Panhypopituitarism

Question 1

condition in which the production and secretion of all hormones by the pituitary gland is reduced.

Answer 1

Panhypopituitarism

Question 2

Panhypopituitarism

Primary is caused by DO that affect the ____
Secondary is caused by DO that affect the ____

Answer 2

Primary = pituitary gland
Secondary = hypothalamus

Question 3

Panhypopituitarism MCC

Answer 3

Pituitary Adenoma

Question 4

Panhypopituitarism is the reduced production and secretion of multiple hormones in the pituitary. Which hormones are lost first?

Answer 4

1. Growth Hormone (GH)
2. Gonadotropins (FSH/LH)
3. Thyroid-stimulating hormone (TSH)
4. Adrenocorticotropin hormone (ACTH)

Question 5

What might be the first signs of Panhypopituitarism?

Answer 5

Low GH:
- Children -> puberty delay
- Adult Women -> amenorrhea, decr libido, infertility
- Adult Men -> ED, testicular atrophy, decr libido, decr spermatogenesis

Low GH in general -> decr enegy, abnorm body composition, dyslipidemia

Question 6

Low TSH or Low ACTH?

Fatigue,hypotension, and intolerance to stress and infection

Answer 6

Low ACTH (Hypoadrenalism)

Low TSH (Hypothyroidism) -> fatigue, facial puffiness, hoarse voice, bradycardia, cold intolerance

Question 7

Panhypopituitarism WU

Answer 7

• Brain MRI or CT W/Contrast
• Pituitary hormone levels -> TSH + T4, Prolactin, LH, FSH
• Target hormone levels -> Free thyroxine (T4), testosterone(in men) orestradiol(in women), andcortisollevels + provocative testing of pituitary-adrenal axis
• +/- other provocative testing (Adrenal)

Question 8

Panhypopituitarism WU

Adult labs show defiency in TSH and ACTH. Should we screen for GH deficiency?

Answer 8

NO, it is NOT recommended for adults. Assume if >= 2 other hormones are deficient

Question 9

Panhypopituitarism or hypothyroidism?

TSH - low or norm
T4 - low

Answer 9

Panhypopituitarism

Hypothyroidism = High TSH and low T4

Question 10

Does Panhypopituitarism cause HIGH or LOW Prolactin level?

Answer 10

HIGH

often elevated up to 5 times normal values when a large pituitary tumor is present, even if it does not produce prolactin.
The tumor compresses the pituitary stalk, preventingdopamine, which inhibits pituitary prolactin production and release, from reaching the pituitary.

Question 11

What does hyperprolactinemia do to your gonads?

Answer 11

hypogonadotropism and secondary hypogonadism.

Question 12

Measurement of basal levels of ____ and ____is most helpful in evaluating hypopituitarism in postmenopausal women not taking exogenousestrogensin whom circulating gonadotropin concentrations are normally high >30 mIU/mL

Answer 12

LH and FSH

gonadotropin levels tend to be low- normal

Question 13

Panhypopituitarism Trmnt

Answer 13

• Hormone replacement -> daily GH SubQ
• Trmnt of cause (tumor)