Hypopituitarism

Question 1

Hypopituartism

What is affected?

Answer 1

Reduced secretion of anterior pituitary hormones

Growth hormone

Gonadotrophins : FSH and LH

TSH

ACTH

Prolactin

Question 2

Causes

Answer 2

At level of hypothalamus:

• Kallman’s Syndrome (anosmia + reduced gonadotrophins)
• tumour
• infection (meningitis)

Pituitary:
Trauma 
Ischaemia (Sheehan's) 
Irridation 
Infiltration = amyloidosis
Tumour- stalk = craniopharyngioma

Question 3

Features

Answer 3

LACK OF GROWTH HORMONE:

• Central obesity
• Osteoporosis
• Atherosclerosis
• Reduced cardiac output
• Hypoglycaemia
• Dry and wrinkly

LACK OF GONADOTROPHINS

• Oligo- or amenorrhoea
• Reduced fertility,
• Osteoporosis

HYPOTHYROIDISM

LACK OF CRH = ADRENAL INSUFFICIENCY

MASS EFFECT: bitemporal hemianopia

Question 4

Investigations

Answer 4

BLOODS:
- levels of all the hormones: LH, FSH, Testosterone / Oestradiol, TSH, T4, IGF1 (for growth hormone), Cortisol

DYNAMIC TEST:
1. Short Synacthen Test

2. Insulin Tolerance Test : insulin should raise glucose and growth hormone. But in hypopituiritasim it doesn’t

(CI: epilepsy, adrenal failure, heart disease. Do glucagon stimulation test)

3. Arginine and growth hormone-releasing hormone test

INVESTIGATE CAUSE:
MRI to look for hypothalamic or pituitary lesion

Question 5

Management

Answer 5

Hydrocortisone for secondary adrenal failure (give before you give the other hormones)

Thyroxine if hypothyroid

Hypogonadism: give oestrogen or testosterone patches etc.

Gonadotrophin therapy to fix fertility issues

Somatotrophin mimics human growth hormone