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Transcript
Internal Medicine
•
Varying degrees of hypopituitarism may develop suddenly, and the patient may present
in vascular collapse because of deficient ACTH and cortisol secretion. Often the CSF is
hemorrhagic.
Diagnosis:
1) Evaluation of target organ function: is often the first step in the diagnosis of
hypopituitarism; this condition is often suspected because of failure o more than one target
organ
•
Evaluation of thyroid function: T4, T3, TSH
•
Evaluation of ACTH secretion
•
Evaluation of prolactin levels: prolactin not regularly depressed
•
Evaluation of serum LH and FSH levels: helpful in postmenopausal women, not so
much in others.
•
Measurement of GH hormone level: may be undetectable under baseline
condition, provocative maneuvers are needed to prove inadequacy of hormone
production
o
Insulin induced hypoglycemia/ Insulin tolerance:
test is the most
consistent effective test : Regular insulin at a dosage of 0.1 U/kg body weight
is given IV over 15 to 30 sec, and venous blood samples are obtained to
determine GH, cortisol, and glucose levels at zero time (before insulin
administration) and 30, 60 and 90 minutes later. The fall in serum glucose
level is maximal at 30 minutes, is followed by a rise in GH level to a level
greater than 8-10ng/ml n normal individuals. Blood cortisol level is also
expected to rise. Failure to rise in the level of both hormones may suggest
hypopituitarism.
2) Imaging studies
•
Skull x-ray of sella turcica (detects macroadenomas > 10 mm)
•
High-resolution CT or MRI if available
3) Formal visual field testing
Differential diagnosis:
•
Anorexia nervosa,
•
Chronic liver disease (alcohol, hemochromatosis),
•
Polyglandular autoimmune disease
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