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PRL - normal values 10-20 ng/ml in women and 1-16 ng/ml in men.


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Laboratory and paraclinical evaluation

The PRL levels are positively correlated with the sizeof the tumor and the clinical findings.

Values

over 200 ng/ml = macroadenoma.

over 100 ng/ml = microadenoma,

40-100 ng/ml =hypothalamic-pituitary dysfunction

between 20 and 40 ng/ml = functional hyperprolactinemias

Normal ACTH ranged between 8-52 pg/ml

at 8:00 AM


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Cushings syndrome etiology ACTH dependent

ACTH independent

Pseudo-Cushing chronic alcohol ingestion, depressivepsychosis.

Iatrogenic Cushing syndrome

ACTH secreting pituitary adenomaACTH secreting tumors ectopic secretionHypothalamic CRH excess Itenko Cushing diseaseEctopic paraneoplastic CRH secretion - carcinoid tumors

Benign adrenal tumors (adenomas)Adrenal carcinomasMicronodular adrenal hyperplasiaMacronodular adrenal hyperplasiaEctopic cortisol secretion in ovarian or testicular tumors.


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Cushing Disease

Most frequently- basophile/cromophobe microadenoma The adrenal glands are hyperplasic

12-24g (normal range 8-10g).


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Complications

Nelson Syndrome - afterbilateral adrenalectomy

growth of the pituitary tumor

neurologic andophthalmologic syndrome

intense hyperpigmentation

extremely high ACTH levels

TSH Glycoprotein consisted of two subunits: and .

The half-life is 50-60 minutes.

It has a circadian rhythm with a peak secretionregistered at night

Plasmatic normal range is 0.5-4.5 mU/L


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SOD

Etiopathogenesis4.Pituitary infarction

secondary to circulation deficit during coronary by-pass inthe elderly or diabetic people.

Sheehan syndrome - massive bleeding during labor

Severe form lethargy,

anorexia,

important weight loss

lack of lactation. Mild forms

Diabetes insipidus


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Etiopathogenesis

5. Pituitary apoplexy = spontaneous infarction in apituitary tumor (usually an adenoma)

clinical findings:

intense headache,

meningism,

visual disturbances

signs of acute pituitary failure

Pituitary failure in childrenClinical signs:

Thin, pale, dry skin

Overweight

muscular mass, hypotonia

Acromicria

Infantil facies

orthodontic disturbances

High pitched voice

IQ is not affected, Childish behavior

Inferiority complexes


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Pituitary failure in children

Clinical signs: Microphalus - in boys (


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Growth curves


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Pituitary dwarfism- differentialdiagnosis

Endocrine diseases: Functional GH deficit:

psychosocial dwarfism.

Primary IGF 1 deficit:

Different mutations/dysfunctions of the GHR;

Laron dwarfism

IGF 1 gene deletions/ defects

in transport, metabolism ofIGF 1

IGF 1 resistance mutations

in IGF1 R

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