Post-partum Hypopituitarism Hormone Substitution
Post-partum hypopituitarism, often due to Sheehan's syndrome, requires careful hormone replacement therapy. The order is critical to prevent life-threatening complications.
Priority of Hormone Replacement
The primary goal is to replace the most critical hormones first:
- Glucocorticoids: Essential for life. Deficiency causes adrenal insufficiency, which can lead to an adrenal crisis. This must be addressed first.
- Thyroxin: Treats hypothyroidism resulting from TSH deficiency. It should only be initiated after glucocorticoid replacement is stable, as thyroxin can worsen adrenal insufficiency if cortisol levels are insufficient.
- Oral Contraceptives (or Sex Hormones): Addresses hypogonadism due to LH/FSH deficiency. This replacement is important for long-term health but is less immediately critical than glucocorticoids or thyroxin.
Correct Substitution Order
Based on the priority, the correct sequence for hormone substitution is:
- Glucocorticoids: Replace cortisol deficiency.
- Thyroxin: Replace thyroid hormone deficiency.
- Oral Contraceptives: Replace sex hormone deficiency (estrogen/progesterone).
Therefore, the correct order is Glucocorticoids, thyroxin, oral contraceptives.
Important Questions from Adrenal Disorders
- Which one of the following is a cause of Secondary Hyperaldosteronism?
Which of the following are correct regarding Cortisol?
1. Levels are highest in the morning on waking.
2. Cortisol falls dramatically during an illness.
3. More than 95% circulating cortisol is protein bound.
4. It is the major glucocorticoid in humans and can also activate mineralocorticoid receptors.
Select the answer using the code given below :
- A 50-year lady, who is a known case of rheumatoid arthritis, presents with obesity, moon facies, abdominal striae and hypertension. Overnight dexamethasone suppression test shows serum cortisol is greater than 50 nmol/L, serum ACTH is less than 1.1 pmol/L. The adrenal imaging and brain CT/MRI imaging studies are unremarkable. The likely diagnosis is
- Hirsutism is seen in which of the following ?
1. Polycystic ovarian syndrome
2. Congenital adrenal hyperplasia
3. Hypothyroidism
4. Ovarian tumour
Select the correct answer using the code given below: - A patient presents with circulatory shock, nausea, vomiting and diarrhoea. A diagnosis of acute adrenal crisis is considered. A blood sample is stored for measurement of serum cortisol and treatment started without delay. Which of the following are appropriate interventions?
1. IV normal saline
2. IV hydrocortisone 100 mg stat
3. IV 10% glucose
4. IV KCl as infusion
Select the correct answer using the code given below:
