Pituitary Gland Diseases

Hypopituitarism

-Abnormal decrease in activity of pituitary gland

Symptoms:

Dwarfism

Abnormality of secondary sex characteristics

Amenorrhea and infertility in adult females

Lowered testosterone level, decreased libido, loss of facial and body hair in adult males

Diagnosis of pituitary function by blood test

Treatment:

Hormone replacement

Monitoring

Adjustment

Diabetes insipidus

Caused by:

Defect in the pituitary gland OR defect in kidney tubules

Both defects result in a decrease of vasopressin or antidiuretic hormone

Symptoms:

Excessive polyuria

Urinating 2 to 15 gallons of urine in 24 hours

Polydipsia

Hypotension

Dizziness
Constipation

Diagnosis:

Urinalysis

Water restriction test

Treatment:

Administration of vasopressin

Medications that lower urine output

Hyperthyroidism

-Thyroid gland secretes excessive thyroxine

Causes:

Tumor of thyroid gland

Heredity

Excessive intake of iodine

Excessive thyroid hormone medication

Graves’ disease is most common cause

 Graves’ disease is an autoimmune condition where antibodies stimulate the thyroid

gland to produce hormone

Symptoms:

Goiter

Tachycardia

Nervousness

Hyperactivity

Weakness

Excessive excitability

Tremendous appetite with weight loss

Symptoms: (continuation of hyperthyroidism huwag mo ilagay tong nasa parentheses hahaha)

Diarrhea

High heat production - moist skin

Extreme thirst

Exophthalmos

Treatment Medication:

Radiation

Surgery

Adrenal glands
-Also known as suprarenal

-Have two distinct parts:

1. Inner

-Medulla releases epinephrine and norepinephrine

>>Fight-or-flight hormones

2. Outer

-Cortex controlled by ACTH from the pituitary gland

-Adrenal glands secrete mineralocorticoids, glucocorticoids, and sex hormones

 Mineralocorticoids: aldosterone
 Glucocorticoids: cortisol and hydrocortisone
 Sex hormones: androgens and estrogens

-Cortisone

 Glucocorticoid used to treat inflammatory disease

 Should be used short-term only

Cortisone side effects:

Hypertension
Ulcers

Moon face

Drowsiness

May mask symptoms of infection

Adrenal Gland Diseases

Conn’s syndrome/Primary aldosteronism

-Overproduction of mineralocorticoid aldosterone

Causes:

 Solitary adrenal nodule

The most common cause (75% of the time) is a small (<2cm), benign tumor on one of your
adrenal glands called an “aldosteronoma”.
 Bilateral Adrenal Hyperplasia
In the other 25% of cases, both of your adrenal glands become hyperplastic, or plump, and
continuously produce aldosterone.

Risk Factors:

 Age: Conn’s syndrome is most common in people who are in their 30s and 40s.
 Family history: Conn’s syndrome is more common in people with a family history of the
condition or of high blood pressure or stroke before age 40.
 Sex: Conn’s syndrome is more common in women than men.

Signs and Symptoms:

 Hypertension that is difficult to control.

 Low potassium. This can be either without symptoms or can lead to
+muscle weakness
+Cramps
+Fatigue
+numbness

Diagnosis:

The first part of the diagnosis is series of blood tests to determine that you have too much aldosterone
in your body and that it isn’t secondary to other causes.
Treatment:

 Unilateral adrenal nodules that cause primary hyperaldosteronism are treated with a
laparoscopic adrenalectomy. This is a minimally invasive procedure that will remove the tumor
that is over-producing aldosterone hormone, allowing your body to return back to its normal
state.
 Bilateral Adrenal Hyperplasia is treated with medication that includes aldosterone-antagonist
drugs and a low salt diet.

Cushing’s syndrome

-characterized by excess secretion of the adrenal cortex hormones.

Causes:

Iatrogenic causes: excessive cortisol levels from chronic therapy with glucocorticoids.

Primary cause: excessive cortisol production from adrenal neoplasms such as adenomas or carcinomas.

Secondary cause: excessive production of ACTH from the anterior pituitary gland

Risk Factors:

 Women are five times more likely than men.

 Women of age 20 to 40 years.
 Long term corticosteroid therapy.
 Family history

Signs and Symptoms of Cushing’s Syndrome

Diagnosis:

Laboratory studies

Imaging studies (CT scan or MRI of adrenal glands and pituitary glands)

Treatment:

Glucocorticoid medications

Adrenogenital syndrome/Congenital Adrenal Hyperplasia

-any of a group of inherited disorders that are characterized by enlargement of the adrenal glands
resulting primarily from excessive secretion of androgenic hormones by the adrenal cortex.

Cause:

lack of the enzyme known as 21-hydroxylase

Two major types of congenital adrenal hyperplasia:

 1. Classic CAH. This form is rarer and is usually detected in infancy. Approximately two-
thirds of people who have classic CAH have what's known as the salt-losing form, while
one-third have what's referred to as the simple-virilizing form.
2. Nonclassic CAH. This form is milder and more common, and may not become evident
until childhood or early adulthood.

Risk factors:

Factors that increase the risk of having CAH include:

 Parents who both have CAH or are both carriers of the genetic defect for the disorder
 Certain ethnic heritages, such as Ashkenazi Jew, but also Hispanic, Italian, Yugoslav and Yupik
Inuit

Signs and symptoms:

 For classic CAH

+Appearance of pubic hair at a very early age
+Rapid growth during childhood, but shorter than average final height
 For nonclassic CAH
+Irregular or absent menstrual periods
+Masculine characteristics such as facial hair, excessive body hair and a deepening voice
+Severe acne

Diagnosis:
Prenatal testing
Physical Exam
Blood and Urine tests
Gene testing
Testing to determine a child’s sex

Treatment
-Medications:
Corticosteroids to replace cortisol
Mineralocorticoids to replace aldosterone to help retain salt and get rid of excess potassium
Salt supplements to help retain salt
-Reconstructive surgery
-Prenatal treatment

Hypoadrenalism or Addison’s disease

-Low secretion of hormones by adrenal cortex

Signs and Symptoms:

Extreme fatigue

Weight loss and decreased appetite

Darkening of your skin (hyperpigmentation)

Low blood pressure, even fainting

Salt craving

Low blood sugar (hypoglycemia)

Nausea, diarrhea or vomiting (gastrointestinal symptoms)

Abdominal pain

Muscle or joint pains

Irritability

Depression or other behavioral symptoms

Body hair loss or sexual dysfunction in women

Causes:

There are two major classifications for Addison’s disease: primary adrenal insufficiency and secondary
adrenal insufficiency. In order to treat the disease, your doctor will need to find out which type is
responsible for your condition.

1. Primary adrenal insufficiency

-occurs when your adrenal glands are damaged so severely that they can no longer produce
hormones.
-This type of Addison’s disease is most often caused when your immune system attacks your
adrenal glands.
-other causes:
prolonged administration of glucocorticoids (e.g. prednisone)
infections in your body
cancer and abnormal growths (tumors)
certain blood thinners used to control clotting in the blood

2. Secondary adrenal insufficiency

-occurs when the pituitary gland (located in your brain) can’t produce adrenocorticotropic
hormone (ACTH).
-other causes of secondary adrenal insufficiency:
tumors
medications
genetics
traumatic brain injury
Risk factors:
 have cancer
 take anticoagulants (blood thinners)
 have chronic infections like tuberculosis
 had surgery to remove any part of your adrenal gland
 have an autoimmune disease, like type 1 diabetes or Graves’ disease


Diagnosis:

They will do a physical examination, and they may order some lab tests to check your potassium and
sodium levels.

Your doctor may also order imaging tests and measure your hormone levels.

Treatment:

-treatment will depend on what’s causing your condition

-Medications:

combination of glucocorticoids medications

Hormone replacements may be prescribed to replace hormones that your adrenal glands are not
making.

-Home care

-Alternative therapies. It’s important to keep your stress level down if you Addison’s disease.