Hypopituitarism history and symptoms: Difference between revisions
Jump to navigation
Jump to search
Iqra Qamar (talk | contribs) |
m (Bot: Removing from Primary care) |
||
| (14 intermediate revisions by 4 users not shown) | |||
| Line 4: | Line 4: | ||
==Overview== | ==Overview== | ||
A positive history of [[head trauma]] | A positive history of [[head trauma]], [[adenoma]], a [[lesion]] such as a [[Sella turcica|sellar]] lesion, or any symptom related to [[Pituitary gland|pituitary]] [[hormonal]] deficiency is suggestive of [[hypopituitarism]]. Patients of [[hypopituitarism]] may be [[asymptomatic]] or show symptoms which can be nonspecific or specific for the deficient [[hormone]]. Patients with acute onset of [[Hypopituitarism (patient information)|hypopituitarism]] can present with a [[headache]], [[nausea]], [[vomiting]], [[visual impairment]], [[fatigue (physical)|fatigue]], [[cold]] intolerance, [[hypotension]], and [[dizziness (patient information)|dizziness]]. Patients with chronic [[hypopituitarism]] can present with [[pallor]], [[weight loss]], and [[anorexia]]. | ||
==History== | ==History== | ||
A positive history of [[head trauma]] | |||
=== Past medical history === | |||
* A positive history of [[head trauma]], [[adenoma]], a [[lesion]] such as a sellar lesion, or any symptom related to [[Pituitary gland|pituitary]] [[hormonal]] deficiency is suggestive of [[Hypopituitarism (patient information)|hypopituitarism]]. | |||
* The Growth Hormone Research Society recommends the consideration of diagnosis of [[growth hormone]] ([[Growth hormone|GH]]) deficiency only in those patients who have a positive history of any [[Pituitary gland|pituitary]] disease or damage secondary to [[trauma]], [[surgery]], [[radiation]], [[tumor]], and previous history of [[growth hormone]] therapy because some factors such as [[obesity]] and age can affect the results of dynamic tests and may lead to inappropriate diagnosis<ref name="pmid9467545">{{cite journal |vauthors= |title=Consensus guidelines for the diagnosis and treatment of adults with growth hormone deficiency: summary statement of the Growth Hormone Research Society Workshop on Adult Growth Hormone Deficiency |journal=J. Clin. Endocrinol. Metab. |volume=83 |issue=2 |pages=379–81 |year=1998 |pmid=9467545 |doi=10.1210/jcem.83.2.4611 |url=}}</ref><ref name="pmid16597813">{{cite journal |vauthors=Prabhakar VK, Shalet SM |title=Aetiology, diagnosis, and management of hypopituitarism in adult life |journal=Postgrad Med J |volume=82 |issue=966 |pages=259–66 |year=2006 |pmid=16597813 |pmc=2585697 |doi=10.1136/pgmj.2005.039768 |url=}}</ref> | |||
==Symptoms== | ==Symptoms== | ||
Patients of [[Hypopituitarism (patient information)|hypopituitarism]] may be asymptomatic or show symptoms which can be nonspecific or specific for the deficient [[hormone]]. | Clinical presentation in [[Hypopituitarism (patient information)|hypopituitarism]] depends upon following factors: | ||
'''(a) The onset''' | |||
*[[Acute]]: Sudden onset of [[symptoms]] as seen in [[pituitary apoplexy]]. | |||
*[[Chronic]]: Slow onset, may take years to manifest such as [[radiation]] damage. | |||
'''(b) The severity of hormonal deficiency''' | |||
*Complete [[hormonal]] deficiency: May present even in normal circumstances. | |||
*Partial [[hormonal]] deficiency: May present only in times of [[stress]]. | |||
'''(c) The number of deficient hormones''' | |||
*One [[hormone]] or some hormones are deficient. | |||
*All of the [[Pituitary hormone|pituitary hormones]] ([[panhypopituitarism]]). | |||
