_, Increased Appetite, Nausea, Polydipsia (excessive thirst), Diarrhea, Heart palpatations
Yes, Ask patient if they are taking artificial TSH, They are, Reduce TSH dosage, They are not, Take blood sample to test TSH levels, TSH levels are greater than 4.5 mU/L, Send patient for an MRI to look for a thyrotropic adenoma, Thryrotropic adenoma not found, Take blood sample and test TRH levels, TRH levels greater than 6 pg/ml, Refer patient to a neurologist as they likely have a problem with their hypothalmus, TRH levels are not greater than 6pg/ml, Redo blood tests and confirm that the patient is not taking artificial TSH as the only way to have high TSH levels but not TRH levels is by taking artificial TSH, What is TRH?, Thyrotropic adenoma found, Thyropropic adenoma, Treatment, Surgery, Surgery is often done laproscopicly by inserting a tube into the nose and sliding it through the nasal cavity to reach the pituitary gland. As no incision is required the risks associated with this surgery are incredibly low., Dopamine agonists and radiotherapy, Although these methods can work on small pituitary tumors there has never been a reported case of these treatments working on thryrotropic tumors. These methods would only be used as a last resort., What is it?, It is a swelling of the Thyrotropic region of the anterior pituitary gland. This swelling causes an increase in the production of TSH. These masses are almost never cancerous, What is TSH?, TSH stands for thyroid stimulating hormone and is also known as thrytropin. It works by attaching to TSH receptors in the thyroid gland. This causes the thyroid gland to increase production of T3 and t4 hormones which increase metabolism. High levels of TSH can cause hyperthyroidism, Regulation of TSH production, Promoters, TRH (Thyrotropin Releasing Hormone) is produced by the hypothalamus and increases TSH production, Inhibitors, Somatostatin, Somatostatin is produced by the hypothlamus and decreased TSH production., T3 and T4, Both these hormones are produced by the thyroid gland. TSH promotes the production of these hormones and they inhibit the production of TSH. This is what is known as a negative feedback loop., If the patient has any metal in their body (eg. joint replacements or pins for a fractured bone) a cat scan is an alternative test that can be used as an MRI would super heat the metal in their body which would be incredibly painful and could kill them., TSH levels are not greater than 4.5 mU/L, Refer patient to an endocrinologist as they likely have a problem with their thyroid gland, What is TSH?
No, Refer patient to a psychiatrist as the patient may be suffering from an eating disorder
Loss of vision is due to an ocular problem, Optomologist will treat the ocular problem
Loss of vision is not due to an occular problem, Send patient for an MRI to look for masses in the brain, MRI finds a thyrotropic adenoma, MRI finds mass elsewhere in the brain, Take a biopsy of the mass, Tumor is cancerous, Refer patient to an oncologist to treat the cancer, Tumor is benign, Call for a surgical consult to have the tumor removed, If the patient has any metal in their body (eg. joint replacements or pins for a fractured bone) a cat scan is an alternative test that can be used as an MRI would super heat the metal in their body which would be incredibly painful and could kill them.
