Hypopituitarism Flashcards

1
Q

Define:

A

Deficiency in one or more of the hormones secreted by the anterior pituitary.

GH –> LH/FSH –> prolactin –>TSH –> ACTH (the order in which they are affected)

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2
Q

Aetiology/Risk factors:

A
  • Hypothalamus affected
  • Pituitary stalk
  • Pituitary
  • Pituitary Masses
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3
Q

Hypothalamus causes:

A
o	Kallman’s Syndrome
o	Tumour
o	Inflammation
o	Infection – meningitis, TB
o	Ischaemia 
o	Dysfunction due to anorexia, starvation or over-exercise
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4
Q

Pituitary stalk causes:

A
o	Trauma – base of skull fractures
o	Surgery
o	Mass lesion – craniopharyngioma (tumour arising from Rathke’s pouch situated between the pituitary and 3rd ventricle floor)
o	Meningioma
o	Carotid artery aneurysm
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5
Q

Pituitary causes:

A

o Tumour – adenoma mostly, cysts
o Irradiation
o Inflammation
o Autoimmunity
o Infiltration – haemochromatosis, amyloid, metastases, sarcoidosis
o Ischaemia – pituitary apoplexy (rapid pituitary enlargement from a bleed into a tumour may cause mass effects, CVS collapse due to mass hypopituitarism and death), DIC, Sheehan’s
o Genetic Mutations - Pit-1 and Prop-1 genes

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6
Q

Pituitary mass causes:

A

o Most commonly adenomas
o Others include craniopharyngioma, meningioma, glioma, metastases
o Cysts

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7
Q

Epidemiology:

A

Pituitary adenoma annual incidence: 1/100,000

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8
Q

Signs and symptoms of low GH:

A

CHILDREN: short stature

ADULTS: low mood, fatigue, reduced exercise capacity and muscle strength, increased abdominal fat mass, dry wrinkly skin, reduced balance and strength, osteoporosis, a therosclerosis, low CO

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9
Q

Signs and symptoms of low LH/FSH:

A

• Delayed puberty

FEMALES: loss of secondary sexual hair, breast atrophy, menstrual irregularities, dyspareunia, decreased libido, infertility

MALES: loss of secondary sexual hair, gynaecomastia, small and soft testes, decreased libido, impotence

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10
Q

Signs and symptoms of low ACTH:

A

Signs/symptoms of adrenal insufficiency

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11
Q

Signs and symptoms of low TSH:

A

signs/symptoms of hypothyroidism

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12
Q

Signs and symptoms of low prolactin:

A

Lack of lactation

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13
Q

Signs and symptoms of pituitary apoplexy:

A

o Headache
o Visual loss
o Cranial nerve palsies

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14
Q

Investigations:

A
•	Pituitary Function Tests
o	Basal Tests
•	9 am cortisol
•	LH and FSH levels 
•	Testosterone levels 
•	Oestrogen levels 
•	IGF-1 levels 
•	Prolactin levels – may be high due to loss of hypothalamic dopamine that normally inhibits its release
•	Free T4 and TSH levels 
o	Dynamic Tests (rarely performed)
•	Insulin-induced hypoglycaemic (should cause a rise in GH and cortisol) 
o	Short synacthen test (for adrenal insufficiency)
o	MRI/CT of brain 
o	Visual field testing
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15
Q

Management:

A
•	Hormone Replacement
o	Hydrocortisone 
o	Levothyroxine
o	Sex hormones 
•	Testosterone in males 
•	Oestrogen with/without progesterone in females 
•	Growth hormone 
•	Desmopressin (if central diabetes insipidus as a result of panhypopituitarism)
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16
Q

Complications:

A
•	Addisonian crisis 
•	Hypoglycaemia 
•	Myxoedema coma 
•	Infertility
•	Osteroporosis 
•	Dwarfism (children) 
•	Complications of pituitary mass:
o	Optic chiasm compression (leading to bitemporal hemianopia) 
o	Hydrocephalus 
o	Temporal lobe epilepsy
17
Q

Prognosis:

A

• GOOD prognosis with lifelong treatment