Hypopituitarism

Question 1

What are the causes of hypopituitarism?

Answer 1

Large pituitary adenoma which cause structural damage to pituitary

Pituitary surgery

Pituitary irradiation

Sheehan’s syndrome= post-partum pituitary infarction due to pituitary being very vascular organ and expanding during pregnancy meaning that post-partum haemorrhage leads to hypoperfusion of pituitary= infarct

Peripartum pituitary necrosis due to DM

Question 2

A women has a very traumatic birth where she losses a lot of blood. 4 weeks later she has still been unable to produce milk for her baby and her breasts have become much smaller. What has happened?

Answer 2

Sheehan’s syndrome

I.e. manifests as failure to lactate 4 weeks post pregnancy and breast atrophy

Question 3

What are the 5 main deficiencies that can present clinically due to hypopituitarism?

Answer 3

GH deficiency

• children= failure to grow
• adults= fine wrinkling around mouths and eyes

Gonadotrophin deficiency

• F= amenorrhoea + infertility
• M= decreased libido, decreased body hair, gynaecomastia

TSH deficiency
-hypothyroidism w/o goitre

ACTH deficiency
-loss of appetite, fatigue, weight loss, abnormal response to stress

AVP deficienct
-diabetes insipidus

Question 4

What are the diagnostic tests for the 5 hormone deficiencies which can arise from hypothyroidism?

Answer 4

GH= insulin tolerance test 
Gonadotrophin def= measure gonadotrophin levels or sex hormones 
TSH= TSH,T3,T4 
ACTH= synacthen test 
AVP= water deprivation test

Question 5

How do you treat hypopituitarism?

Answer 5

Replacement of the relevant hormone deficiencies