Hypopituitarism

Question 1

Hypothalamic causes

Answer 1

Kallmann’s (anosmia + GnRH deficiency) Tumour

Inflam, infection, ischaemia

Question 2

Pituitary stalk causes

Answer 2

Trauma
Surgery
Tumour (e.g. craniopharyngioma)

Question 3

Pituitary causes

Answer 3

Irradiation
Tumour
Ischaemia: apoplexy, Sheehan’s Infiltration: HH, amyloid

Question 4

Commonest causes of panhypopituitarism

Answer 4

Surgery
Tumour
Irradiation

Question 5

Features of hormone deficiency - GH

Answer 5

central obesity, atherosclerosis, ↓CO, ↓stength

Question 6

Features of hormone deficiency - LH/FSH

Answer 6

M: ↓libido, ED, ↓hair

F: ↓libido, amenorrhoea, breast atrophy

Question 7

Features of hormone deficiency - TSH

Answer 7

hypothyroidism

Question 8

Features of hormone deficiency - ACTH

Answer 8

Secondary adrenal failure

Question 9

Ix

Answer 9

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

Question 10

Rx

Answer 10

Hormone replacement

Treat underlying cause

Question 11

Prolactin axis

Answer 11

decreased by: dopamine

increased by: TRH, oestrogen, nipple suckling