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| '''For patient information click [[{{PAGENAME}} (patient information)|here]]'''
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| {{SI}}
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| __NOTOC__ | | __NOTOC__ |
| {{CMG}} | | {{DiseaseDisorder infobox | |
| | Name =Hypopituitarism | |
| | Image = Illu endocrine system New.png | |
| | Caption = Hypopituitarism - By US Government, Via: Wikimedia.org<ref> <http://training.seer.cancer.gov/module_anatomy/unit6_3_endo_glnds.html>''Public Domain''<https://commons.wikimedia.org/w/index.php?curid=15860440> </ref>| |
| | }} |
| | {{Hypopituitarism}} |
| | {{CMG}}; {{AE}} {{AEL}} {{IQ}} |
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| == Overview ==
| | '''For patient information click [[{{PAGENAME}} (patient information)|here]]''' |
| '''Hypopituitarism''' is a medical term describing the deficiency (''hypo'') of one or more [[hormone]]s of the [[pituitary gland]]. The [[hypothalamus]] regulates pituitary secretion by the production of ''releasing hormones'' and [[posterior pituitary]] hormones and hence its dysfunction can also lead to hypopituitarism. | |
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| In [[endocrinology]], deficiency of one or multiple hormones of the [[anterior pituitary]] is generally referred to as ''hypopituitarism'', while deficiency of the posterior lobe generally only leads to [[Diabetes insipidus#Pathophysiology|central]] [[diabetes insipidus]]. The deficiency of ''all'' [[anterior pituitary]] hormones is termed '''panhypopituitarism'''.
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| ==Pathophysiology==
| | {{SK}} Pituitary failure, Adenohypophyseal hyposecretion, Panhypopituitarism |
| * The hormones of the anterior pituitary include 2 [[protein]]s, 3 [[glycoprotein]]s and a polypeptide:
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| #[[prolactin]] (PRL) - stimulates milk production in the [[breast]]
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| #[[growth hormone]] (GH) - growth and [[glucose]] homeostasis
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| #[[luteinizing hormone]] (LH) - [[menstrual cycle]] and reproduction
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| #[[follicle stimulating hormone]] (FSH) - same
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| #[[thyroid stimulating hormone]] (TSH) - stimulates [[thyroxine]] production in the [[thyroid]]
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| #[[adrenocorticotropic hormone]] (ACTH) - stimulates [[glucocorticoid]] production in the [[adrenal gland]]
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| * These hormones excreted are secreted in individually characteristic pulsatile patterns, often with distinct [[circadian rhythm]], rather than at steady rates throughout 24 hours.
| | {{Infobox_Disease | |
| * The posterior pituitary is the site of release of the nonapeptide hormones [[antidiuretic hormone]] (ADH) and [[oxytocin]], the former regulating plasma [[osmolarity]] and the latter regulating [[uterus|uterine]] [[contraction (childbirth)|contractions]] during [[childbirth]] as well milk ejection from the breasts.
| | Name = Hypopituitarism | |
| * Deficiency of a single pituitary hormone occurs less commonly than deficiency of more than one hormone. Sometimes referred to as progressive pituitary hormone deficiency or partial hypopituitarism, there is usually a predictable order of hormone loss.
| | Image = | |
| * Generally, growth hormone is lost first, then luteinizing hormone deficiency follows. The loss of follicle-stimulating hormone, thyroid stimulating hormone, adrenocorticotopic hormones and prolactin typically follow much later. The progressive loss of pituitary hormone secretion is usually a slow process, which can occur over a period of months or years. Hypopituitarism does occasionally start suddenly with rapid onset of symptoms
| | Caption = | |
| * Most people with hypopituitarism lack growth hormone as well as one or more others. As for the posterior pituitary, antidiuretic hormone deficiency is the main problem, while oxytocin deficiency rarely causes clinically significant problems.