Does the Patient have these symptoms? -Infertility -Menstrual Disorders -Obesity -Acne -Abnormal facial, chest and pubic hair growth, Yes, Is Patient Taking artificial LH?, Yes, Reduce Dosage, No, Diagnostic testing should be preformed to test for hormone and overy disorders, Ultrasound, Thickened, White Surface On Overy, Small Ovarian Follicles, Ovaries and Eggs look normal, Take blood sample to test LH levels, Ratio of LH to FSH is greater than 1:1, Additional blood testing is required, Increased Levels of: -Androgen -Androstenedione -Testosterone -Dehydropiandrosterone Sulfate -High lipid levels, Polycystic Ovary Syndrome, Causes Of PCOS, Causes of PCOS are high levels of LH and/or high levels of insulin in the blood. It is often caused by positive feedback of insulin resistance and hyperandrogenism and it is thought to be genetic. Causes of the irregular hormone levels are still unknown., Treatment, For Obese Patients, When the patient with PCOS is obese, a positive treatment is weight loss through exercise and a diet that is low in carbohydrates. Weight loss will increase the patients fertility and can cause spontaneous ovulation. Medication is available to treat PCOS, it reduces insulin resistance and is most effective when the patient has a body mass index of less than 25., Non-obese, but anovulatory patients, For PCOS patients that are not obese but are still anovulatory (do not ovulate), taking FSH and additional selective estrogen receptor modulators like clomiphene citrate. For any women who are still infertile after weight loss, medication and taking clomiphene citrate, assisted reproductive technology is available. This would include ovarian hyperstimulation with FSH injections and in vitro fertilization., When left untreated, PCOS can lead to further complications, • Cancer of the uterine lining • Type II diabetes • High blood pressure • Depression • Dyslipidemia • Cardiovascular disease • Stroke • Weight Gain • Miscarriage, Test by Fasting Glucose for insulin resistance, Normal Resistance, High Resistance, Ratio of LH to FSH is at 1:1, Treatment for individual symptoms will be required, Abnormal Hair Growth, Laser hair removal, Waxing, Acne, Refer to dermatologist, Infertility, Refer to fertility specialist, Obesity, Refer to nutritionist, Menstrual Disorders, Refer to Gynecologist, What is LH?, Luteinizing Hormone Structure, LH, or the luteinizing hormone, is a hormone produced by the anterior pituitary gland. This is the hormone that triggers ovulation in females and stimulates the production of testosterone in males. It works with FSH, which is why the normal ratio of LH to FSH is 1:1., LH Receptor (LHR) is found in the ovaries and testis, When the LH binds to the receptor, the signal activates the G-protein that is in the structure of the LHR. When the LH is attached to the LHR, the conformation changes and the G-protein detaches from the receptor and activates the cAMP system, The cAMP leads the the production of kinase, which, through feedback inhibition, can inhibit the LHR by phosphorylation., In females, LH levels are stimulated by FSH and estrogen levels. Levels of LH are higher during ovulation and decreases after ovulation., To decrease levels of LH, lysosomes metabolize the proteins in the receptors so LH can not be activated., No, Patient should be prescribed the contraceptive pill to regulate menstrual periods.
Is the patient experiencing the following symptoms? - Inability to breast feed - Pubic or under arm hair loss - Lowered blood pressure - Fatigue - Weight loss, Yes, Has the patient experienced any recent head traumas?, No, Take blood samples to see hormone levels, Hormone levels are normal, Refer to Gynecologist, Leuteinizing hormone, Follicle Stimulating Hormone, Thyroid Stimulating Hormone levels are low, The patient may be diagnosed with Sheehan's syndrome, which occurs after giving birth., What is Sheehan's Syndrome?, Sheehan's syndrome is a condition that affects women who experience life-threatening blood loss during or after childbirth. Severe blood loss deprives your body of oxygen and can seriously damage vital tissues and organs. Sheehan's syndrome damages the pituitary gland — a small gland at the base of your brain. The result is the permanent underproduction of essential pituitary hormones - also known as postpartum hypopituitarism., Treatment, Treatment involves FSH and TSH hormone replacement therapy, which must be taken for the rest of your life. Thyroid and adrenal hormones also must be taken., Outlook: If treated early, the outlook is excellent, with the right hormone replacements the patient will be able to live normally. If not treated early, this condition can be life threatening., Prevention, Extreme bleeding during childbirth can often be prevented by proper medical care. Otherwise, Sheehan syndrome is not preventable., FSH, What is it?, A hormone, secreted by the pituitary gland, that is responsible for stimulating the growth and development of eggs in women, and stimulating the growth and development of sperm cells in men (targets ovaries for women, testes for men). FSH levels are often tested (via a blood test) during routine fertility work-ups for women., Regulation, Sex steroids such as testosterone, estrogen and progesterone, inhibit the release of GnRH, thereby inhibiting the release of FSH. This inhibition leads to the secretion of FSH, which is related to the stage in a women's menstrual cycle., Run MRI, Yes, Run an MRI, No, Direct patient to a Gynecologist. There, the patient will be thoroughly examined, and given a remedy for their irregular menstrual cycle.