Hypopituitarism physical examination: Difference between revisions

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{{Hypopituitarism}}
{{Hypopituitarism}}
{{CMG}}; {{AE}} {{AEL}}, {{IQ}}


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==Overview==
Clinical presentation in [[Hypopituitarism (patient information)|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 (patient information)|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 reflex|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 (patient information)|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 hormone|pituitary hormones]] ([[panhypopituitarism]]).
* 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"
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Hormonal deficiency
! colspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" + |Finding
|-
| rowspan="2" | '''ACTH'''
|Acute
|
* [[Postural hypotension]]
* [[Tachycardia]]
|-
|Chronic
|
* [[Anorexia]]
* [[Weight loss]]
* No [[hyperpigmentation]]
|-
|'''TSH'''
| colspan="2" |
* Slow movement and slow speech
 
* Delayed [[relaxation]] of [[Tendon reflex|tendon reflexes]]
 
* [[Bradycardia]]
 
* [[Carotenemia]]
 
* Coarse [[skin]]
 
* Puffy face and loss of [[eyebrows]]
 
* [[Periorbital edema]]
 
* [[Macroglossia|Enlargement of the tongue]]
 
* [[Diastolic blood pressure|Diastolic]] [[hypertension]]


{{CMG}}
* [[Pleural Effusion|Pleural]] and [[Pericardial effusion|pericardial effusions]]


==Overview==
* [[Ascites]]
 
* [[Galactorrhea]]
|-
| rowspan="2" |'''Gonadotropins'''
|Male
|
* Soft [[testes]]
* Reduced [[muscle mass]]
* Diminished facial and body hair
* Fine facial wrinkles
* [[Gynecomastia]]
* Regression of [[sexual characteristics]]
|-
|Female
|
* Breast [[atrophy]]
* Regression of [[sexual characteristics]]
|-
| rowspan="2" |'''Growth hormone'''
|Children
|
* [[Short stature]]
|-
|Adults
|
* Decreased [[sweating]] and impaired [[thermogenesis]]
* Reduced [[muscle mass]] and strength
* Fine facial wrinkles
* Increased central [[obesity]]
|}
 
===Appearance of the patient===
*Patients of [[Hypopituitarism (patient information)|hypopituitarism]] are ill appearing and usually look [[tired]].<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><ref name="pmid16597813">{{cite journal| author=Prabhakar VK, Shalet SM| title=Aetiology, diagnosis, and management of hypopituitarism in adult life. | journal=Postgrad Med J | year= 2006 | volume= 82 | issue= 966 | pages= 259-66 | pmid=16597813 | doi=10.1136/pgmj.2005.039768 | pmc=2585697 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16597813  }} </ref><ref name="AscoliCavagnini2006">{{cite journal|last1=Ascoli|first1=Paola|last2=Cavagnini|first2=Francesco|title=Hypopituitarism|journal=Pituitary|volume=9|issue=4|year=2006|pages=335–342|issn=1386-341X|doi=10.1007/s11102-006-0416-5}}</ref>


==Physical Examination==
===Vital Signs===
===Vital Signs===
* [[Hypotension]]
* [[Orthostatic hypotension]]
 
=== Skin ===
* [[Xeroderma|Dry skin]]
* [[Pallor]]
* [[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 ===
* [[Dyspnea]]
 
=== Heart ===
* [[Bradycardia]]
* [[Atherosclerosis]]
 
=== Abdomen ===
* [[Rebound tenderness]]
 
=== Neuromuscular ===
* [[Muscle weakness]]
* [[Osteoporosis]]  


===Genitals===
===Genitourinary ===
* [[Micropenis]]
* [[Hypogonadism]] ([[Micropenis]])
* [[Erectile dysfunction]]


==References==
==References==
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[[Category:Needs content]]
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[[Category:Disease]]
[[Category:Endocrinology]]


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Latest revision as of 18:09, 16 October 2017

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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:

Hormonal deficiency Finding
ACTH Acute
Chronic
TSH
  • Slow movement and slow speech
Gonadotropins Male
Female
Growth hormone Children
Adults

Appearance of the patient

Vital Signs

Skin

Lungs

Heart

Abdomen

Neuromuscular

Genitourinary

References

  1. ↑ 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.
  2. ↑ 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.
  3. ↑ Ascoli, Paola; Cavagnini, Francesco (2006). "Hypopituitarism". Pituitary. 9 (4): 335–342. doi:10.1007/s11102-006-0416-5. ISSN 1386-341X.
  4. ↑ Arlt W, Allolio B (2003). "Adrenal insufficiency". Lancet. 361 (9372): 1881–93. doi:10.1016/S0140-6736(03)13492-7. PMID 12788587.

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