Endocrine system investigations and treatment.pptx

Endocrine system

1. Investigation and treatment Roll no. 19117

2. investigation Testing for Cushing’s syndrome should be avoided under condition of stress. Under stress causes activation of HPA axis , causes potentially spurious results.

3. Diagnosis is a two step process

4. Establishing the presence of disease Confirmed by using two of three main test:

5. Dexamethasone is used because it does not cross react in immune-assays for cortisol. In ONDST , 1mg dexamethasone is administrated at 2300 hrs and measurement of serum cortisol at 0900hrs. In LDDST , 0.5 mg dexa 4time daily for 48hr and measure serum cortisol. Oestrogens to be stopped for 6 weeks prior , to allow CBG level to normal and avoid false- positive responses.

6. Tests to determine the underlying cause.

7. Other investigations Biochemical investigations : Blood glucose. Cholesterol. LDL. Radiological investigations : Plain radiograph of the chest. CT MRI

8. treatment Exogeneous Cushing’s disease : taper and withdraw the glucocorticoid. Cushing’s disease Medical therapy to reduce ACTH : Ketoconazole 200mg TID and increased to 400 mg TID Adrenolytic drugs { metyrapone or mitotane } should be added.

9. Pituitary targeted therapies: somatostatin analog : Pasireotide . Dopamine agonist : Cabergoline. Combination of two . Trans-sphenoidal adenectomy : treatment of choice. When there is clear circumscribed microadenoma . Otherwise subtotal resection of anterior pituitary. Radiotherapy and radiosurgery. Bilateral adrenalectomy with lifelong daily glucocorticoid and mineralocorticoid replacement is final definitive cure.

10. For adrenal tumour and ectopic ACTH syndrome. Surgical resection Medical adrenalectomy by ketoconazole , metyrapone, mitotane .

11. THANK YOU.