Hypopituitarism

Question 1

Hypopituitarism describes?

Answer 1

the inadequate production of one or more of the hormones secreted by the pituitary gland.

Question 2

Causes of hypopituitarism?

Answer 2

At 3 levels:

1. Hypothalamus: Kallman’s syndrome, tumour, inflammation, infection (meningitis, TB), ischaemia
2. Pituitary stalk: Trauma, surgery, mass lesion, meningioma, carotid artery aneurysm
3. Pituitary: Tumour!! irradiation, inflammation, autoimmunity, infiltration (haemochromatosis, amyloid, metastases), ischaemia (pituitary apoplexy)

Question 3

Most common cause of hypopituitarism?

Answer 3

Compression of the pituitary gland by non-secretory pituitary macroadenoma

Question 4

Sheehan’s syndrome can lead to?

Answer 4

Hypopituitarism

postpartum pituitary necrosis secondary to a postpartum haemorrhage

Question 5

Give an example of a hypothalamic tumour that can lead to hypopituitarism?

Answer 5

craniopharyngioma

Question 6

pituitary apoplexy?

Answer 6

Apoplexy means bleeding into an organ or loss of blood flow to an organ. Pituitary apoplexy is commonly caused by bleeding inside a noncancerous (benign) tumor of the pituitary. These tumors are very common and are often not diagnosed. The pituitary is damaged when the tumor suddenly enlarges.

Question 7

The clinical features depend on which hormones are deficient:

Answer 7

low ACTH
- tiredness
- postural hypotension

low FSH/LH
- amenorrhoea
- infertility
- loss of libido

low TSH
- feeling cold
- constipation

low GH
- if occurs during childhood then short stature

low prolactin
- problems with lactation

there may also be features suggestive of the underlying causes
- pituriary macroadenoma → bitemporal hemianopia
- pituitary apoplexy → sudden, severe headache

Question 8

Investigations for hypopituitarism

Answer 8

hormone profile testing

imaging such as MRI to look for a hypothalamic or pituitary lesion

Question 9

Treatment for hypopituitarism

Answer 9

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

replacement of deficient hormones

Question 10

Patient’s skin in hypopituitarism?

Answer 10

A prominent feature of hypopituitarism is a pallor of the skin with a yellowish tinge. The skin is also thinner, resulting in fine wrinkling around the eyes and mouth, making the patient look older.