Hypopituitarism Flashcards
def
deficiency of one or more of the hormones secreted by the anterior pituitary
def of panhypopituitarism
deficiency of all pituitary hormones
aetiology
1 pituitary masses (most commonly adenomas)
2 pituitary trauma (radiation, surgery, skull base fracture)
3 hypothalamus (functional): anorexia, starvation, over-exercise
4 infiltration (TB, sarcoidosis)
5 infection (meningitis, encephalitis)
epi
annual incidence & prevalence of pituitary adenomas
1 per 100,000
9 per 100,000
history & examination
signs & symptoms depending on aetiology
-bitemporal hemianopia caused by pituitary mass
signs & symptoms according to type of hormone deficiency
features of GH deficiency in children
short stature
features of GH deficiency in adults
low mood
fatigue
decreased exercise capacity or strength
increased abdominal fat
features of LH/FSH deficiency
delayed puberty females: -loss of secondary sexual characteristics -menstrual irregularity -decreased libido -infertility males: -loss of secondary sexual characteristics -gynaecomastia -decreased libido -impotence
features of prolactin deficiency
absence of lactation in sheehan’s syndrome
what is pituitary apoplexy
haemorrhage/infarction of a pituitary tumour
life-threatening hypopituitarism with headache, visual loss & cranial nerve palsies
what is sheehans syndrome
pituitary infarction, haemorrhage & necrosis following a post-partum haemorrhage
investigations performed in suspected hypopituitarism
pituitary function tests
- basal tests (9am cortisol, LH, FSH, testosterone, oestradiol, IGF-1, prolactin, free T4 & TSH)
- dynamic tests
short synacthen test
MRI/CT of brain
visual field testing
management of hypopituitarism
hormone replacement
- hydrocortisone (20mg am, 10mg pm)
- L-thyroxine (100micrograms daily)
- sex hormones (testosterone in males, oestrogen with/without progesterone in females)
- GH (SC 1.2units/day
why should L-thyroxine always be taken after hydrocortison
to avoid addisonian crisis
what should be given with posterior pituitary deficiency (damage to pituitary stalk)
desmopressin (vasopressin analogue)
10-20micrograms daily intranasally
