting (adults)
      • hypoglycemia (adults) 
        • GH normally gluconeogenic
    • ↓ TSH
      • weakness
      • constipation
      • cold intolerance
Evaluation
  • FSH/LH
    • GnRH stimulation test
      • no change in FSH/LH release in hypopituitarism
      • see ↑ in cases of hypothalamic causes
  • GH
    • Arginine and sleep stimulation tests
      • no change in GH release in hypopituitarism
      • GH normally released at maximum rate at 5 AM
  • TSH
    • TRF stimulation
      • no change in TSH release in hypopituitarism
  • ACTH
    • metyrapone test
      • inhibitor of adrenal 11-hydroxylase
        • normally results in ↓ conversion of 11-deoxycortisol to cortisol
        • consequent ↑ in ACTH release and ↑ in 11-deoxycortisol proximal to the inhibited enzymes
      • in cases of hypopituitarism there is no ↑ in ACTH or 11-deoxycortisol
      • in adrenal disease there is an ↑ in ACTH but not 11-deoxycortisol


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AVERAGE 5.0 of 5 RATINGS

Qbank (1 Questions)

TAG
(M1.EC.6) A 16-year-old girl presents with fatigue and reports missing her period for the past several months though her prior menses were regular. She is short for her age. Her mother has been worried since her daughter started bumping into the furniture around the house. You perform a visual field in the office which reveals the following (Figure A). Vital signs are stable with the exception of blood pressure which is slightly lower than her baseline. The remainder of her physical examination is unremarkable. Regarding this patient, one would also expect to find: Topic Review Topic
FIGURES: A          

1. Hyperkalemia
2. Hyperpigmentation
3. Salt Wasting
4. Elevated plasma cortisol level
5. Hypoglycemia

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