Panhypopituitarism

Question 1

what is it?

Answer 1

hypofunction of the whole pituitary gland

Question 2

what does hypofunction of the anterior pituitary do?

Answer 2

growth hormone - growth failure 
TSH - hypothyroidism 
LH/FSH - hypogonadism 
ACTH - hypoadrenal 
prolactin - none known

Question 3

what does hypofunction of the posterior pituitary do?

Answer 3

diabetes insipidus

Question 4

how does it present?

Answer 4

menstrual irregularities (F)
infertility, impotence 
gynaecomastia (M)
abdominal obesity 
loss of facial hair (M) 
loss of axillary and pubic hair (M & F)
dry skin and hair 
hypothyroid faces 
growth retardation (children)

Question 5

what causes it?

Answer 5

pituitary tumours
other local brain tumours - astrocytoma, meningioma, glioma, clival chordoma
iatrogenic - surgery
granulomatous diseases - TB, histiocytosis X, sarcoidosis
vascular diseases - polyarteritis
Trauma - road accidents, skull fractures
2ndry metastatic lesions - lung, breast
hypothalamic diseases - syphilis, meningitis
AI; Sheenan - post-pregnancy
infection; meningitis

Question 6

how is it diagnosed?

Answer 6

check for all the anterior pituitary hormones

Question 7

how is it managed?

Answer 7

replacement therapy for the hormones
thyroxine - 100-150mcg/day
hydrocortisone - 10-25mg/day (am/pm) split 2-3 times per day e.g. 10mg/5mg/5mg
ADH - desmospray (nasal) or desmopressin tablets
GH - GH nightly sc
Sex steroids - HRT/oest/prog pill for female and testostreone for males