Name
HYPOPITUITARISM ( PANHYPOPITUITARISM )
DESCRIPTION
DETAIL
THE DISEASE MAY INVOLVE ONE OR MORE PITUITARY HORMONES LIKE ACTH, FSH, LH, GH, PROLACTIN, TSH, ADH CAUSES : CAUSES IN CHILDREN : 1. CONGENITAL - DEFECTIVE PITUITARY DEVELOPMENT LEADING TO PITUITARY APLASIA - EMPTY SELLA - ENCEPHALOCELE - MIDLINE DEFECTS - SEPTOOPTIC DYSPLASIA - GENETIC ABNORMALITIES INCLUDING AUTOSOMAL RECESSIVE, AUTOSOMAL DOMINANT OR SEX LINKED DEFECTS OR A MUTATION OR DELETION IN THE GH GENE OR IN GH-RELEASING HORMONE 2. ACQUIRED CONDITIONS - TUMORS OF HYPOTHALAMIC-PITUITARY REGION - CRANIAL IRRADIATION - INFILTRATIVE DISEASES - TRAUMA - HYPOXIC INSULT - IDIOPATHIC CAUSES IN ADULTHOOD * > 90% HAVE PITUITARY DISEASE LIKE - TUMOR LIKE * CRANIOPHARYNGIOMA * ADENOMA - SURGERY - IRRADIATION - ISCHEMIA OR INFARCTION LIKE * SHEEHAN SYNDROME * APOPLEXY - TRAUMA - INFILTRATIVE DISEASES LIKE * SARCOIDOSIS * HISTIOCYTOSIS X DISEASE * HEMOCHROMATOSIS - INFECTIONS LIKE * TUBERCULOSIS * SYPHILIS * MENINGITIS - AUTOIMMUNE * LYMPHOCYTIC INFILTRATION ( LYMPHOCYTIC HYPOPHYSITIS ) -------------------------------------------------------------------------- D.D. : - HYPOTHYROIDISM - KALLMANN SYNDROME & IDIOPATHIC HYPOGONADOTROPIC HYPOGONADISM - PITUITARY MACROADENOMAS - PITUITARY MICROADENOMAS - POLYGLANDULAR AUTOIMMUNE SYNDROME, TYPE I - POLYGLANDULAR AUTOIMMUNE SYNDROME, TYPE II - POLYGLANDULAR AUTOIMMUNE SYNDROME, TYPE IIIINVESTIGATIONS DEPENDING ON THE INDIVIDUAL HORMONAL INVOLVEMENT OR CAUSE * ACTH & CORTROSYN STIMULATION TEST * TSH & THYROXINE * FSH, LH & EITHER ESTRADIOL OR TESTOSTERONE TEST * PROLACTIN * GROWTH HORMONE PROVOCATIVE TESTING
TYPENOTES
RISK FACTORS: Trauma, Pregnancy and deliveryMedical Care Medical care consists of hormone replacement as appropriate and treatment of the underlying cause. " Glucocorticoids are required if the ACTH-adrenal axis is impaired. This is particularly important in sudden collapse due to pituitary apoplexy or acute obstetric hemorrhage with pituitary insufficiency. In such circumstances, do not delay initiation of a possibly life-saving treatment pending a definitive diagnosis. " " Treat secondary hypothyroidism with thyroid hormone replacement. " " Treat gonadotropin deficiency with sex-appropriate hormones. In men, testosterone replacement is used and modified if the patient desires fertility. In women, estrogen replacement is used with or without progesterone as appropriate. " " GH is replaced in children as appropriate. GH is not routinely replaced in adults unless the patient is symptomatic. Surgical Care Surgical care depends on the underlying cause and the severity of hypopituitarism. " In pituitary apoplexy, prompt surgical decompression may be life saving if head imaging reveals tumor mass effect. " " Extirpate macroadenomas that do not respond to medical therapy. Diet No special diet is necessary unless dictated by an underlying disease process. Salt use in adrenal insufficiency may be liberalized in special circumstances (eg, excessive diaphoresis). Activity No restrictions are necessary unless dictated by an underlying disease process. DRUG TREATMENT : THE GOAL OF TREATMENT IS TO RESTORE TARGET HORMONES TO PHYSIOLOGICAL LEVELS. 1. CORTICOSTEROIDS ( GLUCOCORTICOIDS ) : - HYDROCORTISONE 2. THYROID HORMONES : - LEVOTHYROXINE 3. GROWTH HORMONE : - HUMAN GROWTH HORMNE, SOMATROPIN 4. SEX HORMONES : - TESTOSTERONE - OESTROGEN, CONJUGATED ( PREMARIN )
RELATED DISEASE
Not Available Disease
DISEASE
INVESTIGATION
COMPLETE BLOOD COUNT, MRI