Hypopituitarism physical examination: Difference between revisions
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==Physical Examination== | ==Physical Examination== | ||
Clinical presentation in [[Hypopituitarism (patient information)|hypopituitarism]] depends upon | Clinical presentation in [[Hypopituitarism (patient information)|hypopituitarism]] depends upon factors as followings: | ||
*The onset: | *The onset: | ||
**[[Acute]]: | **[[Acute]]: Sudden onset of symptoms as seen in [[pituitary apoplexy]]. | ||
**[[Chronic]]: | **[[Chronic]]: Slow onset, may take years to manifest such as [[radiation]] damage. | ||
*The severity of hormonal deficiency: | *The severity of hormonal deficiency: | ||
**Complete hormonal deficiency: | **Complete hormonal deficiency: May present even in normal circumstances. | ||
**Partial hormonal deficiency: | **Partial hormonal deficiency: May present only in times of [[stress]]. | ||
*The number of deficient hormones: | *The number of deficient hormones: | ||
**One [[hormone]] or some hormones are deficient. | **One [[hormone]] or some hormones are deficient. | ||
| Line 19: | Line 19: | ||
* Patients with sellar [[mass]] may present with a [[headache]], [[diplopia]], or [[Vision loss|visual loss]]. Physical examination of patients with [[Hypopituitarism (patient information)|hypopituitarism]] is usually remarkable for: | * Patients with sellar [[mass]] may present with a [[headache]], [[diplopia]], or [[Vision loss|visual loss]]. Physical examination of patients with [[Hypopituitarism (patient information)|hypopituitarism]] is usually remarkable for: | ||
{| class="wikitable" | {| class="wikitable" | ||
!Hormonal deficiency | ! align="center" style="background:#4479BA; color: #FFFFFF;" + |Hormonal deficiency | ||
! colspan="2" |Finding | ! colspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" + |Finding | ||
|- | |- | ||
| rowspan="2" | ACTH | | rowspan="2" | '''ACTH''' | ||
|Acute | |Acute | ||
| | | | ||
| Line 34: | Line 34: | ||
* No [[hyperpigmentation]] | * No [[hyperpigmentation]] | ||
|- | |- | ||
|TSH | |'''TSH''' | ||
| colspan="2" | | | colspan="2" | | ||
* Slow movement and slow speech | * Slow movement and slow speech | ||
| Line 46: | Line 46: | ||
* Coarse [[skin]] | * Coarse [[skin]] | ||
* Puffy | * Puffy face and loss of [[eyebrows]] | ||
* [[Periorbital edema]] | * [[Periorbital edema]] | ||
| Line 52: | Line 52: | ||
* [[Macroglossia|Enlargement of the tongue]] | * [[Macroglossia|Enlargement of the tongue]] | ||
* Diastolic [[hypertension]] | * [[Diastolic blood pressure|Diastolic]] [[hypertension]] | ||
* [[Pleural Effusion|Pleural]] and [[Pericardial effusion|pericardial effusions]] | * [[Pleural Effusion|Pleural]] and [[Pericardial effusion|pericardial effusions]] | ||
| Line 60: | Line 60: | ||
* [[Galactorrhea]] | * [[Galactorrhea]] | ||
|- | |- | ||
| rowspan="2" |Gonadotropins | | rowspan="2" |'''Gonadotropins''' | ||
|Male | |Male | ||
| | | | ||
| Line 67: | Line 67: | ||
* Diminished facial and body hair | * Diminished facial and body hair | ||
* Fine facial wrinkles | * Fine facial wrinkles | ||
* Gynecomastia | * [[Gynecomastia]] | ||
* Regression of [[sexual characteristics]] | * Regression of [[sexual characteristics]] | ||
|- | |- | ||
|Female | |Female | ||
| | | | ||
* Breast atrophy | * Breast [[atrophy]] | ||
* Regression of [[sexual characteristics]] | * Regression of [[sexual characteristics]] | ||
|- | |- | ||
| rowspan="2" |Growth hormone | | rowspan="2" |'''Growth hormone''' | ||
|Children | |Children | ||
| | | | ||
| Line 84: | Line 84: | ||
* Decreased [[sweating]] and impaired [[thermogenesis]] | * Decreased [[sweating]] and impaired [[thermogenesis]] | ||
