ACTH and TSH DEFICIENCY Diagnosis with Treatment

ACTH DEFICIENCY

ACTH SYNTHESIS —

  • POMC also contains the sequences for other hormonal peptides, including the melanocyte-stimulating hormones (MSHs) lipotropins (LPHs), and beta-endorphin (beta-END)
  • ACTH is synthesized as part of a large precursor (241 amino acids in humans) called proopiomelanocortin (POMC).

Disorders of Anterior Pituitary

ACTH and TSH DEFICIENCY Diagnosis with Treatment


Adrenal insufficiency secondary to ACTH defi­ciency is due to :

  • · glucocorticoid withdrawal after long treatment
  • · surgical resection of pituitary adenoma
  • · pituitary adenomas or other masses due to compression effect
  • There is fatigue, weakness, anorexia, nausea, vomiing, hypoglycemia.
  • There are no pigmentation changes or mineralocorti­coid deficiency which is a feature of primary adrenal failure.

ACTH DEFICIENCY Lab diagnosis:

  • low ACTH levels with low cortisol levels.
  • On giving ACTH stimulation, there is no cortisol re­sponse.

CONTROL OF ACTH SECRETION —

  • ACTH secretion is regulated by multiple hormones.
  • CRH is probably the most important ACTH secretagogue  .
  • Beta-END has potent opioid activity in the central nervous system, but its function in peripheral plasma is unknown
  • AVP alone is a weak stimulator of ACTH secretion, but it potentiates the action of CRH in vivo and in vitro

TSH DEFICIENCY

Major symptoms and signs of hypothyroidism

TSH DEFICIENCY  Mechanism TSH DEFICIENCY Symptoms TSH DEFICIENCY Signs
Slowing ofmetabolic processes Weight gainMental retardation (infant) Growth failure Fatigue and weakness Dyspnea on exertion Constipation Cold intolerance Cognitive dysfunction BradycardiaCarotenemia Delayed relaxation of tendon reflexes Slow movement and slow speech
Accumulation ofmatrix substances Dry skinEdema Hoarseness Coarse skinEnlargement of the tongue Periorbital edema Puffy facies and loss of eyebrows
Other ArthralgiaDecreased hearing Depression Menorrhagia Myalgia and paresthesia Pubertal delay AscitesDiastolic hypertension Galactorrhea Pleural and pericardial effusions
  • Pituitary hypothyroidism is characterized by low TSH level with low free thyroid hormone.

Hypothalamic hypothyroidism:

  •  Patients with hy­pothyroidism of hypothalamic origin will have de­creased TRH and slightly increased TSH levels.
  • TRH 200 IJg IV causes a double increase in TSH levels in half an hour.

Treatment:

  • Thyroid replacement therapy.
  • Levothyroxine (Synthroid, Levothroid): 1.6 mcg/kg/d; increase by 25 mcg/d every 4–6 weeks until TSH in normal range