Hypopituitarism

Question 1

What are the causes of Hypopituitarism?

Answer 1

Hypothalamic - Inflammation, Ischaemia, Infection, Tumour
Pituitary stalk - Trauma, Surgery, Tumour eg craniopharyngioma
Pituitary - Tumour, Ischaemia (Sheehan’s), Irradiation, Infiltration eg amyloidosis

Question 2

What are the 3 most common causes of panhypopituitarism?

Answer 2

Surgery
Irradiation
Trauma

Question 3

What are the features of GH deficiency?

Answer 3

Central obesity
Atherosclerosis
↓CO
↓strength

Question 4

What are the features of LH/FSH deficiency?

Answer 4

Men - ↓libido, Erectile Dysfunction, ↓hair

Women - ↓libido, amenorrhoea, breast atrophy

Question 5

What are the features of TSH deficiency?

Answer 5

Hypothyroidism

Question 6

What are the features of ACTH deficiency?

Answer 6

Secondary Adrenal failure/insufficiency

Question 7

What investigations can be done in a patient with suspected Hypopituitarism?

Answer 7

Basal hormone tests
MRI brain
Dynamic pituitary function tests;
- Insulin→ ↑ cortisol + ↑ GH 
- GnRH→ ↑ LH/FSH 
- TRH→ ↑T4

Question 8

What is the management of Hypopituitarism?

Answer 8

Hormone replacement

Treat underlying cause

Question 9

What is the insulin tolerance test?

Answer 9

Give insulin which causes a drop in blood glucose
GH/ACTH (Stress hormones released) to increase blood glucose
If blood glucose doesn’t increase, know that less GH/ACTH is secreted ie Pituitary gland isn’t functioning