Patients of [[Hypopituitarism (patient information)|hypopituitarism]] may be [[asymptomatic]] or show [[symptoms]] which can be nonspecific or specific for the deficient [[hormone]] such as an [[adrenal crisis]] or profound [[hypothyroidism]]. Patients can also present with [[symptoms]] suggestive of a [[mass]] lesion. [[Metastasis]] usually involves [[Posterior pituitary gland|posterior pituitary]] initially thus presenting as [[diabetes insipidus]]. Patients with a sellar [[mass]] may present with a [[headache]], [[diplopia]], or [[Vision loss|visual loss]]. | |||
===Non-specific symptoms=== | ===Non-specific symptoms=== | ||
Patients of [[Hypopituitarism (patient information)|hypopituitarism]] may present with the following [[symptoms]]: | Patients of [[Hypopituitarism (patient information)|hypopituitarism]] may present with the following [[symptoms]]: | ||
{| class="wikitable" | {| class="wikitable" | ||
!Acute hypopituitarism | ! align="center" style="background:#4479BA; color: #FFFFFF;" + |Acute hypopituitarism (several hours to a few days) | ||
!Chronic hypopituitarism | ! align="center" style="background:#4479BA; color: #FFFFFF;" + |Chronic hypopituitarism (week to months/years) | ||
|- | |- | ||
| | | | ||
| Line 23: | Line 37: | ||
* [[Visual impairment]] | * [[Visual impairment]] | ||
* [[Fatigue (physical)|fatigue]] | * [[Fatigue (physical)|fatigue]] | ||
* Cold intolerance | * [[Cold]] intolerance | ||
* [[Hypotension]] | * [[Hypotension]] | ||
* [[Dizziness]] | * [[Dizziness]] | ||
| Line 33: | Line 47: | ||
===Symptoms of deficient hormones=== | ===Symptoms of deficient hormones=== | ||
In [[Hypopituitarism (patient information)|hypopituitarism]], either one of the [[pituitary gland]] [[hormones]] | In [[Hypopituitarism (patient information)|hypopituitarism]], either one of the [[pituitary gland]] [[hormones]] may be deficient or all [[hormones]] may be deficient (depending upon the extent of [[pituitary gland]] involvement- complete or partial). The following table enlists the [[symptoms]] associated with each [[hormonal]] deficiency:<ref name="FleseriuHashim2016">{{cite journal|last1=Fleseriu|first1=Maria|last2=Hashim|first2=Ibrahim A.|last3=Karavitaki|first3=Niki|last4=Melmed|first4=Shlomo|last5=Murad|first5=M. Hassan|last6=Salvatori|first6=Roberto|last7=Samuels|first7=Mary H.|title=Hormonal Replacement in Hypopituitarism in Adults: An Endocrine Society Clinical Practice Guideline|journal=The Journal of Clinical Endocrinology & Metabolism|volume=101|issue=11|year=2016|pages=3888–3921|issn=0021-972X|doi=10.1210/jc.2016-2118}}</ref> | ||
{| class="wikitable" | {| class="wikitable" | ||
!Pituitary gland | ! align="center" style="background:#4479BA; color: #FFFFFF;" + |Pituitary gland | ||
!Hormone | ! align="center" style="background:#4479BA; color: #FFFFFF;" + |Hormone | ||
!Symptoms of deficiency | ! align="center" style="background:#4479BA; color: #FFFFFF;" + |Symptoms of deficiency | ||
|- | |- | ||
| rowspan="5" |'''Anterior pituitary''' | | rowspan="5" |'''Anterior pituitary''' | ||
|[[Adrenocorticotropic hormone|Adrenocorticotrophic Hormone (ACTH)]] | |[[Adrenocorticotropic hormone|Adrenocorticotrophic Hormone (ACTH)]] | ||
|The most critical [[hormonal]] | |The most critical [[hormonal]] deficiency associated with hypopituitarism.<ref name="Burke1985">{{cite journal|last1=Burke|first1=C.W.|title=Adrenocortical insufficiency|journal=Clinics in Endocrinology and Metabolism|volume=14|issue=4|year=1985|pages=947–976|issn=0300595X|doi=10.1016/S0300-595X(85)80084-0}}</ref><ref name="pmid25098712">{{cite journal| author=Bancos I, Hahner S, Tomlinson J, Arlt W| title=Diagnosis and management of adrenal insufficiency. | journal=Lancet Diabetes Endocrinol | year= 2015 | volume= 3 | issue= 3 | pages= 216-26 | pmid=25098712 | doi=10.1016/S2213-8587(14)70142-1 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25098712 }}</ref> | ||
