(!) Hypopituitary

Question 1

Define Hypopituitary

Answer 1

Pit failure-partial or total
destruction of the pit gland function because of other cause (e.g: pit tumour, heammorghage, radiotherapy for Pit cancer)

Question 2

Aetiology and risk factors of Hypopituatary

Answer 2

can be conginatal or aquired
Congenital-rare and not super relevant
Acquired
Neoplastic-Pit adenoma is most common cause
Vascular-apoplexy, sheehans
Infection-TB
Radiotherapy
Previous Pit surgery
Brain injury

Risk factors:
Known Pit tumour
Apoplexy-can develop over years
Radiation
Post partum haemorrhage/past pregnancy

Question 3

Management of Hypopituitary

Answer 3

Want to replace whats missing
most common-steroids, thyroxin, sex hormones, then GnRh and finally gonadotrophin

BUT NOT PIT GLAND-cant titrate levels with hormones

usually Prednisolone 4mg (OD)(hydroxycortisone needs to be given TDS-with 10 at am, 5 noon 5 evening),

Levothyroxine 50-100microgram OD
but because no Pit gland-> cannot use TSH as a measure

Testosterone-IM /3months
Or sustanon 1 monthly
or gel every day
or oestrogen-contraceptive pill, or HRT-lower dose

Can give recombinant growth hormones-somatrophin

and desxopressin if ADH deficiency

Question 4

Epidiemology of Hypopiturarism

Answer 4

relatively rare-45 in 100 000-less common than pit adenomas

CVD and cerebrovascular death common in Hypopit

Question 5

Signs and Sx of Hypopituarism

Answer 5

Endocrine-loss of pituitary tumours
The 3 main ones, often in order-LH/FSH, TSH, ACTH

LH/FSH-
men-loss of libido, erectile dysfunction, loss of morn erection, reduce body mass, loss of hair
Women-ammenorhoea/oligorrhoae, Infertility, breast atrophy, hot flush
TSH-hypothyroidism-weight gain, appetite lot, cold intolerance, fatigue, dry skin, constipation, bradycardia
ACTH-anorexia, weight loss, nausea, myalgia, hypocalceamia, pallor, loss of hair-NO hyper pigmentation/hypotense

GH def-Obesity, reduced lean body, fatigue, reduce wellbeing, insulin resistance

ADH can be affected-central diabetes insipidus-polyuria/polydyspia/nucturia

And some Sx depends on cause
If adenoma-commonly prolactinoma-presents with galactorrhoae
Or GH -acromegaly
and Sx of space occupying lesion-headache, cranial nerve palsy, epilepsy, rinnirhoea
BITEMPORAL HEMIAnopia

Question 6

Investigations of Hypopituitarism

Answer 6

Knowing pt has any cause is enough to prompt investigation, even with Sx

endocrine blood test-
Low TSH/T3/4
Low morning cortisol
Low LH/FSH
Hyponatremia suggest ACTH/TSH issue. Hypernatremia-ADH problems
water deprivation test/Desompression supression-central ADH
Dexamethasone supression test-secondary ACTH

MRI is technique of choice for imaging and diagnosis

Question 7

Complications of Hypopituitarism

Answer 7

Infertility for male and female
Steroid/TSH/GH/Desmo/testo over replacement

Main cause of death is CVD and cerebrovascular issues-

Question 8

Prognosis of Hypopituitarism

Answer 8

Its lifelong replacement for everyone
1.8x mortality compared with age adjusted
Probs because of GH deficiency