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Pituitary Insufficiency Flashcards

1
Q

What is hypopituitarism?

A

Deficiency of one or more anterior pituitary hormones due to aplasia/hypoplasia, destruction, infiltration, or compression of the hypothalamus/pituitary gland.

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2
Q

What are the types of hypopituitarism?

A
  • Congenital or acquired
  • Familial or sporadic
  • Partial or complete
  • Transient or permanent
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3
Q

Does most patients with anterior pituitary insufficiency have Central Diabetes Insipidus (CDI)?

A

No

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4
Q

What can CDI suggest in the context of hypopituitarism?

A
  • Craniopharyngioma
  • Hypophysitis
  • Metastatic cancer
  • Sarcoidosis
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5
Q

What is the incidence of hypopituitarism?

A

4.2 cases per 100,000 per year

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6
Q

What is the prevalence of hypopituitarism?

A

45 cases per 100,000

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7
Q

Is there a significant gender difference in the incidence of hypopituitarism?

A

No

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8
Q

What is the most common cause of hypopituitarism?

A

Pituitary adenoma and/or its treatment (surgery, radiation)

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9
Q

What are some other causes of hypopituitarism?

A
  • Neoplastic: Pituitary adenoma, craniopharyngioma, metastatic disease
  • Traumatic: TBI, surgery, radiation
  • Vascular: Sheehan’s syndrome, apoplexy
  • Infiltrative/Inflammatory: Hypophysitis, sarcoidosis, hemochromatosis
  • Infectious: Abscess, tuberculosis, fungal infections
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10
Q

What are the acute onset symptoms of hypopituitarism?

A
  • Hypotension
  • Shock
  • Obtundation
  • Coma
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11
Q

What are the chronic onset symptoms of hypopituitarism?

A
  • Fatigue
  • Malaise
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12
Q

What are the symptoms of ACTH deficiency?

A
  • Fatigue
  • Weight loss
  • Nausea
  • Postural hypotension
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13
Q

What are the symptoms of TSH deficiency?

A
  • Weight gain
  • Cold intolerance
  • Constipation
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14
Q

What are the symptoms of gonadotropin deficiency?

A
  • Decreased libido
  • Infertility
  • Amenorrhea
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15
Q

What are the symptoms of GH deficiency?

A
  • Fatigue
  • Increased adiposity
  • Exercise intolerance
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16
Q

What is a symptom of PRL deficiency?

A

Agalactia (postpartum)

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17
Q

What are the physical examination findings for ACTH deficiency?

A
  • Postural hypotension
  • Pallor
  • Areolar hypopigmentation
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18
Q

What are the physical examination findings for TSH deficiency?

A
  • Bradycardia
  • Facial puffiness
  • Delayed reflexes (Woltman’s sign)
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19
Q

What are the physical examination findings for gonadotropin deficiency in prepubertal individuals?

A

Eunuchoid features

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20
Q

What are the physical examination findings for gonadotropin deficiency in postpubertal individuals?

A
  • Fine facial wrinkling
  • Gynecomastia (men)
  • Vaginal atrophy (women)
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21
Q

What is a physical examination finding for GH deficiency?

A

Short stature (if onset before growth plate closure)

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22
Q

What is the morning cortisol level indicative of ACTH deficiency?

A

<3 mcg/dL (rule in), >15 mcg/dL (rule out)

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23
Q

What indicates adrenal insufficiency in the ACTH stimulation test?

A

Cortisol <18 mcg/dL at 30/60 minutes

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24
Q

What are the laboratory findings for TSH deficiency?

