Hypopituitarism Flashcards
Define Hypopituitarism
Partial or complete deficiency of one or more anterior pituitary hormones
Panhypopituitarism = deficiency of all anterior hormones
Aetiology of Hypopituitarism
Hypothalamus: Kallman’s | tumour | inflammation | infection (meningitis, TB | ischaemia
Pituitary stalk: trauma | surgery | mass lesions | meningioma | carotid artery aneurysm
Pituitary: tumour | irradiation | inflammation | autoimmune | infiltration (amyloid, haemochromatosis) | ischaemia (pituitary apoplexy, DIC, Sheehan’s)
Symptoms of Hypopituitarism
GH: Central obesity | atherosclerosis | dry wrinkly skin | reduced strength, balance, well-being, exercise ability | osteoporosis
LH/FSH: Oligomenorrhoea/amenorrhoea | reduced fertility, libido, muscle bulk, hair, ejaculate | osteoporosis | breast atrophy | dyspareunia | erectile dysfunction | small testes
TSH: hypothyroidism
ACTH: Adrenal insufficiency (NO skin pigmentation)
Prolactin: Absent lactation
investigations for Hypopituitarism
Pituitary function tests:
Basal: 9am cortisol, LH/FSH, testosterone, oestradiol, IGF-1, prolactin, free T4/TSH
Dynamic: insulin-induced hypoglycaemia
Short synacthen testing
MRI/CT brain
Visual field testing
Management for Hypopituitarism
Hormone replacement:
1. Hydrocortisone 20mg in the morning, 10 mg in the evening + double dose for illness/surgery
- Levothyroxine daily (AFTER hydrocortisone)
- Sex hormones: testosterone or oestrogen + progesterone
- Growth hormone, SC
- Desmopressin if posterior pituitary affected
Complications of Hypopituitarism
Adrenal crisis Hypoglycaemia Myxoedema coma Infertility Osteoporosis, dwarfism Complications of the mass: optic chiasm compression, hydrocephalus (third ventricular compression), temporal lobe epilepsy
Prognosis for Hypopituitarism
Good with lifelong hormone replacement
Higher mortality
Cardiovascular + cerebrovascular death rates are higher (Potentially GH)
