Summary: Pituitary Hormone Excess

00:01 Let's summarize what we learned from the previous four cases and compare and contrast the different conditions causing hormone excess from the anterior pituitary.

00:11 First of all, ACTH.

00:13 The clinical syndrome consists of moon faces, centripetal obesity, the presence of striae, diabetes, and hypertension.

00:21 This is Cushing disease most likely caused by ACTH-secreting pituitary adenoma.

00:27 The best tests to order here are a 24-hour urine cortisol, a dexamethasone suppression test, a midnight salivary cortisol level, and a serum ACTH level.

00:40 For TSH, these patients present with goiters and hyperthyroidism, and under these circumstances, a TSH-secreting pituitary adenoma should be ruled out.

00:50 Under these circumstances, the TSH is usually normal or elevated, and an increased T4 can be found as well.

00:58 Excess growth hormone release from the anterior pituitary presents with acromegaly.

01:03 This manifests as increased spacing between the teeth of the lower jaw, enlarged hands, feet, head, and tongue.

01:12 Here, the best test to order is IGF-1 level, check to screen, and then an oral glucose tolerance test is used to confirm the diagnosis.

01:22 Prolactin will produce galactorrhea and amenhorrhea.

01:26 The clinical condition is usually a prolactinoma, and here, the best test to order is a serum prolactin level.