Hypopituitarism Flashcards
Define Hypopituitarism?
Deficiency in one or more of the hormones secreted by the anterior pituitary
What is Panhypopituitarism?
Deficiency of ALL pituitary hormones
What is the aetiology of Hypopituitarism?
Pituitary Masses Pituitary Trauma Hypothalamic Dysfunction Infiltrative Diseases Vascular Infection Genetic Mutation
What are some Pituitary Masses that can cause Hypopituitarism?
Most commonly adenomas
Others include craniopharyngioma, meningioma, glioma, metastases
Cystss
What are some examples of Pituitary Trauma that can cause Hypopituitarism?
Radiation
Surgery
Base of skull fractures
What are some examples of Hypothalamic Dysfunction that can cause Hypopituitarism?
Due to anorexia, starvation, over-exercise
What are some examples of Infiltrative Diseases that can cause Hypopituitarism?
Sarcoidosis
Haemochromatosis
Langerhans’ Cell Histiocytosis
What are some vascular causes of Hypopituitarism?
Pituitary Apoplexy
Sheehan’s Syndrome
What are some infective causes of Hypopituitarism?
Meningitis
Encephalitis
What are some examples of Genetic mutations that can cause Hypopituitarism?
Pit-1 and Prop-1 genes
What is the epidemiology of Hypopituitarism?
Pituitary adenoma annual incidence: 1/100,000
What are the signs and symptoms of Hypopituitarism?
Depends on cause
Symptoms and signs are dependent on the hormone that is deficient
What are the signs and symptoms if GH is deficient in Hypopituitarism?
Children: Short Stature
Adults: low mood, fatigue, reduced exercise capacity and muscle strength, increased abdominal fat mass
What are the signs and symptoms if LH or FSH is deficient in Hypopituitarism?
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
What are the signs and symptoms if there is ACTH deficiency in Hypopituitarism?
Signs/symptoms of adrenal insuffiency
What are the signs/symptoms if there is TSH deficiency in Hypopituitarism?
Signs/symptoms of hypothyroidism
What are the signs and symptoms if there is a Prolactin deficiency in Hypopituitarism?
Absence of Lactation (not usually noticed clinically)
What are some symptoms of Pituitary Apoplexy in Hypopituitarism?
Headache
Visual Loss
Cranial Nerve Palsies
What Pituitary Function Tests would you do to investigate Hypopituitarism?
Basal Tests Dynamic Tests Short synacthen test MRI/CT of brain Visual field testing
What Basal Tests would you do to investigate Hypopituitarism?
9 am cortisol LH and FSH levels Testosterone levels Oestrogen levels IGF-1 levels Prolactin levels Free T4 and TSH levels
What Dynamic tests would you do for Hypopituitarism?
Rarely performed
Insulin-induced hypoglycaemic (should cause a rise in GH and cortisol)
Why do we do a Short Synacthen Test to investigate Hypopituitarism?
For adrenal insufficiency
What is the general management plan for Hypopituitarism?
Hormone Replacement
Which hormones would you replace in Hypopituitarism?
Hydrocortisone
Levothyroxine
Sex hormones
What sex hormones would need replacing in Hypopituitarism?
Testosterone in males
Oestrogen with/without progesterone in females
Growth hormone
Desmopressin (if central diabetes insipidus as a result of panhypopituitarism)
What are the possible complications of Hypopituitarism?
Addisonian Crisis Hypoglycaemia Myxoedema Coma Infertility Osteoporosis Dwarfism (children) Complications of pituitary mass
What are some complications of pituitary mass?
Optic chiasm compression (leading to bitemporal hemianopia)
Hydrocephalus
Temporal lobe epilepsy
What is the prognosis for patients with Hypopituitarism?
Good prognosis with lifelong treatment
