Trong cấp 2 ° suy thượng thận, hoặc AI (ví dụ, ngập máu tuyến yên), một kích thích Cortrosyn kiểm tra kết quả có thể là bình thường bởi vì các tuyến thượng thận không có thời gian để teo. Vì vậy, nếu nghi ngờ cho AI là rất cao, điều trị với steroid! | TABLE . Anterior Pituitary Hormones and Their Function ENDOCRINOLOGY Hormone Increased by Decreased by Excess Deficiency Target Organ ACTH CRH stress High cortisol Cushing s syndrome Adrenal insufficiency Adrenals TSH TRH High T4 and or T3 Hyperthyroidism Hypothyroidism Thyroid LH FSH GnRH Gonadal sex steroids Hypogonadism Gonads GH GHRH hypoglycemia dopamine Somatostatin Childhood Gigantism Adulthood Acromegaly childhood Short stature Adulthood Poor sense of wellbeing Liver Multiple Prolactin Pregnancy nursing TRH stress Dopamine Galactorrhea hypogonadism Inability to lactate Breasts Diagnosis In acute 2 adrenal insufficiency or AI . Labs Once a tumor is identified check TSH free T4 prolactin ACTH cortisol LH FSH IGF-1 and testosterone in men or estradiol in women with amenorrhea to assess for hormonal excess or deficiency. Pituitary imaging The best imaging of tumors is obtained with a sellar-specific MRI. A regular MRI of the brain may miss these small tumors Formal visual field testing For macroadenomas or tumors compressing the optic chiasm. pituitary apoplexy a Cortrosyn stimulation test result is likely to be normal because the adrenal glands have not had time to atrophy. So if suspicion for AI is high treat with steroids Treatment Medical Some tumors shrink with hormonal manipulation. Prolactinomas are treated primarily with dopamine agonists . bromocriptine cabergoline . Surgical The transsphenoidal approach is successful in approximately 90 of patients with microadenomas. Radiation Conventional radiotherapy or gamma-knife radiosurgery can be used postoperatively if there is residual tumor. It may take years to realize the full effect and there is a high risk of hypopituitarism. TABLE . Posterior Pituitary Hormones and Their Function Hormone Increased by Decreased by Excess Deficiency Target Organ ADH T osmolality hypovolemia ị osmolality SIADH Diabetes insipidus DI Kidneys cardiovascular system Oxytocin Distention of the uterus cervix and .
