Hypopituitarism Flashcards
(28 cards)
What is Hypopituitarism?
Reduced secretion of Ant pituitary hormones
What is the order Ant pituitary hormones are affected in in Hypopituitarism? (5 things)
- Growth Hormone (GH)
- Gonadotropins (FSH + LH)
- TSH
- ACTH
- Prolactin
What is Panhypopituitarism?
Deficiency of ALL Ant pituitary hormones
What is Panhypopituitarism caused by? (3 things)
- Irradiation
- Surgery
- Pituitary tumour
The causes of Hypopituitarism are at 3 levels, what are they?
- Hypothalamus
- Pituitary stalk
- Pituitary
What are the causes of Hypopituitarism @ the level of Hypothalamus? (5 things)
- Kallman’s syndrome
- Tumour
- Inflamm
- Infection (Meningitis / TB)
- Ischaemia
What are the causes of Hypopituitarism @ the level of Pituitary Stalk? (5 things)
- Trauma
- Surgery
- Mass lesion (Craniopharyngioma)
- Meningioma
- Carotid artery aneurysm
What are the causes of Hypopituitarism @ the level of Pituitary? (6 things)
- Tumour
- Irradiation
- Inflamm
- AI
- Infiltration (Haemochromatosis / Amyloid / Metastases)
- Ischaemia
What are the CF of low Growth Hormone in ADULTS? (4 things)
- Low bone density
- Muscle atrophy
- Dyslipidaemia
- Central obesity
What is Dyslipidaemia? (2 things)
- High levels of LDL (bad cholesterol)
- Low levels of HDL (good cholesterol)
What are the CF of low Growth Hormone in CHILDREN? (2 things)
- Short stature
- Growth retardation
What are the CF of low Gonadotropins (FSH / LH) in WOMEN? (5 things)
- Reduced libido
- Breast atrophy
- Osteoporosis
- Oligomenorrhoea / amenorrhoea
- Infertility
What are the CF of low Gonadotropins (FSH / LH) in MEN? (4 things)
- Reduced libido
- Reduced muscle mass
- Erectile dysfunction
- Small testes
What are the CF of low TSH? (6 things)
Hypothyroidism symptoms
- Fatigue
- Dry skin
- Delayed deep tendon reflexes
- Constipation
- Cold intolerance
- Bradycardia
What are the CF of low ACTH? (5 things)
Adrenal insufficiency symptoms
- Malaise
- N + V
- Circulatory collapse
- Hypoglycaemia
- Weight loss
Note: NO hyperpigmentation like in adrenal insufficiency
What are the CF of low Prolactin? (1 thing)
Absent lactation
What investigations should you do for sus Hypopituitarism? (3 things)
- Basal tests
- Dynamic tests
- MRI
What Basal tests should you do for sus Hypopituitarism? (8 things)
- LH + FSH
- Testosterone / Oestradiol
- TSH / T4
- Prolactin
- Insulin-like Growth Factor-1
- Cortisol (low)
- UnEs (Low Na bc dilution)
- Hb (Low = normochromic, normocytic anaemia)
What Dynamic tests should you do for sus Hypopituitarism? (4 things)
- Short Synacthen test (to check adrenal axis)
- Insulin tolerance test (ITT) (to check adrenal + GH axes)
- Glucagon stimulation test if ITT contraindicated
- Arginine + growth hormone-releasing hormone test
What is the use of a MRI in sus Hypopituitarism?
To investigate cause (hypothalamic / pituitary lesion)
How should you manage a Hypopituitarism? (3 things)
Refer to Endocrinologist to:
- Pituitary function assessment
- Oversee hormone replacement
- Treat underlying cause
What is the hormonal treatment for 2ndary Adrenal failure?
Hydrocortisone
What is the hormonal treatment for Hypothyroidism?
Thyroxine
What is the hormonal treatment for Hypogonadism in MEN? (3 things)
- Testosterone enanthate
- Topical gels
- Buccal mucoadhesive tablets
