Hyposecretion of APG hormones Flashcards
5 hormones released from adenohypophysis?
FSH/LH Prolactin ACTH TH GH
What determines the disorder category?
The level at which the defect lies
Primary endocrine gland disease?
Lies in the ENDOCRINE GLAND
Secondary endocrine gland disease?
Defect is in the ANTERIOR PITUITARY HORMONE
Hypopituitarism?
Decreased production of SPECIFIC hormones
Panhypopituitarism?
Decreased production of ALL anterior pituitary hormones
2 types of causes?
Congenital (rare)
Acquired
Cause of congenital panhypopituitarism?
Rare
Cause: mutations of TFs genes needed for normal anterior pituitary development (PROP1 mutation)
Presentations of congenital panhypopituitarism?
Deficient in GH and at least ONE MORE anterior pituitary hormone
Short stature
Hypoplastic APG on MRI
Cause of acquired panhypopituitarism?
x Tumours x Radiation x Infection x Traumatic brain injury x Infiltrative disease x Inflammatory x Pituitary apoplexy x Sheehan's Syndrome (peri-partum infarction)
Acquired panhypopituitarism:
Tumours, Radiation, Infection, Infiltrative disease, Pituitary apoplexy?
Tumours - hypothalamic (craniopharyngiomas) & pituitary (adenomas, metastases, cysts)
Radiation - hypothalamic/pituitary damage (GH most vulnerable, TSH least!)
Infection - meningitis
I.D - often invovles pituitary stalk (neurosarcoidosis)
P.A - haemorrhage (less commonly infarction)
Causes of panhypopituitarism?
Simmond’s Disease
Symptoms due to deficient hormones
FSH/LH on panhypopituitarism?
2o hypogonadism
Reduced libido 2o amenorrhoea (F) Erectile dysfunction (M)
ACTH on panhypopituitarism?
2o hypoadrenalism (cortisol deficiency) Fatigue
TSH on panhypopituitarism?
2o hypothyroisism
Fatigue
What is Sheehan’s Syndrome?
Post-partum Hypopituitarism
2o to hypotension (PPH - post partum haemorrhage)
What causes Sheehan’s Syndrome?
Anterior pituitary englarges in pregnancy (due to lactotroph hyperplasia)
SO the hypotension from loss of blood from giving birth = pituitary becomes under perfused = infarction
(Posterior PG usually NOT affected)
Easy presentations of Sheehan’s Syndrome to notice?
Failure of lactation - PRL deficiency
Failure to resume menses post-delivery
Hard presentations of Sheehan’s Syndrome to notice?
Lethargy
Anorexia
Weight loss (TSH, ACTH, GH) deficiency
What is pituitary apoplexy?
Intra-pituitary haemorrhage (or less commonly infarction)
What type of patients can present with pituitary apoplexy?
Dramatic presentation in patients w. pre-existing pituitary tumours (adenomas)