A

Low free T4 + low/normal TSH

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25
What are the laboratory findings for gonadotropin deficiency?
Low testosterone/estradiol + low/normal LH/FSH
26
What are the laboratory findings for GH deficiency?
Low IGF-1 + GH stimulation test (peak GH <3 mcg/L)
27
What are the laboratory findings for PRL deficiency?
Low/undetectable PRL
28
When is a pituitary MRI indicated?
For unexplained hypopituitarism, hyperprolactinemia, or mass effect symptoms
29
Is MRI needed for functional hypopituitarism (e.g., steroid use)?
No
30
What is the incidence of hypopituitarism after TBI?
76% acutely; 13% at 3 months; 11% at 12 months
31
What are the common deficiencies following TBI?
* GH * Gonadotropin
32
What is the mechanism of hypopituitarism after TBI?
Hemorrhagic infarction of hypothalamus/pituitary
33
When does radiation-induced hypopituitarism typically occur?
Months to years post-radiation
34
What are the deficiencies associated with radiation-induced hypopituitarism?
* GH (100% at 5 years) * Gonadotropin (57%) * ACTH (61%) * TSH (27%)
35
What is Sheehan’s syndrome?
Pituitary infarction postpartum due to massive hemorrhage
36
What are the symptoms of Sheehan’s syndrome?
* Agalactia * Amenorrhea * Hypocortisolemia * Hypothyroidism
37
What imaging finding is associated with Sheehan’s syndrome?
Atrophic/small pituitary, empty sella
38
What causes pituitary apoplexy?
Acute hemorrhage/infarction of pituitary gland/adenoma
39
What are the symptoms of pituitary apoplexy?
* Severe headache * Visual loss * Ophthalmoplegia * Hypotension
40
What is the treatment for pituitary apoplexy?
* Glucocorticoids * Thyroid replacement * Surgical decompression
41
What are the types of hypophysitis?
* Lymphocytic (most common) * Granulomatous * IgG4-associated * Xanthomatous
42
What is the presentation of hypophysitis?
* Headaches * Hypopituitarism * Pituitary enlargement
43
What are the associations of hypophysitis?
* Pregnancy * Anti-CTLA-4 immunotherapy (e.g., ipilimumab)
44
What is the primary empty sella syndrome?
More common in multiparous, obese, hypertensive women
45
What is the secondary empty sella syndrome?
Due to pituitary disease, surgery, or radiation
46
What are the symptoms of empty sella syndrome?
* Headaches * Visual abnormalities * Mild hyperprolactinemia
47
What are the causes of functional hypopituitarism?
* Glucocorticoid use * Anabolic steroid withdrawal * Hypothalamic amenorrhea (anorexia, stress, exercise)
48
Is functional hypopituitarism reversible?
Yes, with cessation of causative factors
49
What is the treatment for ACTH deficiency?
* Hydrocortisone (15–20 mg/day) * Prednisone (5 mg/day) * Stress dosing for illness/surgery
50
What is the treatment for TSH deficiency?
Levothyroxine (target free T4 in mid-upper reference range)
51
What is the treatment for gonadotropin deficiency in men?
Testosterone replacement
52
What is the treatment for gonadotropin deficiency in women?
Estrogen/progesterone until age 45–55
53
What is the treatment for GH deficiency?
GH replacement (0.1–0.4 mg/day) for improved quality of life, body composition
54
What is the treatment for PRL deficiency?
No specific treatment
55
What is monitored in ACTH deficiency?
Clinical status, sense of well-being
56
What is monitored in TSH deficiency?
Free T4 levels (not TSH)
57
What is monitored in gonadotropin deficiency in men?
Testosterone levels, hematocrit
58
What is monitored in gonadotropin deficiency in women?
Symptom relief
59
What is monitored in GH deficiency?
IGF-1 levels (target mid-normal range)
60
What are the risks of glucocorticoid overreplacement?
* Weight gain * Metabolic syndrome * Bone loss
61
What are the risks of levothyroxine overreplacement?
* Atrial fibrillation * Bone turnover * Fractures
62
What are the unclear cardiovascular effects of estrogen/testosterone?
63
What is the treatment for ACTH deficiency during pregnancy?
Hydrocortisone (avoid dexamethasone)
64
What is monitored for TSH deficiency during pregnancy?
Free T4
65
What should be done with GH deficiency during pregnancy?
Discontinue GH (placental GH compensates)
66
What is the effect of antiepileptics on hormone levels?
Increase hormone catabolism (e.g., glucocorticoids, thyroid hormones)
67
What may GH therapy unmask?
Adrenal insufficiency, affect free T4 levels
68
What is the standardized mortality ratio (SMR) for men with hypopituitarism?
2.06
69
What is the standardized mortality ratio (SMR) for women with hypopituitarism?
2.80
70
What are the common causes of increased mortality in hypopituitarism?
* Vascular disease * Cerebrovascular events (especially post-radiation)
71
What is the key point about hypopituitarism?
Hypopituitarism results from hypothalamic/pituitary dysfunction
72
What is the most common cause of hypopituitarism?
Pituitary adenoma/treatment
73
How is hypopituitarism diagnosed?
Basal/dynamic hormone testing, pituitary MRI
74
What is the treatment for hypopituitarism?
Hormone replacement tailored to deficiencies
75
What should be monitored in central hypothyroidism?
Free T4 (not TSH)

Endocrinology Secrets (21 decks)

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