This document summarizes various disorders of the endocrine system, including disorders of the anterior and posterior pituitary gland. It discusses conditions such as dwarfism, gigantism, diabetes insipidus, and Syndrome of Inappropriate ADH Secretion (SIADH). It provides information on causes, clinical features, diagnostic evaluations, and management approaches for each condition.

1. Disorder of Endocrine System
By-
Mr. ASHOK DHAKA BISHNOI
Director , JINC

2. Disorder of Anterior pituitary gland

3. (Growth hormone is specifically made by the
anterior pituitary gland.)
Normal Level
 Men: < 5 ng/mL or < 226 pmol/L
 Women: < 10 ng/mL or < 452 pmol/L
 Children: 0-20 ng/mL or 0-904 pmol/L
 Newborns: 5-40 ng/mL or 226-1808 pmol/L
 Dwarfism (Lorain’s -Levi Syndrome) It is due to
hyposecretion of GH.
 Gigantism – It is due to hypersecretion of GH (In children)
Growth Hormone/somatotropin or somatropin:-

4.  Dwarfism (Lorain’s -Levi Syndrome) It is due
to hyposecretion of GH.
Etiology:-
 Tumor of pituitary gland
 Lack of GHRH
 Autoimmune Disease
 Seehan Syndrome (Necrosis of pituitary
gland or infraction of pituitary gland)

6. C/F:-
 Short stature (adult height that is below 4 feet 10 inches
(147 cm)
 Short hand
 Short feet
D/E:-
 History & PE
 Stumulation test (Arginine test) eg. Norditropin
 CT or MRI scan of the head (showing pituitary tumor)

7. Management:-
M/M
 For adult:-Somatrem (Protropin)
 For Children Somaropin (Humatrope)

8. Gigantism (giantism)– It is due to hyper-
secretion of GH (In children)
Etiology:-
 Tumor of pituitary gland
 Excessive secretion of GHRH

10. C/F:-
 Large hand & feet
 Protrusion of jaw
 Protrusion of tongue
 Deepening of voice
 Protrusion of supra-orbital area
 Enlarged head circumference
 Clubbing like figure
 Joint pain
 Rough skin

11. D/E;-
 History & PE
 Suppression test (Glucose loading test)
 CT or MRI scan of the head showing pituitary tumor
Management:-
M/M
 Bromocriptin (Prevent to release to much growth hormone)
 Octreotide (Sandostatin) –Reduce Level of GH
 S/M
 Hypophysectomy done by 2 approaches
◦ Adenectomy (Craniotomy)
◦ Trans-Sphenoidal Hypophysectomy
Note :- Hypophysectomy may be partial or complete. If Hypophysectomy is done
then patient has to take life long hormonal replacement therapy for pituitary
hormones

13. ADH (Anti-diuretic hormone/vasopressin)
 Normal level of ADH is 1 to 5 picograms per
milliliter (pcg/mL)
 Diabetes Insipidus:- Due to hypo-secretion of
ADH
Cause:-
 Head injury.
 Malignant (cancerous) or benign (non-cancerous)
tumours of your brain or pituitary gland.
 Kidney fail to response ADH
Disorder of Posterior pituitary gland

14. Types of DI:-
two types of DI- Central and nephrogenic
1. Central DI:-Is a lack of ADH production and is
due to damage to the pituitary gland or
hypothalamus where ADH is produced.
1. Nephrogenic DI :-Is lack of response of the
kidney to the fluid-conserving action of ADH
 It also can be due to diseases of the kidney (such
as polycystic kidney disease), certain drugs (such
as lithium)

15. C/F:-
 Polyurea
 Polydipsia
 Sign of dehydration
 Low specific gravity of urine
 Hypotension
 Fatigue
D/E:-
 check sodium and potassium salts in your
blood. These can be high in diabetes
insipidus

16. Management:-
M/M
 Chlorpromide
 Carbamazipine
 Vasopression tennate eg Pitression
 Avoid diuretics
 Low sodium diet is administered

17. Syndrome of in-appropriate ADH (SIADH) is
also known as Schwartz-Bartter syndrome;-
Due hypersecretion of ADH
SIADH was first described in 1957
Etiology:-
 Infections Meningitis, Encephalitis, brain abscess
 Mass / bleed Trauma, Subarachnoid hemorrhage, subdural
hematoma.
 Hydrocephalus

18. C/F:-
 Fluid overload
 HT
 Weight gain
 Change in mental status
 Hyponatremia
 Edema
 Restlessness
 Confusion
 Delirium

19. Management:-
M/M:-
 Diuretics
 Demeclocycline (Declomycin) treatment of
hyponatremia