Hypopituitarism Flashcards

1
Q

Define Hypopituitarism

A

Partial or complete deficiency of one or more anterior pituitary hormones

Panhypopituitarism = deficiency of all anterior hormones

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Aetiology of Hypopituitarism

A

Hypothalamus: Kallman’s | tumour | inflammation | infection (meningitis, TB | ischaemia

Pituitary stalk: trauma | surgery | mass lesions | meningioma | carotid artery aneurysm

Pituitary: tumour | irradiation | inflammation | autoimmune | infiltration (amyloid, haemochromatosis) | ischaemia (pituitary apoplexy, DIC, Sheehan’s)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Symptoms of Hypopituitarism

A

GH: Central obesity | atherosclerosis | dry wrinkly skin | reduced strength, balance, well-being, exercise ability | osteoporosis

LH/FSH: Oligomenorrhoea/amenorrhoea | reduced fertility, libido, muscle bulk, hair, ejaculate | osteoporosis | breast atrophy | dyspareunia | erectile dysfunction | small testes

TSH: hypothyroidism

ACTH: Adrenal insufficiency (NO skin pigmentation)

Prolactin: Absent lactation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

investigations for Hypopituitarism

A

Pituitary function tests:

Basal: 9am cortisol, LH/FSH, testosterone, oestradiol, IGF-1, prolactin, free T4/TSH

Dynamic: insulin-induced hypoglycaemia

Short synacthen testing

MRI/CT brain

Visual field testing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Management for Hypopituitarism

A

Hormone replacement:
1. Hydrocortisone 20mg in the morning, 10 mg in the evening + double dose for illness/surgery

  1. Levothyroxine daily (AFTER hydrocortisone)
  2. Sex hormones: testosterone or oestrogen + progesterone
  3. Growth hormone, SC
  4. Desmopressin if posterior pituitary affected
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Complications of Hypopituitarism

A
Adrenal crisis
Hypoglycaemia
Myxoedema coma
Infertility 
Osteoporosis, dwarfism 
Complications of the mass: optic chiasm compression, hydrocephalus (third ventricular compression), temporal lobe epilepsy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Prognosis for Hypopituitarism

A

Good with lifelong hormone replacement
Higher mortality
Cardiovascular + cerebrovascular death rates are higher (Potentially GH)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly