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ACROMEGALY It is a disorder that results from excess growth hormone (GH) after the growth plates have closed (excess GH after puberty) It is a diseases of anterior pituitary Somatotrophs are abundant cells in pituitary somatotroph adenoma is most common cause of developing Acromegaly Mammosomatotroph adenoma growth hormone and prolactin increases clinical features : Galactorrhea Leading cause of extra pituitary source of excess growth hormone → pancreatic adenoma (islet cells tumor) Leading cause of excessive GHRH production → CARCINOID TUMOR CLINICAL FEATURES : ACRAL ENLARGEMENT : Increase in size of hand/feet Increase in finger thickness leading to spade like hands Lower Jaw prominence called as Prognathism Frontal Bossing Heel pad thickness >21 mm → used for monitoring growth in these patients Coarse facies / deep hollow voice ,Hyperhidrosis(excessive sweating) , sebum increase (increase incidence of acne) , ac

SHEEHAN SYNDROME It is also known as SIMMOND'S SYNDROME / POSTPARTUM HYPOPITUITARISM / POSTPARTUM PITUITARY GLAND NECROSIS Postpartum hemorrhage ↓ causes pituitary damage ↓ results in secondary addison's disease Results in decrease ACTH ↓ decrease cortisol ↓ Hypoglycemia Blood pressure is normal as aldosterone is not affected No hyperpigmentation as ACTH levels are low TREATMENT: DEXAMETHASONE

WATERHOUSE-FRIDERICHSEN SYNDROME It is also known as HEMORRHAGIC ADRENALITIS / FULMINANT MENINGOCOCCEMIA It is defined as adrenal gland failure due to bleeding into the adrenal glands,commonly caused by severe bacterial. It is caused by Neisseria Meningitidis / Pseudomonas Leads to Sepsis DIC (Disseminated intravascular coagulation) → adrenal hemorrhage → leading to Addisonian crisis TREATMENT : I.V  Hydrocortisone + Antibiotics + Fluid replacement

ADDISON'S DISEASE It is also known as PRIMARY ADRENAL INSUFFICIENCY / HYPOCORTISOLISM It is a long term endocrine disorder in which the adrenal glands do not produce enough steroid hormone(cortisol and aldosterone) Leading cause  → Autoimmune destruction most common cause in india → Tuberculosis of adrenals CLINICAL FEATURES : Aldosterone decrease resulting in : Salt wasting , craving for salty foods polyuria (urine output >3L/day) postural hypotension hyperkalemia metabolic acidosis Cortisol decrease resulting in : cortisol deficiency results in decreased blood sugar → palpitations,tremors,diaphoresis,RAGE attack,emotional fragility ACTH increased : Have partial melanocyte stimulating hormone like action resulting in Hyperpigmentation at palmar / sole creases scars / areola / axilla / cubital fossa groin area oral mucosa nails DHEAS (Dehydroepiandrosterone sulfate) decreased resulting in : decrease libido er