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Hypopituitarism

Pituitary gland is unable to produce significant levels of hormones.

Etiology

  • May be isolated or multiple
  •   (tumour/lesions)
    • Pituitary tumours (adenoma) or non-pituitary tumours (craniopharyngioma, meningioma, glioma)
  • Causes by genetic, sporadic, autoimmune
  • Order of deficiencies (pituitary hormones)
    • GH/gonadotropins > Hyperprolactinemia > TSH/ACTH

Clinical features

  • 2o hypothyroidism /adrenal failure – tiredness, malaise
  • Hypothyroid symptoms
  • Hypoadrenalism – hypotension, hyponatremia (brain edema), cadiovascular collapse
  • Gonadal deficiency – libido loss, amenorrhea, puberty hair loss, erectile dysfunction
  • Hyperprolactinemia – galactorrhoea, hypogonandism
  • Chronic panhypopituitarism – pallor with hairlessness

Specific syndromes

  • Kallmann – gonadotropin deficiency – KAL1 mut (anosmin)
  • Sheehan – postpartum haemorrhagic necrosis
  • Pituitary apoplexy – pituitary tumour rapidly enlarging due to infarction
  • Empty sella – sella turcica void of pituitary tissue – cisternal herniation

Diagnosis

  • Separate tests need to be carried out for each individual hormone axis
  • Insulin tolerance test for ACTH and GH

Treatment

  • Thyroid and steroids are essential for life
  • Glucocorticoid function needs to be adequate before starting thyroid medication – risk of Adrenal crisis
  • Glucocorticoid deficiency may Mask  diabetes insipidus – becomes apparent after steroid replacement.

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