Hyperprolactinema Adrenal Insufficiency 1° (Addison’s) ↓ FSH, LH ↑ ACTH


Pituitary tumor

Bilateral milky discharge, amenorrhea, headaches Weakness, fatigue, anorexia, weight loss, hyperpigmentation, hypotension, GI problems, salt craving Adrenals atrophy Virilization of female fetus Same effects in male + rapid genital devo if prepubertal Moon facies, red cheeks, truncal obesity, HTN, thin skin, striae, m. atrophy (↑ catabolism for gluconeogenesis), hirsutism Same


Autoimmune destruction of adrenals

Fatal if not tx Test w/ ACTH stim test – AI= subnormal cortisol response Most common cause of ambiguous genitalia in female babies Masked in adult male by testosterone from testes Test w/ salivary cortisol at bedtime d/t circadian rhythmicity Cushing’s Dz Differentiate – test blood in petrosal sinus (↑= pituitary, ↓=ectopic) Pre-puberty-gigantism Post-puberty-acromegaly

2° (Hypopituitarism) Congenital Adrenal Hyperplasia (Adrenogential Syndrome) Cushing’s Syndrome

↓ ACTH ↑Androgens

21-β-Hydroxylase deficiency most common, adrenal tumor - ↑ amt 17OH-progesterone and pregnenolone→ converted to androgens Endogenous (excess from adrenals) Exogenous (rx)

↑ glucocorticoids (cortisol)

ACTH Dependent


Pituitary tumor Ectopic tumor

ACTH Independent GH Excess GH Deficiency Hypothyroidism 1° (Hashimoto’s Thyroiditis) 2° Hyperthyroidism 1° (Grave’s Dz) 2°

↓ ACTH ↑ IGF-1 Stimulation test tT4 TBG N ↓ ↓ ↑ ↑ N N N

Adrenal tumor - ↑ cortisol w/o ACTH GH secreting pituitary tumor Hypopituitarism fT4 ↓ ↓ ↑ ↑ TSH ↑ ↓/N ↓ ↑ Autoimmune antithyroid Ab Hypopituitarism Autoimmune stim TSH-R via ↑TSI TSH secreting tumor

Same Tall stature Large forehead, tongue, nose, jaw, hands, etc Short stature, thin Myxedema - ↑ GAGs pull H2O into skin

Cretinism in children

Pemberton sign Very rare

Diabetes Mellitus Type I Type II

↑ fasting glucose ↑ fasting glucose

Autoimmune islet cell destruction Insulin resistance

Retinoptahy, nephropathy, neuropathy, CV dz, poor wound healing

Tx: insulin Sulfonylureas - ↑ insulin Metformin - ↓hepatic gluconeogenesis Glitazones - ↑ insulin sensitivity GLP agonist/GLP metabolism inhibitors - ↑ insulin secretion, β cell mass

Gestational Diabetes Secondary Hyperglycemia Hyperparathyroidism 1°

↑ size of baby, ↑ problems ↑ fasting glucose Ca+2 ↑ PTH ↑ Diagnostic Test PO4-3 ↓ ↑↑ counter-regulatory hormones (d/t acromegaly, Cushing’s, etc) Parathyroid adenoma ↑ PTH causes usual effects, but ↑↑ Renal failure, malabsorption (sprue) Iodogenic, idiopathic, familial PTHrp ↑ Vit. D ↑ Hypercalcemia of malignancy Vit. D Intoxication (rare) Loss of testes Loss of 2° sex characteristics, obesity, tall stature (if lost before puberty) ↑ Ca+2 in urine (filtered load > Tm) Hypercalcemia

2° Hypoparathyroidism 1° 2° Hypogonadism in Male 1°

↓ ↓ ↑

↑ ↓ ↓

1,25-(OH)2-D ↓

Hypocalcemia Hypocalcemia Hypercalcemia

↓ Testosterone ↓ Testosterone

Gonadotroph deficiency (↓ GnRH)