Hypopituitarism

Question 1

What is hypopituitarism?

Answer 1

Inadequate production of one or more of the hormones secreted by the pituitary gland

Question 2

What is the most common cause of hypopituitarism?

Answer 2

Compression of the pituitary gland by non-secretory pituitary macroadenoma

Question 3

What are other possible causes of hypopituitarism?

Answer 3

• Craniopharyngioma
• Pituitary apoplexy
• Sheehan’s syndrome

Question 4

What is a craniopharyngioma?

Answer 4

Children pituitary adenom

Question 5

What is Sheehan’s syndrome?

Answer 5

Postpartum pituitary necrosis

Question 6

How does hypopituitarism present?

Answer 6

• Low ACTH
• low FSH/LH
• low TSH
• low GH
• low prolactin

Question 7

What can low ACTH cause?

Answer 7

Tiredness

Postural hypotension

Question 8

What can low FSH/LH cause?

Answer 8

Amenorrhoea
Infertility
Loss of libido

Question 9

What does low TSH cause?

Answer 9

Feeling cold

Constipation

Question 10

What does low GH cause?

Answer 10

If during childhood then short stature

Question 11

What does low prolactin cause?

Answer 11

Problems with lactation

Question 12

Which features would suggest the underlying cause?

Answer 12

Bitemporal hemianopia

Sudden, severe headache

Question 13

What does bitemporal hemianopia suggest?

Answer 13

Pituritary macroadenoma

Question 14

What does sudden, severe headache suggest?

Answer 14

Pituitary apoplexy

Question 15

How is hypopituitarism diagnosed?

Answer 15

• Hormone profiling

* Imaging

Question 16

What is the management of hypopituitarism?

Answer 16

Treatment of any underlying cause (e.g. surgical removal of pituitary macroadenoma)

Replacement of deficient hormones

Question 17

What is the presentation dependent on?

Answer 17

The hormone that is deficient

Question 18

How would a patient present if the growth hormone was deficient?

Answer 18

Central obesity
Dry skin
Reduced muscle strength
Reduced exercise tolerance

Question 19

How would the patient present if the gonadotropins were deficient?

Answer 19

In females: oligomenorrhoea or amenorrhoea, infertility, sexual dysfunction, breast atrophy

In males: infertility, sexual dysfunction, hypogonadism

Question 20

How would a patient present if the TSH was deficient?

Answer 20

Hypothyroidism

Question 21

How would a patient present if ACTH was deficient?

Answer 21

Adrenal deficiency

• Fatigue, reduced muscle mass, anorexia,

Question 22

How would a patient present if the ADH was deficient?

Answer 22

Diabetes insipidus