Phaeochromocytoma – phenoxybenzamine followed by propanolol 10% rule bilateral, malignant, familial, extra-adrenal – Von-Hippel Lindau, neurofibromatosis, MEN II Other adrenal problems: Waterhouse-Friedrichson syndrome adrenal haemorrhage following massive G – –ive meningitis Nelson’s syndrome: pituitary enlargement following bilateral adrenalectomy high ACTH – and pigmentation Failure: Primary TB, Addison’s – Secondary low ACTh (pituitary failure) – Short SynACTHen test if cortisol rises then the problem is probably in the pituitary – Long SynACTHen test fails to rise – Cushing’s Learn the features May be iatrogenic Rheum patients! – Pseudo-Cushing’s depression/alcohol with normal cortisol and ACTH – Cushing’s disease pituitary over-producing ACTH – Low dose dexamethasone suppression test won’t suppress any hyperACTH state – High dose will suppress only Cushing’s disease, not SCC of the lung Prolactinoma Galactorrhoea Infertility in women DA agonists inhibit PL secretion cabergoline and bromocriptine – ...TRH increases it could be d/t hypothyroidism – Growth Hormone Acromegaly glucose tolerance test GH levels fail to suppress – – Big tongue, hat sizes Diabetes and hypertension; cardiomyopathy Acne
Phaeochromocytoma – phenoxybenzamine followed by propanolol 10% rule – bilateral, malignant, familial, extra-adrenal Von-Hippel Lindau, neurofibromatosis, MEN II Other adrenal problems: Waterhouse-Friedrichson syndrome – adrenal haemorrhage following massive G –ive meningitis Nelson’s syndrome: pituitary enlargement following bilateral adrenalectomy – high ACTH and pigmentation Failure: Primary – TB, Addison’s Secondary – low ACTh (pituitary failure) Short SynACTHen test – if cortisol rises then the problem is probably in the pituitary Long SynACTHen test – fails to rise Cushing’s Learn the features May be iatrogenic – Rheum patients! Pseudo-Cushing’s – depression/alcohol with normal cortisol and ACTH Cushing’s disease – pituitary over-producing ACTH Low dose dexamethasone suppression test – won’t suppress any hyperACTH state High dose will suppress only Cushing’s disease, not SCC of the lung Prolactinoma Galactorrhoea Infertility in women DA agonists inhibit PL secretion – cabergoline and bromocriptine ...TRH increases it – could be d/t hypothyroidism Growth Hormone Acromegaly – glucose tolerance test – GH levels fail to suppress Big tongue, hat sizes Diabetes and hypertension; cardiomyopathy Acne