Hypopituitarism Flashcards
What is hypopituitarism
This refers to the reduced secretion of pituitary hormones, which ca result from disease of either the pituitary gland or the hypothalamus
What are the majority of hypopituitarism caused by
pituitary tumours or their treatment
Mutations in what gene are the most common cause of both familial and sporadic congenital combined pituitary hormone deficiency
PROP 1
What do mutations in the PROP 1 gene result in
deficiencies in GH, prolactin, TSH, LH and FSH
What do mutations in TPIT cause
adrenocorticotrophin hormone (ACTH) deficiency
What can mutations in TPIT cause if not detected early
Neonatal death
What are the clinical presentations of GH deficiency
Fatigue
impaired psychological well being
reduced energy, muscle strength and exercise capacity
increased abdominal adiposity (fat mass)
What does LH / FSH deficiency result in
secondary hypogonadism
What are symptoms of secondary hypogonadism in males
Reduced libido oligospermia infertility loss of body hair fine premolar wrinkles flushes osteoporosis
What are symptoms of secondary hypogonadism in females
oligomennorrhoea amenorrhoea infertility dyspareunia breast atrophy hot flushes osteoporosis
What does ACTH deficiency result in
secondary adrenal insuffieicney
What are symptoms of ACTH deficiency
fatigue weakness nausea vomiting weight loss hypoglycaemia loss of pubic and axillary hair in females
What does TSH deficiency result in
secondary hypothyroidism
What are symptoms of TSH deficiency
fatigue apathy muscle weakness cold intolerance constipation weight gain dry skin
What is the only known presentation of prolactin deficiency
inability to lactate after delivery
What is the treatment for ACTH deficiency
Hydrocortisone for glucocorticoid replacement ( this is made by the adrenals)
What might chronic over-replacement with hydrocortisone result in
Cushing’s syndrome
Do patients with ACTH deficiency require mineralocorticoid replacement therapy
no because aldosterone release is under the control of the renin-angiotensin system and is not ACTH driven
What is the treatment for TSH deficiency
Levothyroxine 100ug per day in young without cardiac disease
Levothyroxine of 25-50ug per day in older patients or those with cardiac disease
Why must levothyroxine only be started after hydrocortisone replacement
It may increase the clearance of the little cortisol that i produced and may precipitate an Addisonian crisis
What does long term over-replacement of levothyroxine increase
the risk of osteoporosis and AF
What is the treatment for women with LH and FSH deficiency
Do not desire fertility - oestrogen-progestin replacement therapy for the prevention of osteoporosis
Desire fertility - pulsatile GnRH or gonadotrophins
How is FSH given
according to a step-up or step-down protocol
What is the treatment for men with LH and FSH deficiency
Do not desire fertility - testosterone replacement therapy
Desire fertility 0 gonadotrophin replacement therapy or pulsatile GnRH
What is adult onset GH deficiency associated with
unfavourable serum lipid profiles,
increased body fat
decreased muscle mass and bone mineral density
lower sense of well being and overall quality of life
What does GH treatment result in
decreased fat mass and increased muscle mass
increased bone mineral density (2 years)
an improved sense of well being and overall quality of life
reduced serum total cholesterol, low density lipoprotein and triglyceride levels