| | DiseasesDB = 6522| |
| | ICD10 = {{ICD10|E|23|0|e|20}}, {{ICD10|E|89|3|e|70}} | |
| | ICD9 = {{ICD9|253.7}}| |
| | ICDO = | |
| | OMIM = | |
| | MedlinePlus = 000343 | |
| | MeshID = D007018 | |
| | }} |
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| ==Causes== | | ==[[Hypopituitarism overview|Overview]]== |
| ===Common Causes===
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| Hypopituitarism and panhypopituitarism can be congenital or acquired. A partial list of causes and forms:
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| * Congenital hypopituitarism
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| **Hypoplasia of the pituitary
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| ***Isolated idiopathic congenital hypopituitarism
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| ***Associated with other congenital [[syndrome]]s and [[birth defect]]s
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| ****[[Septo-optic dysplasia]]
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| ****[[Holoprosencephaly]]
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| ****[[Chromosome 22 deletion syndrome]]
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| ****Rapaport syndrome
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| ** Single gene defect forms of anterior pituitary hormone deficiency
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| * Acquired hypopituitarism (Simmonds' disease)
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| ** [[Physical trauma|trauma]] (e.g., skull base fracture)
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| ** [[surgery]] (e.g., removal of pituitary neoplasm)
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| ** [[tumor]] - secretory and non-secretory (20%) [[Pituitary adenoma|pituitary]] or hypothalamic neoplasms, cause hypopituitarism by compressing the remaining tissue
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| ** [[inflammation]] (e.g. [[sarcoidosis]] or autoimmune hypophysitis)
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| ** [[radiation]] (e.g., after cranial irradiation for childhood [[leukemia]])
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| ** [[Shock (medical)|shock]]
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| *** ([[Sheehan's syndrome]] is hypopituitarism after heavy [[hemorrhage|bleeding]] in [[childbirth]])
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| ** [[haemochromatosis|hemochromatosis]]
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| * other diseases.
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| ===Causes in Alphabetical Order=== | | ==[[Hypopituitarism historical perspective|Historical Perspective]]== |
| *[[Anorexia Nervosa]]
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| *[[Bulimia Nervosa]]
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| *Changes in body weight
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| *[[Congestive Heart Failure]]
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| *Emotional disorders
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| *[[Empty Sella Syndrome]]
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| *Habitual exercise
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| *Head Trauma
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| *[[Hemochromatosis]]
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| *Infection
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| :*Fungal
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| :*[[Malaria]]
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| :*[[Meningitis]]
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| :*[[Syphillis]]
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| :*[[Tuberculosis]]
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| *Ischemic nerosis of the pituitary
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| :*Anticoagulant therapy
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| :*[[Arteriosclerosis]]
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| :*[[Arteritis temporalis]]
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| :*Blood dyscrasias
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| :*Brain Trauma
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| :*[[Diabetes Mellitus]]
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| :*Eclampsia
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| :*Increased cranial pressure
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| :*[[Sheehan's Syndrome]]
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| :*[[Sickle Cell Anemia]]
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| :*Tumor
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| *Iatrogenic
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| *Parasellar tumor/pituitary compression
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| :*Craniopharyngioma
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| :*Chromophobe adenoma
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| :*Intracranial cartoid branch aneurysm
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| :*Lymphoma
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| :*Meningioma
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| :*Metasteses
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| :*Optic nerve neurinoma
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| *Pituitary adenomas
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| *[[Renal Failure]]
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| *[[Sarcoidosis]]
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| *[[Wegener's Granulomatosis]]
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| ==Diagnosis== | | ==[[Hypopituitarism classification|Classification]]== |
| === Symptoms ===
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| Hypopituitarism may come to medical attention by symptoms or features of pituitary hormone deficiency
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| * poor growth
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| * [[Micropenis]]
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| * [[Polyuria]]
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| * [[Impaired libido]]
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| * [[Fatigue (physical)|fatigue]]
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| * [[Muscle weakness]]
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| * [[Weight loss]]
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| * [[Headache]]
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| * [[Nausea]] and [[vomiting]]
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| * [[Loss of appetite]]
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| * [[Diarrhea]]
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| === Physical Examination === | | ==[[Hypopituitarism pathophysiology|Pathophysiology]]== |
| ====Vital Signs====
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| * [[Hypotension]]
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| ====Genitals==== | | ==[[Hypopituitarism causes|Causes]]== |
| * [[Micropenis]]
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| === Laboratory Findings === | | ==[[Hypopituitarism differential diagnosis|Differentiating Hypopituitarism from other Diseases]]== |
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| ==== Electrolyte and Biomarker Studies ==== | | ==[[Hypopituitarism epidemiology and demographics|Epidemiology and Demographics]]== |
| *[[ACTH stimulation test]]: The ACTH stimulation test is the most common test for patients who are suspected of diagnosing adrenal insufficiency. During this test, before and after being injected ACTH, the patient is detected with the level of blood cortisol and urine cortisol. In normal person, after an ACTH injection, it may show a rise in blood and urine cortisol levels. Patients with causes of adrenal insufficiency have little or no increase in cortisol levels.
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| *[[CRH stimulation test]]: This test can differ the primary and secondary adrenal insufficiency. In this test, the patient is injected synthetic CRH and measured blood cortisol before and 30, 60, 90, and 120 minutes after the injection. The leval of blood cortisol in people with primary adrenal insufficiency such as Addison’s disease, demonatrates high levels of ACTH but no cortisol. For the patients with secondary adrenal insufficiency, they appear absent or delayed ACTH.
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| * A provocative test ([[triple bolus test]]) measures the secretory response of the pituitary to a stimulus (other hormones, drugs, exercise, etc.) by measuring serum levels of the hormone involved.
