Hypopituitarism

Question 1

What is hypopituirarism?

Answer 1

deficiency in 1 or more of the hormones secreted by the anterior pituitary.

Question 2

What pituitary masses may cause hypopituitarism?

Answer 2

Most commonly adenomas 
Craniopharyngioma 
Meningioma
Glioma
Metastases 
Cysts

Question 3

What 3 forms of trauma could cause hypopituitarism?

Answer 3

Radiation
Surgery
Base of skull fractures

Question 4

What 3 states affecting the hypothalamus can lead to functional hypopituitarism?

Answer 4

Anorexia
Starvation
Over-exercise

Question 5

What other general causes may lead to hypopituitarism?

Answer 5

Infiltrative Diseases: TB, sarcoidosis, haemochromatosis
Vascular: pituitary apoplexy, Sheehan’s syndrome
Infection: meningitis, encephalitis
Genetics: Pit-1 + Prop-1 genes

Question 6

Describe the epidemiology of hypopituitarism

Answer 6

Pituitary adenoma annual incidence: 1/100,000

Question 7

What signs and symptoms indicate GH deficiency in hypopituitarism?

Answer 7

CHILDREN: short stature  
ADULTS: 
low mood
fatigue
reduced exercise capacity + muscle strength
increased abdominal fat mass

Question 8

What signs and symptoms indicate LH or FSH deficiency in hypopituitarism?

Answer 8

Delayed puberty
FEMALES: loss of secondary sexual hair, breast atrophy, menstrual irregularities, dyspareunia, decreased libido, infertility
MALES: loss of secondary sexual hair, gynaecomastia, small + soft testes, decreased libido, impotence

Question 9

List 5 signs and symptoms that indicate ACTH deficiency in hypopituitarism

Answer 9

Fatigue
Weight loss
Hypotension
Nausea + vomiting
Diarrhoea / Constipation

Question 10

List 5 signs and symptoms that indicate TSH deficiency in hypopituitarism

Answer 10

Fatigue
Weight gain
Constipation
Cold intolerance
Muscle aches

Question 11

What signs and symptoms indicate Prolactin deficiency in hypopituitarism? When is this seen?

Answer 11

absence of lactation

Seen in Sheehans syndrome

Question 12

What is pituitary apoplexy? List 3 features of this

Answer 12

Haemorrhage or infarction of pituitary tumour
Headache
Visual loss
Cranial nerve palsies

Question 13

What basal tests can be performed to assess pituitary function?

Answer 13

9 am cortisol 
LH + FSH 
Testosterone  
Oestrogen 
IGF-1
Prolactin
Free T4 + TSH

Question 14

What dynamic tests can be performed to assess pituitary function?

Answer 14

Insulin-induced hypoglycaemica (should cause a rise in GH + cortisol but does not in hypopituitarism)

Question 15

List 3 other investigations that may be performed in suspected hypopituitarism

Answer 15

Short synacthen test (for adrenal insufficiency)
MRI/ CT of brain
Visual field testing

Question 16

What is Sheehans syndrome?

Answer 16

Pituitary infarction, haemorrhage + necrosis following postpartum haemorrhage

Question 17

What hormone therapy is used in hypopituitarism?

Answer 17

Hydrocortisone 10/5/5mg
Levothyroxine 50-100mcg
Sex hormones: 
Testosterone in M. 
Oestrogen +/- progesterone in F. 
Growth hormone

Question 18

List 6 complications that can arise in hypopituitarism

Answer 18

Addisonian crisis  
Hypoglycaemia  
Myxoedema coma  
Infertility 
Osteroporosis  
Dwarfism (children)

Question 19

List 3 complications of a pituitary mass

Answer 19

Optic chiasm compression (leading to bitemporal hemianopia)
Hydrocephalus (3rd ventricular compression)
Temporal lobe epilepsy