Hypopituitarism Flashcards
Define hypopituitarism
Deficiency in 1 or more of the hormones secreted by the anterior pituitary
Define panhypopituitarism
Deficiency of ALL pituitary hormones
Risk factors for hypopituitarism
7
Pituitary masses - most commonly adenoma, also craniopharyngiomas, meningioma, glioma, metastases, cysts
Pituitary trauma - radiation, surgery, base of skull fractures
Hypothalamic dysfunction - due to anorexia, starvation, over exercise
Infiltrative diseases - sarcoidosis, haemochromatosis, Langerhans cell histiocytosis
Vascular - pituitary apoplexy
Infection - meningitis, encephalitis
Genetic mutations - Pit-1 & Prop-1 genes
Epidemiology of hypopituitarism
Pituitary adenoma annual incidence 1/100,000
Presenting symptoms & signs of hypopituitarism
general + 5 groups
Depends on CAUSE - hormone that is deficient GH LH or FSH ACTH TSH Prolactin
Presenting symptoms & signs of hypopituitarism - GH
1 children + 4 adult
Children -
Short stature
Adults - Low mood Fatigue Reduced exercise capacity & muscle strength Increased abdominal fat mass
Presenting symptoms & signs of hypopituitarism - LH/FSH
2 general, 5 female, 4 male
Delayed puberty
Loss of secondary sexual hair
Females - Breast atrophy Menstrual irregularities Dyspareunia Decreased libido Infertility
Males - Gynaecomastia Small & soft testes Decreased libido Impotence
Presenting symptoms & signs of hypopituitarism - ACTH
Signs/symptoms of adrenal insufficiency
Presenting symptoms & signs of hypopituitarism - TSH
Signs/symptoms of hypothyroidism
Presenting symptoms & signs of hypopituitarism - Prolactin
Absence of lactation (not usually noticed clinically)
Investigations for hypopituitarism
general +5
PITUITARY FUNCTION TESTS -
Basal tests Dynamic tests (rarely performed) Short synacthen test (for adrenal insufficiency) MRI/CT of brain Visual field testing
Basal pituitary function tests
7
9am cortisol LH & FSH levels Testosterone levels Oestrogen levels IGF-1 levels Prolactin levels Free T4 & TSH levels
Dynamic pituitary function test
insulin induced hypoglycaemia (should cause GH & cortisol rise)
Management of hypopituitarism
general +3
HORMONE REPLACEMENT -
Hydrocortisone
Levothyroxine
Sex hormones
Complications of hypopituitarism
6
Addisonian crisis Hypoglycaemia Myxoedmal coma Infertility Osteoporosis Dwarfism (children)
