1.
Approach to a Patient with Pituitary Disease
2.
Presentation Mass effect Hormonal Work-up Imaging Hormonal Differential Diagnosis Treatment
3.
- Symptoms -
4.
Symptoms -
5.
Ophthalmoplegia: III , IV , VI nerves
6.
Symptoms - Hydrocephalus
7.
- Symptoms -
8.
Hypopituitarism (Simmonds’ cachexia)
9.
Workup for Hypopituitarism
10.
How to assess HPA axis?
11.
When to order a dynamic test?
12.
- Symptoms -
13.
- Symptoms -
14.
Hypercortisolism
15.
Workup – Cushing’s Syndrome
16.
Differentiate ACTH Dependent from ACTH Independent
17.
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18.
When to order IPS catheterization?
19.
Inferior Petrosal Sinus Sampling
20.
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21.
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22.
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23.
How do you assess remission?
24.
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25.
Prolactinoma
26.
Diagnosis of Prolactinoma
27.
47 yo man with hypopituitarism, headaches, visual loss, proptosis PRL=40, FT4=low
28.
Pathology: adenoma Immunostains: +++ PRL Repeat PRL = 45
29.
Normal Two-Site Immunoassay
30.
Schematic Depiction of Hook Effect
31.
What is the prevalence of the
32.
Wrong question!
33.
It depends on the assay
34.
Macroprolactinemia
35.
Macroprolactinemia: quick facts
36.
Diagnosis of macroprolactinemia
37.
Shrinkage of macroprolactinoma with Pergolide
38.
Re-expansion of macroprolactinoma
39.
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40.
28 yo woman with headaches, fatigue PRL=40, FT4=0.56 (L) AM cortisol=9
41.
Untreated Hypothyroidism:
42.
Acromegaly -Symptoms
43.
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44.
Diagnosis of Acromegaly
45.
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46.
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47.
Patients May Have Minimal Acromegalic Features
48.
Mean GH = 7.15 µg/L IGF-I = 652 ng/ml
49.
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50.
Mean GH = 4.15 µg/L IGF-I = 413 ng/ml
51.
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52.
Acromegalic Patients
53.
Acromegaly: How Low Can You Go?
54.
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