* [[Nausea and vomiting]] | * [[Nausea and vomiting]] | ||
* [[Fatigue]] | * [[Fatigue]] | ||
| Line 52: | Line 66: | ||
|[[Growth hormone|Growth Hormone (GH)]] | |[[Growth hormone|Growth Hormone (GH)]] | ||
| | | | ||
* [[Short stature]] ( | * [[Short stature]] (in children) | ||
* [[Fatigue]] | * [[Fatigue]] | ||
* Decreased tolerance of exercise | |||
* Decreased social functioning | |||
* Increased [[cardiovascular]] risk | * Increased [[cardiovascular]] risk | ||
* Decrease [[muscle mass]] | * Decrease [[muscle mass]] | ||
| Line 64: | Line 80: | ||
* [[Loss of libido]] | * [[Loss of libido]] | ||
* [[Erectile dysfunction]] | * [[Erectile dysfunction]] | ||
* Decreased volume of [[ejaculate]] | |||
* [[Hot flashes]] | |||
* Decrease [[bone mass]] | * Decrease [[bone mass]] | ||
* Reduced energy and vitality | * Reduced energy and vitality | ||
| Line 71: | Line 89: | ||
* [[Oligomenorrhea]] | * [[Oligomenorrhea]] | ||
* [[Dyspareunia (patient information)|Dyspareunia]] | * [[Dyspareunia (patient information)|Dyspareunia]] | ||
* [[Loss of libido]] | * [[Loss of libido|Decreased libido]] | ||
* [[Hot flashes]] | |||
* [[Vaginal]] dryness | |||
* [[Infertility]] | * [[Infertility]] | ||
|- | |- | ||
| Line 95: | Line 115: | ||
| | | | ||
* [[Muscle aches]] | * [[Muscle aches]] | ||
* Decreased milk ejection during [[lactation]] | |||
* [[Sleep disturbance]] | * [[Sleep disturbance]] | ||
* [[Anxiety]] | * [[Anxiety]] | ||
| Line 107: | Line 128: | ||
==References== | ==References== | ||
{{Reflist|2}} | {{Reflist|2}} | ||
| |||
{{WH}} | {{WH}} | ||
{{WS}} | {{WS}} | ||
[[Category:Medicine]] | |||
[[Category:Endocrinology]] | |||
[[Category:Up-To-Date]] | |||
Latest revision as of 22:19, 29 July 2020
|
Hypopituitarism Microchapters |
|
Diagnosis |
|---|
|
Treatment |
|
Case Studies |
|
Hypopituitarism history and symptoms On the Web |
|
American Roentgen Ray Society Images of Hypopituitarism history and symptoms |
|
Risk calculators and risk factors for Hypopituitarism history and symptoms |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Ahmed Elsaiey, MBBCH [2], Iqra Qamar M.D.[3]
Overview
A positive history of head trauma, adenoma, a lesion such as a sellar lesion, or any symptom related to pituitary hormonal deficiency is suggestive of hypopituitarism. Patients of hypopituitarism may be asymptomatic or show symptoms which can be nonspecific or specific for the deficient hormone. Patients with acute onset of hypopituitarism can present with a headache, nausea, vomiting, visual impairment, fatigue, cold intolerance, hypotension, and dizziness. Patients with chronic hypopituitarism can present with pallor, weight loss, and anorexia.
History
Past medical history
- A positive history of head trauma, adenoma, a lesion such as a sellar lesion, or any symptom related to pituitary hormonal deficiency is suggestive of hypopituitarism.
- The Growth Hormone Research Society recommends the consideration of diagnosis of growth hormone (GH) deficiency only in those patients who have a positive history of any pituitary disease or damage secondary to trauma, surgery, radiation, tumor, and previous history of growth hormone therapy because some factors such as obesity and age can affect the results of dynamic tests and may lead to inappropriate diagnosis[1][2]
Symptoms
Clinical presentation in hypopituitarism depends upon following factors:
(a) The onset
- Acute: Sudden onset of symptoms as seen in pituitary apoplexy.
