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.