Hypopituitarism

Abstract

Hypopituitarism is the partial or complete insufficiency of anterior pituitary hormone secretion and may result from pituitary or hypothalamic disease. The reported incidence (12-42 new cases per million per year) and prevalence (300-455 per million) is probably underestimated if its occurrence after brain injuries (30-70% of cases) is considered. Clinical manifestations depend on the extent of hormone deficiency and may be non specific, such as fatigue, hypotension, cold intolerance, or more indicative such as growth retardation or impotence and infertility in GH and gonadotropin deficiency, respectively.A number of inflammatory, granulomatous or neoplastic diseases as well as traumatic or radiation injuries involving the hypothalamic-pituitary region can lead to hypopituitarism. Several genetic defects are possible causes of syndromic and non syndromic isolated/multiple pituitary hormone deficiencies. Unexplained gonadal dysfunctions, developmental craniofacial abnormalities, newly discovered empty sella and previous pregnancy-associated hemorrhage or blood pressure changes may be associated with defective anterior pituitary function.The diagnosis of hypopituitarism relies on the measurement of basal and stimulated secretion of anterior pituitary hormones and of the hormones secreted by pituitary target glands. MR imaging of the hypothalamo-pituitary region may provide essential information. Genetic testing, when indicated, may be diagnostic.Secondary hypothyroidism is a rare disease. The biochemical diagnosis is suggested by low serum FT4 levels and inappropriately normal or low basal TSH levels that do not rise normally after TRH. L-thyroxine is the treatment of choice. Before starting replacement therapy, concomitant corticotropin deficiency should be excluded in order to avoid acute adrenal insufficiency. Prolactin deficiency is also very rare and generally occurs after global failure of pituitary function. Prolactin deficiency prevents lactation. Hypogonadotropic hypogonadism in males is characterized by low testosterone with low or normal LH and FSH serum concentrations and impaired spermatogenesis. Hyperprolactinemia as well as low sex hormone binding globulin concentrations enter the differential diagnosis. Irregular menses and amenorrhea with low serum estradiol concentration (<100 pmol/l) and normal or low gonadotropin concentrations are the typical features of hypogonadotropic hypogonadism in females. In post menopausal women, failure to detect high serum gonadotropin values is highly suggestive of the diagnosis. In males, replacement therapy with oral or injectable testosterone results in wide fluctuations of serum hormone levels. More recently developed transdermal testosterone preparations allow stable physiological serum testosterone levels. Pulsatile GnRH administration can be used to stimulate spermatogenesis in men and ovulation in women with GnRH deficiency and normal gonadotropin secretion. Gonadotropin administration is indicated in cases of gonadotropin deficiency or GnRH resistance but is...

Abdominal Paın and Pıtuıtary Insuffıcıency Assocıatıon: Retrospective Case Series

“…İnsanın normal yaşamının idamesinde çok geniş ve henüz keşfedilmemiş önemleri vardır (7)(8)(9)(10)(11)(12)(13) Hipopituitarizm klinik olarak sinsice ortaya çıkmaktadır. İnfeksiyon ya da travma gibi strese neden olan bir durumla ilişkilidir.…”

“…Bir veya birkaç hormonun eksikliği söz konusuysa kısmi hipopitüitarizmden, tüm hipofiz hormonlarının eksikliği varsa panhipopitüitarizmden, tek bir Adress for correspondence: Uzm. Dr. Ali İmran KÜÇÜK, Kocaeli Derince E A H Genel Cerrahi Kliniği Kocaeli -Türkiye e-mail: drkucuk64@hotmail.com Available at www.actaoncologicaturcica.com Copyright ©Ankara Onkoloji Hastanesi hormon eksikliğinde ise izole hipopitüitarizmden bahsedilir (7)(8)(9)(10)(11)(12)(13).…”

Using the Complexity of Hypopituitarism Aetiology to Understand and Teach Hormone Function in Endocrinology

“…The incidence rate (12 to 42 new patients per million per year) and the prevalence rate (300 to 455 patients per million) seems to underestimate the actual incidence of this disorder keeping in mind that 30% to 70% of patients show decreased diminished pituitary secretion post trauma [3].…”

“…Thus, to begin with, distinction should be made between Panhypopituitarism and partial hypopituitarism. For instance, a partial hormone deficiency may progress slowly in the initial stages, going undetected for years, however, the sudden and complete loss of hormone secretion may result in an emergency situation that requires immediate medical attention [3].…”

Underlying medical conditions

“…14 The cortisol level in a pregnant woman is about three to five times that of a non-pregnant female. 12 Management consists of replacing the affected hormones 13 ; for example, thyrotropin deficiency needs l-thyroxin. In women with severe pan-hypopituitary crisis, it is important to give intravenous hydrocortisone initially with a high dosage of 100-150 mg hydrocortisone three times daily.…”