Hypopituitarism

Question 1

Which hormone is released from somatotrophs?

Answer 1

Growth hormone

Question 2

What hormones are released by the anterior pituitary gland?

Answer 2

• Growth hormone
• Prolactin
• Thyroid stimulating hormone (TSH)
• Luteinising hormone (LH) and Follicle stimulating hormone (FSH)
• Adrencorticotrophic hormone (ACTH)

Question 3

Which glands can fail resulting in endocrine hormone deficiencies?

Answer 3

Thyroid gland
adrenal cortex
gonads
Pituitary gland

Question 4

What are the hormone levels in primary hypothyroidisim?

Answer 4

T3 and T4 deficiency

TSH increases

Question 5

What are the hormone levels in secondary hypothyroidism?

Answer 5

Insufficient TSH secretin causing downstream reduction in T3 and T4.

Question 6

Which hormone is regulated by ACTH?

Answer 6

Cortisol

Question 7

A cortisol deficiency will lead to an increase in which hormone?

Answer 7

ACTH

Question 8

What is an example of secondary hypoadrenalism?

Answer 8

Pituitary tumour damaging corticotrophs

Question 9

What are the common causes of primary hypogonadism?

Answer 9

Trauma
Mumps (destruction of testes)
Chemotherapy (ovaries).

Question 10

Which mutation is concerned with congenital hypopituitarism?

Answer 10

PROP1 mutation (transcription factor required for anterior pituitary development)

Question 11

A pituitary MRI will reveal what type of gland abnormality in congenital hypopituitarism?

Answer 11

Hypoplastic (underdeveloped)

Question 12

What are the associated causes of acquired hypopituitarism?

Answer 12

• Adenomas, metastases, cysts
• Radiation (Hypothalamic/pituitary damage)
• Infection (meningitis)
• Traumatic brain injury
• Pituitary surgery
• Inflammation (hypophysitis)
• Pituitary apoplexy (haemorrhage)
• Peri-partum infarction (Sheehan’s syndrome)

Question 13

What is panhypopituitarism?

Answer 13

Total deficit in anterior and posterior pituitary gland function

Question 14

Which types of hormones are most sensitive to radiotherapy?

Answer 14

Growth hormones and goadotrophins

Prolactin (loss of hypothalamic dopamine)_

Question 15

Why can prolactin increase in during radiotherapy?

Answer 15

Loss of hypothalamic dopamine

Question 16

What are the common presentation of hypogonadism?

Answer 16

• Reduced libido
• Secondary amenorrhoea
• Erectile dysfunction
• Reduced pubic hair

Question 17

What are the common presentations of an ACTH deficit?

Answer 17

• Addison’s disease (Not salt losing)

- fatigue

Question 18

What causes post-partum hypopituitarism?

Answer 18

Hypotension associated with a post-partum haemorrhage, this can lead to a pituitary infarction (obstruction to blood supply to pituitary tissue)

Question 19

What type of hyperplasia occurs during pregnancy within the anterior pituitary gland?

Answer 19

Lactotroph hyperplasia.

Question 20

What are the symptoms of Sheehan’s syndrome?

Answer 20

Lethargy, anorexia, weight loss- TSH/ACH/GH deficiency

• Failure of lactation - Prolactin deficiency
• Failure to resume menses post delivery

Question 21

What is a pituitary apoplexy?

Answer 21

Intra-pituitary haemorrhage or infarction

-Can be precipitated by anti-coagulants.

Question 22

What are the associated symptoms with a pituitary apoplexy?

Answer 22

• Severe sudden onset headache
• Visual field defect compressed optic chiasm - bitemporal hemianopia
• Cavernous sinus involvement may lead to diplopia (IV, VI), ptosis (III)

Question 23

Which hormones are released by the anterior pituitary gland in response to hypoglycaemia (<2.2mM)?

Answer 23

GH
ACThH

-Insulin-induced hypoglycaemia stimulates this release

Question 24

What are the radiological diagnoses of hypopituitarism?

Answer 24

Empty sella, thin rim of pituitary tissue.

Question 25

What is the available treatment for a growth hormone deficiency?

Answer 25

growth hormone replacement

Question 26

How are the effects of growth hormone replacement therapy measured?

Answer 26

Improvement in the quality of life

Measure plasma IGF-1

Question 27

What is the treatment for a TSH deficiency?

Answer 27

Levothyroxine (Aim for fT4 above the middle of the reference range)

Question 28

How is an ACTH deficiency managed?

Answer 28

Cortisol replacement
Prednisolone (once daily AM)

Hydrocortisone (thrice daily)

Question 29

What are the clinical features of an adrenal crisis?

Answer 29

Hypotension, dizziness, vomiting, weakness and potential collapse/death.

Question 30

What are the sick day rules for patients who take prednisolone/hydrocortisone?

Answer 30

steroid alert pendant
Double steroid dose if fever/intercurrent illness
-Inject Intramuscularly or attend A&E if unable to orally take medication (vomiting)

Question 31

How can an FSH/LH deficiency be treated in males without the desirability for fertility?

Answer 31

Replace testosterone through intramuscular injections (measure plasma testosterone)

-This does not restore sperm production (endogenous testosterone is required within the seminiferous tubules)- dependent on FSH.

Question 32

How can male fertility be restored in patients with a FSH/LH deficiency?

Answer 32

Gonadotropin injections 
(Sperm production may take 6-12 months) 

Ideal response after puberty (secondary hypogonadism)

Question 33

How can an FSH/LH deficiency be treated in patients not requiring fertility?

Answer 33

Replace oestrogen (Orally or topically) 
\+Progesterone to prevent endometrial hyperplasia of uterus.