HUD OPotent
MILD SEVERITH
MODERATE SEVERTY
↓
mmm
· ·
12-42 per 1men
epidemiology : incidence -
prevalence 300-430 per 1mIn
↓
mcie Mi
· etiology developmental
:
midline cerebral defect syndromes
aplastic hypoplastic ectopic
, ,
gland
acquired pilitary failure- asphyxia
cranial hemor
breech delivery
generic mutations HD , PRLD ,T S
-Pit
50X
acquired mapogonadism + hypothalamic infiltration
disordersarcoidosa
histiocytosis X hypothalamic dyslundion-> Kallmann syndrom
inflammatory lesions - > Lubercolosis
AID S
Syphilis
granuloma
hypophysitis >
primary lymphocyticautoimmune
↳ mainly post-parcum
secondary -
> meds-related - > CTLA)-i + Ami-PD-1 Bardet-Biedl
↳ MJF syn
pilitary apoplexy-> symplons :
hypoglycemic
hypotension aerhage
death Leplin + Leplin-R m
acote +
headachopse
visual
changes Prader-Wini syndr
subarachnoidhemorrhage : CH axis al 71844
↳ atrophy GnD / > 30 Gu
of
gland
emply sella -> primary : herniation of subarachnoid space
↳ PTC
pregnancy ,
secondary of post-surgery/RT
:
regression gland
head inturies (TBD)
brain or pilitary tumors
Sheehan syndrome pilitary
causes
apoplexy
V V
~
GH DEFICIENC En DEFICIENC ACTH DEFICIENC
- TBX19 isolated AC
Congenital
:
2/3
congenital
or RT + cases - Kallman s ·
surgical
·
·
causes - ↓ X4
luncional - stress lumors
Prop1/POUTF1 acquired >
pilitary
-
·
Mutations on
↑ exercise Secondary
·
>
-
lesion
sellar mass
primary GHR dysluncion Low Bre traumz
idiopathic a hypophysicis
malignanc
isolated
organic ->
raumz
GHD +
ne/surgery
Rt
IGF-1
·
diagnostic markers -
147BP3
acid-labile unit of 1GFB complex
V
DIAGNOSIS AGE- (GmD)
·
symploms - depend onl .
hypogonadism in childhood -> ↑
height
no puberly
: stration in adults dysmenorrhea
↓ libido
AXES INVOLVED
&rectile
·
dysfunction
hypothyroidism (TSHD) in childhood - crelirsm
awarlism
in adults -> falique , letarge
weight gail
(ACTHD) childhood -f may kill patient-it may
go unrecognised
hepoadrenalism in
V
V V
v ~ PRLD
TSH deficiency AGHD
GH deficiency GRE deficiency tiredness lactation
: Fatigue
is
·
· acute · no
in child : Short stature cold intolerance
women
:another
·
·
·
rel . hair loss nausea
↓ growth
· · ·
skin
↓libido ·Boge
dry
hypoglycemia
·
·
hoarseness
-
porosis ·
in adult : adiposily atherosch. · crelinism
Chronic : pallor
·
↓ bone mass
bradycardia
·
·
tiredness
itlibid
·
.
men :
↓ muscle mass
·
·
him anorexiz
insulin resist
·
.
↓ erythrop children
mipoglycemia
· . -
.
.
low mood thrive-
·
·
↓ hair
growth · failure to
YESTING
, PITOITARY ADENOMAS
·
generally benign
15 % of all intract. neopl
·
epidemiology +
Round at autopsies
6-11 cases/1mIn in 33yS
microadenoma 11cm
Cassilication - SIZE :
·
macroadenoma (1 cm
EXTENSION : Endosela chemianopsi
to the o c
suprasevar :
impairment of
to the Cs
paraseuar : VI X 11
CN IV, , ,
HOR MONE : NFP A
PRL-om2
GH-om2
Oma
TSH -
ACTH-OM2
LH/FSH-om2
effect -> Horner's es invasion
picture - mass syndrome
-
· dirical irritation
Headache-meningeal
compression
Hemianopsia- Oc
obesity
Hypoth Syndrome DI
-
.
,
hormonal hupersecretion
-> ↑ ACTH : Cushing's
children : gigantism
↑ G-
acromegaly
adults :
↑ PRL > hyperptolachnemiz
hypophysis normal
Gadolinium-enhanced MR - hyper-dense
·
diagnosis -
imaging > -
hypodense
tissues =
adenomatous
CT-second line
hormones
laboratory tests > -
pilitary hormones
hypoth .
secondary glands
VF campimetry
NFPA
·
TREATMENT
E Microsurgery -GH-omas or
Gadenomatous
RTX = > for non-resectable
non-responsive Tissue
hyper-secreting
volume reduction
medical therapy w/DA + SST agonists >
-
growth arrest +
↳ PRL-ona mainly
HUPERPROLACTINEMIA
> 25ng/mL
F
· definition : =
M
<zong/mL =
most common-STRESS
·
physiological :
pregnancy
lactation
· ercise
sleep
coinos
·
pathological : · H-p injury - granulomas
ret
Tumors
pilitary intury
·
t anesthetic
Ind most common
·
drugs- anlipsycholics
a Mi = HTN
- trauma
systemic aisorders
surgery
·
H2
Seizures
clinical ↓ libido
·
presentation ,
I
infertilit
amenorrhea
M >
- ↓ libido
impotence
genecomaslia
ACRONESA
TSH-OMA-rare NFPA-30 %
PRL-OMA-40 % GH-OMA-13 %
100
22 per
prevalence : 8 6 per .
look
incidence : O 15 per
.
