Hypopituitarism Flashcards
Define Hypopituitarism
Partial or complete deficiency of one or more anterior pituitary hormones
Panhypopituitarism = deficiency of all anterior hormones
Aetiology of Hypopituitarism
Hypothalamus:
Kallman’s syndrome
Infection e.g. meningitis, TB
Pituitary stalk:
Trauma
Surgery
Craniopharyngioma
Meningioma
Carotid artery aneurysm
Pituitary
Tumour
Irradiation
Infiltration (haemochromatosis, amyloid, metastases)
Ischaemia (pituitary apoplexy, DIC, Sheehan’s syndrome)
Autoimmune inflammation
Symptoms of Hypopituitarism
GH: Central obesity | atherosclerosis | dry wrinkly skin | reduced strength, balance, well-being, exercise ability | osteoporosis
LH/FSH: Oligomenorrhoea/amenorrhoea | reduced fertility, libido, muscle bulk, hair, ejaculate | osteoporosis | breast atrophy | dyspareunia | erectile dysfunction | small testes
TSH: hypothyroidism
ACTH: Adrenal insufficiency (NO skin pigmentation)
Prolactin: Absent lactation
investigations for Hypopituitarism
Field assessment: ?bitemporal hemianopia
Basal: 9am cortisol, LH, FSH, testosterone, oestradiol, IGF-1, prolactin, free T4 and TSH
CPFT (Combined Pituitary Function Test) “Triple Test”
Pituitary hormone: prolactin, TFTs, cortisol/glucose, GH
MRI: ?pituitary adenoma
Management for Hypopituitarism
Hormone replacement:
1. Hydrocortisone 20mg in the morning, 10 mg in the evening + double dose for illness/surgery
- Levothyroxine daily (AFTER hydrocortisone)
- Sex hormones: testosterone or oestrogen + progesterone
- Growth hormone, SC
- Desmopressin if posterior pituitary affected
Complications of Hypopituitarism
Adrenal crisis
Hypoglycaemia
Myxoedema coma
Infertility
Osteoporosis, dwarfism
Complications of the mass: optic chiasm compression, hydrocephalus (third ventricular compression), temporal lobe epilepsy
Prognosis for Hypopituitarism
Good with lifelong hormone replacement
Higher mortality
Cardiovascular + cerebrovascular death rates are higher (Potentially GH)