- Chronic: Slow onset, may take years to manifest such as radiation damage.
(b) The severity of hormonal deficiency
- Complete hormonal deficiency: May present even in normal circumstances.
- Partial hormonal deficiency: May present only in times of stress.
(c) The number of deficient hormones
- One hormone or some hormones are deficient.
- All of the pituitary hormones (panhypopituitarism).
Patients of hypopituitarism may be asymptomatic or show symptoms which can be nonspecific or specific for the deficient hormone such as an adrenal crisis or profound hypothyroidism. Patients can also present with symptoms suggestive of a mass lesion. Metastasis usually involves posterior pituitary initially thus presenting as diabetes insipidus. Patients with a sellar mass may present with a headache, diplopia, or visual loss.
Non-specific symptoms
Patients of hypopituitarism may present with the following symptoms:
| Acute hypopituitarism (several hours to a few days) | Chronic hypopituitarism (week to months/years) |
|---|---|
|
Symptoms of deficient hormones
In hypopituitarism, either one of the pituitary gland hormones may be deficient or all hormones may be deficient (depending upon the extent of pituitary gland involvement- complete or partial). The following table enlists the symptoms associated with each hormonal deficiency:[3]
| Pituitary gland | Hormone | Symptoms of deficiency |
|---|---|---|
| Anterior pituitary | Adrenocorticotrophic Hormone (ACTH) | The most critical hormonal deficiency associated with hypopituitarism.[4][5] |
| Growth Hormone (GH) |
| |
| Gonadotropin hormones: | In men:
In women:[7] | |
| Thyroid Stimulating Hormone (TSH) |
| |
| Prolactin |
| |
| Posterior pituitary | Oxytocin |
|
| Anti Diuretic Hormone (ADH) |
References
- ↑ "Consensus guidelines for the diagnosis and treatment of adults with growth hormone deficiency: summary statement of the Growth Hormone Research Society Workshop on Adult Growth Hormone Deficiency". J. Clin. Endocrinol. Metab. 83 (2): 379–81. 1998. doi:10.1210/jcem.83.2.4611. PMID 9467545.
- ↑ Prabhakar VK, Shalet SM (2006). "Aetiology, diagnosis, and management of hypopituitarism in adult life". Postgrad Med J. 82 (966): 259–66. doi:10.1136/pgmj.2005.039768. PMC 2585697. PMID 16597813.
- ↑ Fleseriu, Maria; Hashim, Ibrahim A.; Karavitaki, Niki; Melmed, Shlomo; Murad, M. Hassan; Salvatori, Roberto; Samuels, Mary H. (2016). "Hormonal Replacement in Hypopituitarism in Adults: An Endocrine Society Clinical Practice Guideline". The Journal of Clinical Endocrinology & Metabolism. 101 (11): 3888–3921. doi:10.1210/jc.2016-2118. ISSN 0021-972X.
- ↑ Burke, C.W. (1985). "Adrenocortical insufficiency". Clinics in Endocrinology and Metabolism. 14 (4): 947–976. doi:10.1016/S0300-595X(85)80084-0. ISSN 0300-595X.
- ↑ Bancos I, Hahner S, Tomlinson J, Arlt W (2015). "Diagnosis and management of adrenal insufficiency". Lancet Diabetes Endocrinol. 3 (3): 216–26. doi:10.1016/S2213-8587(14)70142-1. PMID 25098712.
- ↑ Murray RD, Columb B, Adams JE, Shalet SM (2004). "Low bone mass is an infrequent feature of the adult growth hormone deficiency syndrome in middle-age adults and the elderly". J Clin Endocrinol Metab. 89 (3): 1124–30. doi:10.1210/jc.2003-030685. PMID 15001597.
- ↑ Miller KK, Biller BM, Hier J, Arena E, Klibanski A (2002). "Androgens and bone density in women with hypopituitarism". J Clin Endocrinol Metab. 87 (6): 2770–6. doi:10.1210/jcem.87.6.8557. PMID 12050248.