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.
First of all, ACTH.
The clinical syndrome consists of
moon faces, centripetal obesity,
the presence of striae, diabetes,
This is Cushing disease most likely caused by
ACTH-secreting pituitary adenoma.
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.
For TSH, these patients present with
goiters and hyperthyroidism,
and under these circumstances,
a TSH-secreting pituitary adenoma
should be ruled out.
Under these circumstances,
the TSH is usually normal or elevated,
and an increased T4
can be found as well.
Excess growth hormone release from the
anterior pituitary presents with acromegaly.
This manifests as increased spacing
between the teeth of the lower jaw,
enlarged hands, feet,
head, and tongue.
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.
Prolactin will produce
galactorrhea and amenhorrhea.
The clinical condition
is usually a prolactinoma,
and here, the best test to order
is a serum prolactin level.