1 min prevalence :
44 4 :1
Epidemiology prevalence look 2 :/ 84 % macroadenoma M >F
: =
per MT F = is
M 5045
F > M 4:1 A go
:
M484
M= F
Age
:
= :
O 5 % of all pit-OMAs F : 42 uS
Age M4On
: .
Lord M = 34 50-6040 belore :
symploms Age :
Symploms
F = G4S 0 Sys
M =F :
Mic
.
Sympt .
belore diagnosis :
1 .
8
↓
of casesa
macroadenomas : 30%
41-50 yo
Age :
microadenomas : toyos
21-3040
Age :
of hands / feet (77 %)
Symptoms # + ↓ libido
-
emargements hupogonadism
infertilit mandibular
·
goiter hypoadrenalism
amenorrhea
·
overgrowth · sweating, nervousness
lips systemic complications
headache
large leshy
:
palpitations visual delicits
PWinsu
↓ libido
· ·
,
M >
-
sleep %)
impotence poor (39
·
cranial ridges so a
·
tremor , loss
of weight hyper-PRL
genecomaslia ·
macroglossia ↓
closure
.
effect
hypopilitarism
(78
of voice
·
gigalism : Only if it occurs prior to epiphysea
· mass
· hoarseness
1 Clinical symploms
Diagnosis .
1 Exclude pharmacological etiology .
IGF-1 . Measure
1
TSH ,TH4 ,
TH3
PRL . Measure
2 GH and
Measure
ng/L
normalhigh
2 to 30 ↳
undetectable
.
↳ att normal :
167-1-
highlyspeciea t . Exclude
2
interfering
sadors
, Hypopituitarism and pituitar
ITT (0.05-0.15 U/kg IV every 30 mi
GH deficiency Arginine test 30g IV over 30 min
GHRH test (1 microg/Kg IV)
L-dopa test (500 mg PO)
GH
IGF-1 levels
GH levels - not indicative due to p
release
Acromegaly (GH-oma)
OGTT
GnRH Deficiency
GnRH test (100 microg IV)
MILD SEVERITH
MODERATE SEVERTY
↓
mmm
· ·
12-42 per 1men
epidemiology : incidence -
prevalence 300-430 per 1mIn
↓
mcie Mi
· etiology developmental
:
midline cerebral defect syndromes
aplastic hypoplastic ectopic
, ,
gland
acquired pilitary failure- asphyxia
cranial hemor
breech delivery
generic mutations HD , PRLD ,T S
-Pit
50X
acquired mapogonadism + hypothalamic infiltration
disordersarcoidosa
histiocytosis X hypothalamic dyslundion-> Kallmann syndrom
inflammatory lesions - > Lubercolosis
AID S
Syphilis
granuloma
hypophysitis >
primary lymphocyticautoimmune
↳ mainly post-parcum
secondary -
> meds-related - > CTLA)-i + Ami-PD-1 Bardet-Biedl
↳ MJF syn
pilitary apoplexy-> symplons :
hypoglycemic
hypotension aerhage
death Leplin + Leplin-R m
acote +
headachopse
visual
changes Prader-Wini syndr
subarachnoidhemorrhage : CH axis al 71844
↳ atrophy GnD / > 30 Gu
of
gland
emply sella -> primary : herniation of subarachnoid space
↳ PTC
pregnancy ,
secondary of post-surgery/RT
:
regression gland
head inturies (TBD)
brain or pilitary tumors
Sheehan syndrome pilitary
causes
apoplexy
V V
~
GH DEFICIENC En DEFICIENC ACTH DEFICIENC
- TBX19 isolated AC
Congenital
:
2/3
congenital
or RT + cases - Kallman s ·
surgical
·
·
causes - ↓ X4
luncional - stress lumors
Prop1/POUTF1 acquired >
pilitary
-
·
Mutations on
↑ exercise Secondary
·
>
-
lesion
sellar mass
primary GHR dysluncion Low Bre traumz
idiopathic a hypophysicis
malignanc
isolated
organic ->
raumz
GHD +
ne/surgery
Rt
IGF-1
·
diagnostic markers -
147BP3
acid-labile unit of 1GFB complex
V
DIAGNOSIS AGE- (GmD)
·
symploms - depend onl .
hypogonadism in childhood -> ↑
height
no puberly
: stration in adults dysmenorrhea
↓ libido
AXES INVOLVED
&rectile
·
dysfunction
hypothyroidism (TSHD) in childhood - crelirsm
awarlism
in adults -> falique , letarge
weight gail
(ACTHD) childhood -f may kill patient-it may
go unrecognised
hepoadrenalism in
V
V V
v ~ PRLD
TSH deficiency AGHD
GH deficiency GRE deficiency tiredness lactation
: Fatigue
is
·
· acute · no
in child : Short stature cold intolerance
women
:another
·
·
·
rel . hair loss nausea
↓ growth
· · ·
skin
↓libido ·Boge
dry
hypoglycemia
·
·
hoarseness
-
porosis ·
in adult : adiposily atherosch. · crelinism
Chronic : pallor
·
↓ bone mass
bradycardia
·
·
tiredness
itlibid
·
.
men :
↓ muscle mass
·
·
him anorexiz
insulin resist
·
.
