Pituitary insufficiency

Published on 02/03/2015 by admin

Filed under Endocrinology, Diabetes and Metabolism

Last modified 02/03/2015

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Pituitary insufficiency

1. What is pituitary insufficiency?

Pituitary insufficiency is a syndrome characterized by one or more anterior pituitary hormone deficiencies as a result of aplasia or hypoplasia, destruction, infiltration, compression, or displacement of the hypothalamus and/or pituitary gland (Fig. 18-1). Pituitary insufficiency can be congenital or acquired; familial or sporadic; partial or complete; and transient (reversible) or permanent. Posterior pituitary failure, characterized by decreased concentrations of antidiuretic hormone, is referred as central diabetes insipidus.

2. Is diabetes insipidus a manifestation of pituitary insufficiency?

3. How common is hypopituitarism in the general population?

4. What causes pituitary insufficiency?

Almost any disease that disturbs the normal interaction between the hypothalamus and the pituitary gland can cause hypopituitarism. The most common etiology of pituitary insufficiency is pituitary damage associated with a pituitary adenoma and/or the effect of its treatment (surgery and/or radiation therapy). Among patients with pituitary macroadenomas, about one third have one or more pituitary hormone deficiencies. Other frequent causes are shown in Box 18-1.

5. How does a patient with pituitary insufficiency present?

The clinical manifestations of hypopituitarism depend on the extent and severity of the specific pituitary hormone deficiency. If the onset is acute, the patient may be critically ill and present with hypotension and shock, obtundation, and even coma. However, if the onset is chronic and the pituitary deficiency is mild, the patient may complain only of fatigue and malaise.

image Adrenocorticotropic hormone (ACTH) deficiency (central adrenal insufficiency): Fatigue, malaise, low-grade fever, weakness, anorexia, nausea, vomiting, abdominal pain, loose stools, and postural lightheadedness.

image Thyroid-stimulating hormone (TSH) deficiency (central hypothyroidism): Impaired mental activity, weight gain, fatigue, cold intolerance, weakness, alopecia, puffiness, and constipation.

image Gonadotropin deficiency (central hypogonadism): Men present with decreased libido, erectile dysfunction, hot flashes, gynecomastia, and infertility. Women complain of oligo/amenorrhea, infertility, decreased libido, hot flashes, vaginal dryness, and dyspareunia.

image Growth hormone (GH) deficiency: Fatigue, increased adiposity, exercise intolerance, and decreased social functioning.

image Prolactin (PRL) deficiency: Agalactia or hypolactia in postpartum women.

6. Are there any signs on physical examination that may suggest pituitary insufficiency?

Aside from delayed relaxation of tendon reflexes in hypothyroid patients, there are no specific or pathognomonic findings on physical exam. Physical findings for specific pituitary hormone deficiencies are as follows:

7. How is hypopituitarism diagnosed?

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