* Reduced [[muscle mass]] and strength | * Reduced [[muscle mass]] and strength | ||
* Fine | * Fine facial wrinkles | ||
* Increased central [[obesity]] | * Increased central [[obesity]] | ||
|} | |} | ||
| Line 97: | Line 97: | ||
* [[Xeroderma|Dry skin]] | * [[Xeroderma|Dry skin]] | ||
* [[Pallor]] | * [[Pallor]] | ||
* [[Hair loss|Loss of hair]] | * [[Hair loss|Loss of hair]] | ||
* Alabaster-like appearance<ref name="pmid12788587">{{cite journal |vauthors=Arlt W, Allolio B |title=Adrenal insufficiency |journal=Lancet |volume=361 |issue=9372 |pages=1881–93 |year=2003 |pmid=12788587 |doi=10.1016/S0140-6736(03)13492-7 |url=}}</ref> | |||
=== Lungs === | === Lungs === | ||
Latest revision as of 18:09, 16 October 2017
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Hypopituitarism Microchapters |
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Treatment |
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Hypopituitarism physical examination On the Web |
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American Roentgen Ray Society Images of Hypopituitarism physical examination |
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Risk calculators and risk factors for Hypopituitarism physical examination |
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
Clinical presentation in hypopituitarism depends upon the onset, the severity of hormonal deficiency and the number of deficient hormones. Patients with hypopituitarism are ill appearing and usually look tired. Physical examination of patients with hypopituitarism is usually remarkable for the respective hormonal deficiency and present with features of that specific hormone such as hypothyroidism presents as delayed relaxation of tendon reflexes, bradycardia, coarse skin, puffy facies, and loss of eyebrows. ACTH deficiency can present with postural hypotension, tachycardia, and weight loss. Gonadotropin deficiency may present with breast atrophy, soft testes, and regression of sexual characteristics. Growth hormone deficiency can present with short stature, decreased sweating with impaired thermogenesis, and reduced muscle mass.
Physical Examination
Clinical presentation in hypopituitarism depends upon factors as followings:
- The onset:
- Acute: Sudden onset of symptoms as seen in pituitary apoplexy.
- Chronic: Slow onset, may take years to manifest such as radiation damage.
- The severity of hormonal deficiency:
- Complete hormonal deficiency: May present even in normal circumstances.
- Partial hormonal deficiency: May present only in times of stress.
- The number of deficient hormones:
- One hormone or some hormones are deficient.
- All of the pituitary hormones (panhypopituitarism).
- Patients with sellar mass may present with a headache, diplopia, or visual loss. Physical examination of patients with hypopituitarism is usually remarkable for:
| Hormonal deficiency | Finding | |
|---|---|---|
| ACTH | Acute | |
| Chronic | ||
| TSH |
| |
| Gonadotropins | Male |
|
| Female |
| |
| Growth hormone | Children | |
| Adults |
| |
Appearance of the patient
- Patients of hypopituitarism are ill appearing and usually look tired.[1][2][3]
Vital Signs
Skin
- Dry skin
- Pallor
- Loss of hair
- Alabaster-like appearance[4]
Lungs
Heart
Abdomen
Neuromuscular
Genitourinary
References
- ↑ 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.
- ↑ 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.
- ↑ Ascoli, Paola; Cavagnini, Francesco (2006). "Hypopituitarism". Pituitary. 9 (4): 335–342. doi:10.1007/s11102-006-0416-5. ISSN 1386-341X.
- ↑ Arlt W, Allolio B (2003). "Adrenal insufficiency". Lancet. 361 (9372): 1881–93. doi:10.1016/S0140-6736(03)13492-7. PMID 12788587.