|
|
| Line 329: |
Line 329: |
| | | | | |
| * [[Endometrial biopsy]] | | * [[Endometrial biopsy]] |
| |}
| |
| {| class="wikitable"
| |
| ! rowspan="3" style="background: #4479BA; width: 200px;" |{{fontcolor|#FFF|Diseases}}
| |
| ! rowspan="3" style="background: #4479BA; width: 200px;" |{{fontcolor|#FFF|Onset}}
| |
| ! colspan="5" style="background: #4479BA; width: 200px;" |{{fontcolor|#FFF|Manifestations}}
| |
| ! colspan="4" style="background: #4479BA; width: 200px;" |{{fontcolor|#FFF|Diagnosis}}
| |
| |-
| |
| ! colspan="4" style="background: #4479BA; width: 200px;" |{{fontcolor|#FFF|History and Symptoms}}
| |
| ! rowspan="2" style="background: #4479BA; width: 200px;" |{{fontcolor|#FFF|Physical examination}}
| |
| ! rowspan="2" style="background: #4479BA; width: 200px;" |{{fontcolor|#FFF|Laboratory findings}}
| |
| ! rowspan="2" style="background: #4479BA; width: 200px;" |{{fontcolor|#FFF|Gold standard}}
| |
| ! rowspan="2" style="background: #4479BA; width: 200px;" |{{fontcolor|#FFF| Imaging}}
| |
| ! rowspan="2" style="background: #4479BA; width: 200px;" |{{fontcolor|#FFF|Other investigation findings}}
| |
| |-
| |
| ! style="background: #4479BA; width: 200px;" |{{fontcolor|#FFF| Trumatic delivery}}
| |
| ! style="background: #4479BA; width: 200px;" |{{fontcolor|#FFF| Lactation failure}}
| |
| ! style="background: #4479BA; width: 200px;" |{{fontcolor|#FFF| Menstrual irregularities}}
| |
| ! style="background: #4479BA; width: 200px;" |{{fontcolor|#FFF| Other features}}
| |
| |-
| |
| ![[Sheehan's syndrome]]
| |
| |Acute
| |
| |<nowiki>++</nowiki>
| |
| | ++
| |
| |[[Oligomenorrhea|Oligo]]/[[amenorrhea]]
| |
| |Symptoms of:
| |
|
| |
| *[[Adrenal insufficiency]]
| |
|
| |
| *[[Hypothyroidism]]
| |
| |
| |
| *[[Breast tissue]] [[atrophy]]
| |
|
| |
| * Decreased [[axillary]] and [[pubic]] hair growth
| |
| |
| |
| *[[Pancytopenia]]
| |
|
| |
| *[[Eosinophilia]]
| |
|
| |
| *[[Hyponatremia]]
| |
|
| |
| * Low [[fasting plasma glucose]]
| |
|
| |
| * Decreased levels of [[anterior pituitary]] [[hormones]] in blood
| |
|
| |
| |
| |
| * Clinical diagnosis
| |
|
| |
| * Most senitive test: Low baseline [[prolactin]] levels w/o response to [[Thyrotropin-releasing hormone|TRH]]
| |
| |CT/MRI:
| |
|
| |
| * Sequential changes of pituitary enlargement followed by:
| |
| * Shrinkage and [[necrosis]] leading to decreased sellar volume or [[empty sella]]
| |
| |
| |
| * Pituitary hormone stimulation tests ([[Metoclopramide]] and [[clomiphene citrate]] stimulation tests)
| |
| |-
| |
| ![[Lymphocytic hypophysitis]]
| |
| |Acute
| |
| |<nowiki>+/-</nowiki>
| |
| |<nowiki>+</nowiki>
| |
| |[[Oligomenorrhea|Oligo]]/[[amenorrhea]]
| |
| |
| |
| * Associated with [[autoimmune]] conditions
| |
|
| |
| * Generalized [[headache]]
| |
|
| |
| * Retro-orbital or Bitemporal [[pain]]
| |
|
| |
| * Mass lesion effect such as [[Visual field defect|visual field defects]]
| |
| |
| |
| *[[Diabetes insipidus|DI]]
| |
|
| |
| *[[Autoimmune]] [[thyroiditis]]
| |
| |
| |
| * Decreased pituitary hormones([[Gonadotropins]] most common)
| |
|
| |
| *[[Hyperprolactinemia]](40%)
| |
|
| |
| *[[Growth hormone|GH]] excess
| |
| |
| |
| *[[Pituitary gland|Pituitary]] [[biopsy]]: [[lymphocytic]] [[Infiltration (medical)|infiltration]]
| |
| |
| |
| *[[CT]] & [[MRI]]: Features of a [[Pituitary gland|pituitary]] [[mass]]
| |
|
| |
| * Diffuse and homogeneous contrast enhancement
| |
| |[[Assay|Assays]] for:
| |
|
| |
| * Anti-TPO
| |
| * Anti-Tg Ab
| |
| |-
| |
| ![[Pituitary apoplexy]]
| |
| |Acute
| |
| |<nowiki>+/-</nowiki>
| |
| |<nowiki>++</nowiki>
| |
| |[[Oligomenorrhea|Oligo]]/[[amenorrhea]]
| |
| |Severe [[headache]]
| |
| *[[Nausea and vomiting]]
| |
| * Paralysis of eye muscles ([[diplopia]])
| |
| * Changes in vision
| |
| |
| |
| *[[Visual acuity]] defects
| |
|
| |
| *[[Cranial nerve palsies|CN palsies]] (nerves III, IV, V , and VI)
| |
|
| |
| |
| |
| * Decreased levels of [[anterior]] pituitary hormones in blood.
| |
| |
| |
| *[[Magnetic resonance imaging|MRI]]
| |
| |
| |
| *[[CT]] scan without [[Contrast medium|contrast]]: Hemorrhag<nowiki/>e on [[CT]] presents as a hyperdense lesion
| |
|
| |
| *[[MRI]]: If inconclusive [[CT]]
| |
| |
| |
| [[Blood tests]] may be done to check:
| |
|
| |
| *[[PT]]/[[INR]] and [[aPTT]]
| |
|
| |
| *[[Pituitary gland|Pituitary]] [[hormonal]] assay
| |
| |-
| |
| ![[Empty sella syndrome]]
| |
| |Chronic
| |
| |<nowiki>-</nowiki>
| |
| |<nowiki>+</nowiki>
| |
| |[[Oligomenorrhea|Oligo]]/[[amenorrhea]]
| |
| |
| |
| *[[Erectile dysfunction]]
| |
|
| |
| *[[Headache]]
| |
|
| |
| * Low [[libido]]
| |
|
| |
| |
| |
| * Signs of raised [[intracranial pressure]] may be present
| |
|
| |
| *[[Nipple discharge|Nipple]] discharge
| |
| |
| |
| * Decreased levels of pituitary hormones in the blood.
| |
| |
| |
| *[[MRI]]
| |
| |
| |
| *[[Empty sella]] containing [[Cerebrospinal fluid|CSF]]
| |
| |
| |
| * Pituitary hormone stimulation tests ([[Metoclopramide]] and [[clomiphene citrate]] stimulation tests)
| |
| |-
| |
| ![[Simmond's Disease|Simmonds' disease]]/[[Pituitary]] [[cachexia]]
| |
| |Chronic
| |
| |<nowiki>+/-</nowiki>
| |
| | +
| |
| |[[Oligomenorrhea|Oligo]]/[[amenorrhea]]
| |
| |
| |
| *[[Cachexia]]
| |
| *[[Premature aging|Premature]] aging
| |
| |
| |
| * Progressive [[emaciation]]
| |
|
| |
| * Loss of body hair
| |
| |
| |
| * Decreased levels of anterior pituitary hormones in the blood.
| |
| |
| |
| *[[Magnetic resonance imaging|MRI]]
| |
| |
| |
| * Done to rule out any pituitary cause
| |
| |
| |
| * Pituitary hormone stimulation tests ([[Metoclopramide]] and [[clomiphene citrate]] stimulation tests)
| |
| |-
| |
| ![[Primary hypothyroidism|Hypothyroidism]]
| |
| |Chronic
| |
| |<nowiki>+/-</nowiki>
| |
| |<nowiki>-</nowiki>
| |
| |[[Oligomenorrhea]]/[[menorrhagia]]
| |
| |
| |
| * Cold intolerance
| |
| *[[Constipation]]
| |
| |
| |
| * Dry skin
| |
|
| |
| *[[Bradycardia]]
| |
|
| |
| * Hair loss
| |
|
| |
| *[[Myxedema]]
| |
|
| |
| * Delayed relaxation phase of deep [[Tendon reflex|tendon reflexes]]
| |
| |
| |
| * Low [[T3]],[[T4]]
| |
|
| |
| * Normal/ low [[Thyroid-stimulating hormone|TSH]]
| |
|
| |
| * Rest of pituitary hormone levels WNL
| |
| |
| |
| *[[TSH]] levels
| |
| |
| |
| * Done to rule out any pituitary cause
| |
| |
| |
| *Assays for anti-TPO and anti-Tg Ab
| |
| *FNA biopsy
| |
| |-
| |
| ![[Hypogonadotropic hypogonadism]]
| |
| |Chronic
| |
| |<nowiki>-</nowiki>
| |
| |<nowiki>-</nowiki>
| |
| |[[Oligomenorrhea|Oligo]]/[[amenorrhea]]
| |
| |
| |
| *[[Hot flushes]]
| |
|
| |
| * Energy and mood changes
| |
|
| |
| * Decreased [[libido]]
| |
| |
| |
| *[[Breast tissue]] [[atrophy]]
| |
| * Decreased [[maturation]] of [[vaginal]] [[mucosa]]
