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Endocrine > Hypopituitarism > Flashcards

Hypopituitarism Flashcards

1
Q

Define Hypopituitarism?

A

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

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2
Q

What is Panhypopituitarism?

A

Deficiency of ALL pituitary hormones

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3
Q

What is the aetiology of Hypopituitarism?

A 
Pituitary Masses
Pituitary Trauma
Hypothalamic Dysfunction
Infiltrative Diseases
Vascular
Infection
Genetic Mutation
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4
Q

What are some Pituitary Masses that can cause Hypopituitarism?

A

Most commonly adenomas
Others include craniopharyngioma, meningioma, glioma, metastases
Cystss

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5
Q

What are some examples of Pituitary Trauma that can cause Hypopituitarism?

A

Radiation
Surgery
Base of skull fractures

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6
Q

What are some examples of Hypothalamic Dysfunction that can cause Hypopituitarism?

A

Due to anorexia, starvation, over-exercise

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7
Q

What are some examples of Infiltrative Diseases that can cause Hypopituitarism?

A

Sarcoidosis
Haemochromatosis
Langerhans’ Cell Histiocytosis

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8
Q

What are some vascular causes of Hypopituitarism?

A

Pituitary Apoplexy

Sheehan’s Syndrome

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9
Q

What are some infective causes of Hypopituitarism?

A

Meningitis

Encephalitis

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10
Q

What are some examples of Genetic mutations that can cause Hypopituitarism?

A

Pit-1 and Prop-1 genes

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11
Q

What is the epidemiology of Hypopituitarism?

A

Pituitary adenoma annual incidence: 1/100,000

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12
Q

What are the signs and symptoms of Hypopituitarism?

A

Depends on cause

Symptoms and signs are dependent on the hormone that is deficient

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13
Q

What are the signs and symptoms if GH is deficient in Hypopituitarism?

A

Children: Short Stature
Adults: low mood, fatigue, reduced exercise capacity and muscle strength, increased abdominal fat mass

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14
Q

What are the signs and symptoms if LH or FSH is deficient in Hypopituitarism?

A

Delayed puberty
Females: Loss of secondary sexual hair, breast atrophy, menstrual irregularities, dyspareunia, decreased libido, infertility
Males: Loss of secondary sexual hair, gynaecomastia, smal and soft testes, decreased libido, impotence

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15
Q

What are the signs and symptoms if there is ACTH deficiency in Hypopituitarism?

A

Signs/symptoms of adrenal insuffiency

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16
Q

What are the signs/symptoms if there is TSH deficiency in Hypopituitarism?

A

Signs/symptoms of hypothyroidism

17
Q

What are the signs and symptoms if there is a Prolactin deficiency in Hypopituitarism?

A

Absence of Lactation (not usually noticed clinically)

18
Q

What are some symptoms of Pituitary Apoplexy in Hypopituitarism?

A

Headache
Visual Loss
Cranial Nerve Palsies

19
Q

What Pituitary Function Tests would you do to investigate Hypopituitarism?

A 
Basal Tests 
Dynamic Tests
Short synacthen test 
MRI/CT of brain
Visual field testing
20
Q

What Basal Tests would you do to investigate Hypopituitarism?

A 
9 am cortisol
LH and FSH levels 
Testosterone levels
Oestrogen levels
IGF-1 levels 
Prolactin levels
Free T4 and TSH levels
21
Q

What Dynamic tests would you do for Hypopituitarism?

A

Rarely performed

Insulin-induced hypoglycaemic (should cause a rise in GH and cortisol)

22
Q

Why do we do a Short Synacthen Test to investigate Hypopituitarism?

A

For adrenal insufficiency

23
Q

What is the general management plan for Hypopituitarism?

A

Hormone Replacement

24
Q

Which hormones would you replace in Hypopituitarism?

A

Hydrocortisone
Levothyroxine
Sex hormones

25
Q

What sex hormones would need replacing in Hypopituitarism?

A

Testosterone in males
Oestrogen with/without progesterone in females
Growth hormone
Desmopressin (if central diabetes insipidus as a result of panhypopituitarism)

26
Q

What are the possible complications of Hypopituitarism?

A 
Addisonian Crisis 
Hypoglycaemia 
Myxoedema Coma
Infertility 
Osteoporosis 
Dwarfism (children)
Complications of pituitary mass
27
Q

What are some complications of pituitary mass?

A

Optic chiasm compression (leading to bitemporal hemianopia)
Hydrocephalus
Temporal lobe epilepsy

28
Q

What is the prognosis for patients with Hypopituitarism?

A

Good prognosis with lifelong treatment

Endocrine (29 decks)

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