Hypopituitarism physical examination: Difference between revisions
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==Overview== | ==Overview== | ||
Clinical presentation in | 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 (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== | ==Physical Examination== | ||
Clinical presentation in | Clinical presentation in hypopituitarism depends upon following factors: | ||
*The onset: | *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: | *The severity of hormonal deficiency: | ||
**Complete hormonal deficiency: may present even in normal circumstances. | **Complete hormonal deficiency: may present even in normal circumstances. | ||
| Line 16: | Line 16: | ||
*The number of deficient hormones: | *The number of deficient hormones: | ||
**One [[hormone]] or some hormones are deficient. | **One [[hormone]] or some hormones are deficient. | ||
**All of the [[Pituitary hormone|pituitary hormones]] ( | **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 | * Patients with sellar [[mass]] may present with a [[headache]], [[diplopia]], or [[Vision loss|visual loss]]. Physical examination of patients with hypopituitarism is usually remarkable for: | ||
{| class="wikitable" | {| class="wikitable" | ||
!Hormonal deficiency | !Hormonal deficiency | ||
| Line 30: | Line 30: | ||
|Chronic | |Chronic | ||
| | | | ||
* | * Anorexia | ||
* | * Weight loss | ||
* No | * No hyperpigmentation | ||
|- | |- | ||
|TSH | |TSH | ||
| Line 38: | Line 38: | ||
* Slow movement and slow speech | * Slow movement and slow speech | ||
* Delayed | * Delayed relaxation of [[Tendon reflex|tendon reflexes]] | ||
* [[Bradycardia]] | * [[Bradycardia]] | ||
| Line 46: | Line 46: | ||
* Coarse [[skin]] | * Coarse [[skin]] | ||
* Puffy facies and loss of | * Puffy facies and loss of eyebrows | ||
* [[Periorbital edema]] | * [[Periorbital edema]] | ||
| Line 65: | Line 65: | ||
* Soft [[testes]] | * Soft [[testes]] | ||
* Reduced [[muscle mass]] | * Reduced [[muscle mass]] | ||
* Regression of | * Regression of sexual characteristics | ||
|- | |- | ||
|Female | |Female | ||
| | | | ||
* Breast atrophy | * Breast atrophy | ||
* Regression of | * Regression of sexual characteristics | ||
|- | |- | ||
| rowspan="2" |Growth hormone | | rowspan="2" |Growth hormone | ||
| Line 85: | Line 85: | ||
===Appearance of the patient=== | ===Appearance of the patient=== | ||
*Patients of | *Patients of 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> | ||
===Vital Signs=== | ===Vital Signs=== | ||
Revision as of 14:43, 13 September 2017
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Hypopituitarism Microchapters |
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Hypopituitarism physical examination On the Web |
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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 following factors:
- 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
Vital Signs
Skin
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.