↓ erythrop children
mipoglycemia
· . -
.
.
low mood thrive-
·
·
↓ hair
growth · failure to
YESTING
, PITOITARY ADENOMAS
·
generally benign
15 % of all intract. neopl
·
epidemiology +
Round at autopsies
6-11 cases/1mIn in 33yS
microadenoma 11cm
Cassilication - SIZE :
·
macroadenoma (1 cm
EXTENSION : Endosela chemianopsi
to the o c
suprasevar :
impairment of
to the Cs
paraseuar : VI X 11
CN IV, , ,
HOR MONE : NFP A
PRL-om2
GH-om2
Oma
TSH -
ACTH-OM2
LH/FSH-om2
effect -> Horner's es invasion
picture - mass syndrome
-
· dirical irritation
Headache-meningeal
compression
Hemianopsia- Oc
obesity
Hypoth Syndrome DI
-
.
,
hormonal hupersecretion
-> ↑ ACTH : Cushing's
children : gigantism
↑ G-
acromegaly
adults :
↑ PRL > hyperptolachnemiz
hypophysis normal
Gadolinium-enhanced MR - hyper-dense
·
diagnosis -
imaging > -
hypodense
tissues =
adenomatous
CT-second line
hormones
laboratory tests > -
pilitary hormones
hypoth .
secondary glands
VF campimetry
NFPA
·
TREATMENT
E Microsurgery -GH-omas or
Gadenomatous
RTX = > for non-resectable
non-responsive Tissue
hyper-secreting
volume reduction
medical therapy w/DA + SST agonists >
-
growth arrest +
↳ PRL-ona mainly
HUPERPROLACTINEMIA
> 25ng/mL
F
· definition : =
M
<zong/mL =
most common-STRESS
·
physiological :
pregnancy
lactation
· ercise
sleep
coinos
·
pathological : · H-p injury - granulomas
ret
Tumors
pilitary intury
·
t anesthetic
Ind most common
·
drugs- anlipsycholics
a Mi = HTN
- trauma
systemic aisorders
surgery
·
H2
Seizures
clinical ↓ libido
·
presentation ,
I
infertilit
amenorrhea
M >
- ↓ libido
impotence
genecomaslia
ACRONESA
TSH-OMA-rare NFPA-30 %
PRL-OMA-40 % GH-OMA-13 %
100
22 per
prevalence : 8 6 per .
look
incidence : O 15 per
.
1 min prevalence :
44 4 :1
Epidemiology prevalence look 2 :/ 84 % macroadenoma M >F
: =
per MT F = is
M 5045
F > M 4:1 A go
:
M484
M= F
Age
:
= :
O 5 % of all pit-OMAs F : 42 uS
Age M4On
: .
Lord M = 34 50-6040 belore :
symploms Age :
Symploms
F = G4S 0 Sys
M =F :
Mic
.
Sympt .
belore diagnosis :
1 .
8
↓
of casesa
macroadenomas : 30%
41-50 yo
Age :
microadenomas : toyos
21-3040
Age :
of hands / feet (77 %)
Symptoms # + ↓ libido
-
emargements hupogonadism
infertilit mandibular
·
goiter hypoadrenalism
amenorrhea
·
overgrowth · sweating, nervousness
lips systemic complications
headache
large leshy
:
palpitations visual delicits
PWinsu
↓ libido
· ·
,
M >
-
sleep %)
impotence poor (39
·
cranial ridges so a
·
tremor , loss
of weight hyper-PRL
genecomaslia ·
macroglossia ↓
closure
.
effect
hypopilitarism
(78
of voice
·
gigalism : Only if it occurs prior to epiphysea
· mass
· hoarseness
1 Clinical symploms
Diagnosis .
1 Exclude pharmacological etiology .
IGF-1 . Measure
1
TSH ,TH4 ,
TH3
PRL . Measure
2 GH and
Measure
ng/L
normalhigh
2 to 30 ↳
undetectable
.
↳ att normal :
167-1-
highlyspeciea t . Exclude
2
interfering
sadors
, Hypopituitarism and pituitar
ITT (0.05-0.15 U/kg IV every 30 mi
GH deficiency Arginine test 30g IV over 30 min
GHRH test (1 microg/Kg IV)
L-dopa test (500 mg PO)
GH
IGF-1 levels
GH levels - not indicative due to p
release
Acromegaly (GH-oma)
OGTT
GnRH Deficiency
GnRH test (100 microg IV)
