Metabolic and sexual dysfunction
Deficiencies of TSH and ACTH are most serious
Can be caused by anorexia nervosa or rapid weight loss, head trauma, shock or severe hypotension, brain tumors, infection or postpartum hemorrhage (see Sheehans)
Pituitary enlarges during pregnancy, postpartum hemorrhage causes hypotension=>ischemia=>necrosis
Side effect of testosterone therapy
Most common cause: pituitary adenoma
Excessive PRL secretion
Inhibits gonadotropins resulting in galactorrhea, amenorrhea and infertility
Excessive GH secretion
Gigantism if it occurs before closure of the growth plates (adolescence), acromegaly if afterwards.
Excessive ACTH secretion
Overstimulation of corticosteroids: glucocorticoids, mineralocorticoids and androgens leading to Cushings
bromocriptine mesylate (Parlodel), cabergoline (Dostinex) and pergolide (Permax)
Side effects: orthostatic hypotension, gastric irritation, nausea, headache, abdominal cramps and constipation.
Serious side effects: dysrhythmias, coronary artery spasms, CSF leakage
Stop for pregnancy
Samostatin analogues: ocreotide (Sandostatin) a GH blocker and Somavert.
Decreases hormone levels, relieve's headaches, may reverse changes in sexual functioning. Body changes, organ enlargement not usually reversible. Mustache pad, monitor for CSF leakage. Elevate HOB 30. Avoid coughing, bending, straining at BM, etc. Monitor for menigitis.
Hormone replacement therapy for the rest of their life. Decreased sense of smell, Vasopressin therapy.
Diabetes Insipidus Manifestation
Polyuria due to ADH deficiency, dehydration is the danger, can be nephrogenic (inherited), primary, secondary or drug-related (Lithium). Low urinary osmolarity <1.005
Drugs: Desmopressin (DDAVP) - synthetic ADH, encourage oral intake of fluids, daily weights, teach: polyuria and polydipsia indicate need for another dose