- ACTH --> stimulates gluccocorticoids and lack of ACTH can lead to hypotension and secondary adrenal crisis/insufficiency. As ACTH doesn't affect mineralocorticoids as much, Na/K are often not affected
- TSH --> Causes central hypothyroidism with low TSH and low FT4; assays for FT3 less reliable.
- GH --> Check IGF1 as well (age-adjusted). Needs replacement in children for growth but replacement in adults is more controversial given expense, may improve QOL
- FSH/LH --> Will lead to low testosterone in men that can be symptomatic, can replace as an outpatient
- Prolactin --> Can check to rule out prolactinoma, which would affect treatment
Posted 06/14/16 10:32:50 AM by Ying Liu
Treatment for Pan-Hypopituitarism and Adrenal Crisis
- Steroid replacement with either hydrocortisone (two doses given in morning and ~2pm, 10mg/5mg is a common dose) or prednisone (5mg for women/7.5mg for men) daily.
- Synthroid for hypothyroidism.
- For young healthy patients, start with 1.6x weight in Kg (112mcg of synthroid is typical dose for 70kg man)
- For patients >65, start at 50mcg daily if no CAD risk factors or 25mcg daily if CAD risk factors
- During sickness or times of stress, would triple steroid replacement to compensate. If unable to tolerate PO, would refer to the ED for IV steroids.
- Important to give steroids before synthroid to avoid adrenal crisis as hyperthyroidism is protective in adrenal insufficiency
Posted 06/14/16 10:42:28 AM by Ying Liu
Central Diabetes Insipidus (DI)
- Hypernatremia with extremely dilute urine as there is no ADH to stimulate aquaporins in the collecting ducts to retain free water (mechanism)
- Can diagnose central DI with Water Deprivation Test with subsequent dosing of 4mcg of ddAVP --> expect to initially see dilute urine that concentrates with ddAVP if central DI
- If intact thirst, can just increase intake of free water or give free water prescription
- If no thirst given neurosurgery, can give intra-nasal ddAVP
Posted 06/14/16 10:55:24 AM by Ying Liu
For further reading...
Posted 06/14/16 10:58:22 AM by Ying Liu
Created by Christopher Kelly
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