21. Hypopituitarism - etiology, clinical manifestation, treatment Flashcards
what is hypopiturism ?
classification of hypopitutrism ?
diminished or absent secretion of one or more pituitary hormones
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primary
caused by destruction of the anterior pituitary gland
seoncdary
deficiency of hypothalamic stimulatory factors acting on the pituitary
what is the etiology of hypopituatrism ?
developmental and structural
pituatory dysplasia and apslpasa
SEPTO OPTIC DYSPLASIA -
encephalocele
primary empty sella - pituitary gland not seen on the MRI can - sella is filled with csf which compresses the pituatory gland
kallman syndrome
prader willi -
traumatic
surgeical resection
radiation
infection
histoplasmosis- fungal
toxoplasmosisi - parasitic
neoplastic
pitatory adenoma
rathke cysts
infiltrative :
lymphocytic hypophysitis
hemochrombtosis
sarcoidosis
vascular
pituitary apoplexy
infraction with diabetes
sickle cell disease
what are the clinical ?manifestations of hypopiturism
gonadoptrpin hormne deficicny = growth disrder
menstrual disroder = amenorrhea , or metrorrhagia
loss of secondary sexual chareteristics in men
TSH = hypothyroidism
and growth defects
ACTH
addison disease
PRL =
filure of lactation
posterioir pituroy
= diabeets insipidus
diagnosis ?
low tsh
and t4
low acth
and low cortisol
what is pituitary apoplexy ? and what causes it ?
it is an endocrine emergency
bleeding into o impaired blood supply to pitutory gland
acute intrapituatory hemorrhagic vascular event
adenoma
postpartum - sheehan syndrome associated with diabetes
haemorrhage of rathke cyst
hypertension ,
acute shock
what are the clinical manifestation of pituitary apoplexy ?
CNS haemorrhage
and death
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acute symptoms - SUDDEN headache - located behind the eye or temples
meningeal irritation signs - neck rigidity , intolerance to bright light , decreased levels of consciousness
pressure on optic nerve = bilatemporal visual loss
visual acuity reduced , double vision , mydriasis
opthamoplegia
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sudden lack in cortisol =addison
low blood pressure
hypoglycemia
and in severe cases cardiovascular collapse
diagnosis of apoplexy the pitutory gland ?
MRI
ct
infarction of pitutory gland
lumbar puncture to rule out meningitis
treatment of pituitary apoplexy ?
Treatment for acute adrenal insufficiency requires the administration of intravenous saline or dextrose solution
followed by the administration of hydrocortisone
transphenoidal surgery The decision on whether to surgically decompress the pituitary gland and remove any adenoma
hormone replacement therapy
what is sheehan syndrome ?
Ischemic damage to the pituitary following postpartum hemorrhage and vascular collapse
hypertrophy of prolactin-producing regions increases the size of the pituitary gland, making it very sensitive to ischemia.
Hypotensionalongwithvasospasmof the hypophysial arteries.
Usually the posterior pituitary is not damaged because of non portal circulation
what are the signs and symptoms of sheehan syndrome ?
most common initial symptoms of Sheehan’s syndrome are agalactorrhea
gonadotropin deficiency
amenorrhea or oligomenorrhea after delivery
secondary hypothyroidism (hypothyroidism due to pituitary dysfunction) with tiredness, intolerance to cold, constipation, weight gain, hair loss and slowed thinking, as well as a slowed heart rate and low blood pressure
secondary adrenal insufficiency
Growth-hormone deficiency
what is prader willi ?
hypogonadotropic hypogonadism
Deletion/mutation of paternal gene copy + maternal gene methylation
signs and symptoms of prader willi
Muscular hypotonia
Increased appetite (hyperphagia) and obesity
Short stature =
hypogonadism , genital hypoplasia
Facial dysmorphia
mental retardation and adult onset diabetes mellitus
diagnosis of PW ?
genetic tests
Fluorescence in situ hybridization (FISH)
Methylation testing
treatment of prader willi ?
Calorie restriction
Substitution of growth hormone and sex hormones
what is Kallmann syndrome ?
hypogonadotropic hypogonadism, associated with hyposmia/anosmia
most common in male individuals due to genetic mutations