| |
| |
| |
| * Low [[estrogen]], [[testosterone]]
| |
|
| |
| * High [[FSH]]/[[Luteinizing hormone|LH]]
| |
| |
| |
| *[[FSH]]
| |
| *[[Luteinizing hormone|LH]]
| |
| |
| |
| * Done to rule out any pituitary cause
| |
| |
| |
| * Genetic tests ([[karyotype]])
| |
| * Measurement of total and free [[testosterone]] and [[17-Hydroxyprogesterone|17-hydroxyprogesterone]] concentrations
| |
| |-
| |
| !Hypoprolactinemia
| |
| |Chronic
| |
| |<nowiki>-</nowiki>
| |
| |<nowiki>+</nowiki>
| |
| |<nowiki>-</nowiki>
| |
| |
| |
| *[[Infertility]]
| |
| * Subfertility
| |
| |
| |
| * Puerperal agalactogenesis
| |
| |
| |
| * No workup is necessary
| |
| |
| |
| * Decreased prolactin levels
| |
| |
| |
| * Done to rule out any pituitary cause
| |
| |
| |
| *[[Prolactin]] assay in [[3rd trimester]]
| |
|
| |
| *[[Luteinizing hormone|LH]], [[Follicle-stimulating hormone|FSH]]
| |
|
| |
| *[[Thyrotropin]] and free [[thyroxine]]
| |
| |-
| |
| ![[Panhypopituitarism]]
| |
| |Chronic
| |
| |<nowiki>-</nowiki>
| |
| |<nowiki>+</nowiki>
| |
| |[[Oligomenorrhea|Oligo]]/[[amenorrhea]]
| |
| |
| |
| *[[Polyuria]]
| |
|
| |
| *[[Polydipsia]]
| |
| * Features of [[hypothyroidism]] and [[hypoadrenalism]]
| |
| |
| |
| *[[Growth failure]]
| |
|
| |
| * B/L [[hemianopsia]]
| |
|
| |
| *[[Papilledema]]
| |
| |
| |
| * All pituitary hormones decreased
| |
| |
| |
| *[[Magnetic resonance imaging|MRI]]
| |
| |
| |
| * Done to rule out any pituitary cause
| |
| |
| |
| * Left hand and wrist [[radiograph]] for [[bone age]]
| |
| |-
| |
| ![[Primary adrenal insufficiency]]/[[Addison's disease]]
| |
| |Chronic
| |
| |<nowiki>-</nowiki>
| |
| | -
| |
| |<nowiki>-</nowiki>
| |
| |
| |
| *[[Hypoglycemia]]
| |
|
| |
| *[[Hypotension]]
| |
| |
| |
| *[[Dehydration]]
| |
|
| |
| *[[Hyperpigmentation]]
| |
|
| |
| * loss of [[pubic]] and [[axillary]] hair
| |
|
| |
| |
| |
| *[[Hyponatremia]] with/without [[hyperkalemia]]
| |
|
| |
| *[[Plasma renin activity]] to [[Aldosterone|aldosterone ratio]]
| |
| |
| |
| * Abdominal [[Computed tomography|CT]]
| |
| |
| |
| * Abdominal [[Computed tomography|CT]]
| |
| |
| |
| * Serum [[cortisol]] testing
| |
|
| |
| * Serum [[ACTH]] testing
| |
|
| |
| * Anti-adrenal [[Antibody|Ab]] testing
| |
| |-
| |
| ![[Menopause]]
| |
| |Chronic
| |
| |<nowiki>-</nowiki>
| |
| |<nowiki>+/-</nowiki>
| |
| |[[Oligomenorrhea|Oligo]]/[[amenorrhea]]
| |
| |
| |
| *[[Hot flashes]]
| |
| *[[Insomnia]]
| |
| *[[Weight gain]] and [[bloating]]
| |
| * Mood changes
| |
| |
| |
| *[[Vaginal atrophy]]
| |
| * Loss of pelvic [[muscle tone]]
| |
| |
| |
| * ↑ [[FSH]]
| |
| * ↓ [[Estradiol]] and [[inhibin]]
| |
| |
| |
| *[[FSH]] > [[LH]]
| |
| |Normal
| |
| |
| |
| *[[Endometrial biopsy]]
| |
| |} | | |} |
| <small> | | <small> |