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| ====X Ray ==== | | ==[[Hypopituitarism risk factors|Risk Factors]]== |
| * Abdominal x-ray test: An x-ray image of abdominen allows the doctor to check the shape and size of the adrenal glands.
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| ====CT ==== | | ==[[Hypopituitarism screening|Screening]]== |
| * These imaging tests can confirm the size and shape of [[pituitary gland]] and [[hypothalamus]] and show the organs near them. It is useful for the diagnosis of secondary adrenal insufficiency. CT scan produce a series of x-ray pictures giving cross-sectional images.
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| ====MRI==== | | ==[[Hypopituitarism natural history, complications and prognosis|Natural History, Complications and Prognosis]]== |
| * A magnetic resonance imaging (MRI) scan may show a three-dimensional image of this region.
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| ====Ultrasound ==== | | ==Diagnosis== |
| * Abdominal [[ultrasound]]: This is an painless test which uses sound waves to create a picture of the internal organs. It can help doctor reveal any signs in adrenal glands.
| | [[Hypopituitarism history and symptoms| History and Symptoms]] | [[Hypopituitarism physical examination | Physical Examination]] | [[Hypopituitarism laboratory findings|Laboratory Findings]] | [[Hypopituitarism electrocardiogram|Electrocardiogram]] | [[Hypopituitarism x ray|X Ray]] | [[Hypopituitarism CT|CT]] | [[Hypopituitarism MRI|MRI]] | [[Hypopituitarism ultrasound|Ultrasound]] | [[Hypopituitarism other imaging findings|Other Imaging Findings]] | [[Hypopituitarism other diagnostic studies|Other Diagnostic Studies]] |
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| ==Treatment== | | ==Treatment== |
| Hypopituitarism and panhypopituitarism are treated by replacement of appropriate hormones. Since most of the anterior pituitary hormones are [[protein]]s or [[glycoprotein]]s released in pulsatile patterns, whose functions are to induce secretion of smaller molecule hormones ([[thyroid]] hormones and [[steroid]]s), it is simpler and less expensive for most purposes to simply replace the target gland hormones. There are a few exceptions, such as fertility induction.
| | [[Hypopituitarism medical therapy|Medical Therapy]] | [[Hypopituitarism surgery|Surgery]] | [[Hypopituitarism primary prevention|Primary Prevention]] | [[Hypopituitarism secondary prevention|Secondary Prevention]] | [[Hypopituitarism cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Hypopituitarism future or investigational therapies|Future or Investigational Therapies]] |
| *[[growth hormone|GH]] is replaced with [[growth hormone treatment|growth hormone]].
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| *TSH is replaced with [[thyroxine]].
| | ==Case Studies== |
| *ACTH is usually replaced with [[hydrocortisone]] but any [[glucocorticoid]] may be used.
| | [[Hypopituitarism case study one|Case#1]] |
| *LH and FSH are most often replaced by supplying the appropriate [[sex steroid]]s (e.g., [[testosterone]] or [[estrogen]] and [[progestin]]). Virtually all people who need T or E2 replacement for hypopituitarism rarely have spontaneous, effective [[spermatogenesis]] or [[ovarian follicle|follicular]] maturation. Both [[GnRH]] by subcutaneous pump and [[gonadotropin]]s (Pergonal) by daily subcutaneous injections have been used effectively to induce [[infertility|fertility]].
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| *Prolactin is not usually replaced, as [[infant formula]] is readily available, simpler, and much cheaper.
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| *ADH is replaced most commonly with oral, nasal, and sometimes intravenous or subcutaneous [[desmopressin]].
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| *[[Oxytocin]] is most important during labor and delivery at the end of pregnancy, and can be replaced in that circumstance by pitressin.
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| ==See also== | | ==Related Chapters== |
| * [[growth hormone deficiency]] | | * [[Growth hormone deficiency]] |
| * [[pituitary gland]] | | * [[Pituitary gland]] |
| * [[Kallmann syndrome]] | | * [[Kallmann syndrome]] |
| * [[Empty sella syndrome]] | | * [[Empty sella syndrome]] |
| * [[Insulin tolerance test]] | | * [[Insulin tolerance test]] |
| | * [[Hypothyroidism]] |
| | * [[Hypogonadism]] |
| | * [[Sheehan's syndrome]] |
| | * [[Diabetes insipidus]] |
| | * [[Adrenal insufficiency (patient information)|Adrenal insufficiency]] |
| | * [[Pituitary apoplexy]] |
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| [[de:Hypophyseninsuffizienz]]
| | ==References== |
| [[es:Hipopituitarismo]]
| | {{reflist|2}} |
| [[no:Hypotyreose]]
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| [[sv:Hypofysinsufficiens]]
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