hypopituitarism

Question 1

define hypopituitarism?

Answer 1

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

Question 2

what is Panhypopituitarism?

Answer 2

deficiency of ALL pituitary hormones

Question 3

causes of hypopituitarism?

Answer 3

• Pituitary Masses
o Most commonly adenomas
• Pituitary Trauma - radiation, surgery, base of skull fractures
• Hypothalamic Dysfunction - due to anorexia, starvation, over-exercise
• Infiltrative Diseases - sarcoidosis, haemochromatosis
• Vascular - pituitary apoplexy, Sheehan’s syndrome
• Infection - meningitis, encephalitis
• Genetic Mutations - Pit-1 and Prop-1 genes

Question 4

what is the epidemiology of hypopituitarism?

Answer 4

1/100,000

Question 5

what are the signs and symptoms of hypopituitarism?

Answer 5

depends on the hormone affected

Question 6

signs of low GH?

Answer 6

o GH
• CHILDREN: short stature
• ADULTS: low mood, fatigue, reduced exercise capacity and muscle strength, increased abdominal fat mass

Question 7

signs of low LH or FSH?

Answer 7

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

Question 8

signs of low ACTH?

Answer 8

signs/symptoms of adrenal insufficiency

- low androgens, low corticosteorids, low mineralocorticoids

Question 9

signs of low TSH?

Answer 9

hypothyroidism

Question 10

signs of low prolactin?

Answer 10

absence of lactation

Question 11

what might pituitary apoplexy result in?

Answer 11

o Headache
o Visual loss
o Cranial nerve palsies

Question 12

what are the appropriate investigations of hypopituitarism?

Answer 12

o	Basal Tests 
•	9 am cortisol 
•	LH and FSH levels  
•	Testosterone levels  
•	Oestrogen levels  
•	IGF-1 levels  
•	Prolactin levels  
•	Free T4 and TSH levels  

o Dynamic Tests (rarely performed)
• Insulin-induced hypoglycaemic
• (should cause a rise in GH and cortisol)
o Short synacthen test (for adrenal insufficiency)
o MRI/CT of brain
o Visual field testing

Question 13

management of hypopituitarism ?

Answer 13

•	Hormone Replacement 
o	Hydrocortisone  
o	Levothyroxine 
o	Sex hormones  
•	Testosterone in males  
•	Oestrogen with/without progesterone in females  
o	Growth hormone  
o	Desmopressin

Question 14

complications of hypopituitarism?

Answer 14

• Addisonian crisis
• Hypoglycaemia
• Myxoedema coma
• Infertility
• Osteroporosis
• Dwarfism (children)

Question 15

complications of a pituitary mass?

Answer 15

o Optic chiasm compression
o Hydrocephalus
o Temporal lobe epilepsy

Question 16

prognosis?

Answer 16

• GOOD prognosis with lifelong treatment