PHAR3818 Lecture Notes - Lecture 19: Bitemporal Hemianopsia, Pituitary Adenoma, Dopamine Agonist
23 Jul 2018
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Document Summary
Arginine vasopressin (avp) = antidiuretic hormone: oxytocin. Isolated hormone deficiency e. g. autoimmune: rare: non functional tumour: pressure effects hormonal deficiencies and visual defects. Functional tumours hormonal hypersecretion: cushing"s syndrome (increase acth), acromegaly (increase gh), prolactinoma (increase prl), central hyperthyroidism (increase tsh, drug effects e. g. phenothiazines = dopamine antagonist increased prl may lead to hypogonadism. Case 1 - jonathan: having problems seeing ball when playing squash. Goes to ophthalmologist who notes visual field defect (bi-temporal hemianopia) Also has experienced lethargy, weight loss and reduced libido. Pituitary mri: large pituitary lesion (3cm: hormonal levels: prolactin high, cortisol normal, free t4 normal, testosterone low, gonadotropins low, igf1 normal. Macroprolactinoma: direct effects of prolactin: galactorrhoea, hypogonadism. Effects of structural lesion (i. e. pituitary tumour): headache, visual field defect or external ophthalmoplegia. Gender females: galactorrhoea (30 80%), menstrual irregularity/amenorrhea, infertility vs. males: galactorrhoea (<30%), impotence, vf defects, headache, extraocular muscle weakness, anterior pituitary malfunction. Treatment: medical treatment is generally more effective.
