Rav Endocrinology Causes And Treatment Of Hypopituitarism

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major cause of hypopituitarism

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The congenital combined deficiencies of GH, prolactin, and thyroid-stimulating hormone (TSH) are a major cause of hypopituitarism and are themselves caused by mutations in the genes for transcription factors (Table 9 ). Gene mutations have also been found for releasing factor receptors, pituitary hormones, and pituitary target organ receptors.

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Neoplastic lesions, particularly pituitary adenomas, cause hypopituitarism by

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Neoplastic lesions, particularly pituitary adenomas, cause hypopituitarism by direct compression of the normal pituitary gland or by disruption of the pituitary stalk

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Conventional and stereotactic gamma knife irradiation causes a progressive hypopituitarism through

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Conventional and stereotactic gamma knife irradiation causes a progressive hypopituitarism through damage to the hypothalamus and the pituitary gland. Hypopituitarism also has been found to occur after traumatic brain injury and subarachnoid hemorrhage in 35% to 50% of patients studied.

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Pituitary tumor apoplexy, which is due to hemorrhagic infarction and is characterized by

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Pituitary tumor apoplexy, which is due to hemorrhagic infarction and is characterized by the sudden onset of headache, stiff neck, fever, and (sometimes) ophthalmoplegia, can also cause hypopituitarism. Acute hormone replacement and surgical decompression are often necessary to treat this disorder.

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Sheehan syndrome

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Sheehan syndrome, another cause of hypopituitarism, is due to silent pituitary infarction and is usually associated with obstetric hemorrhage and hypotension. Acutely, vascular collapse may occur, but this syndrome more commonly presents with amenorrhea, a postpartum inability to lactate, and fatigue due to central hypothyroidism or secondary adrenal insufficiency.

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lymphocytic hypophysitis

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In lymphocytic hypophysitis, a destructive lymphocytic infiltration causes hypopituitarism and, possibly, symptoms of a mass lesion. Adrenocorticotropic hormone (ACTH) insufficiency and adrenal insufficiency are particularly common with this disorder and can be lethal if undetected. Most cases of lymphocytic hypophysitis occur during or after pregnancy. Resolution of hypopituitarism in patients with lymphocytic hypophysitis is uncommon.

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GH and gonadotropins are generally lost before

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GH and gonadotropins are generally lost before ACTH and TSH in most patients, but this finding is not consistent.

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Because ACTH/cortisol deficiency can be potentially life-threatening, what should be assessedhould always be assessed in patients suspected of having hypopituitarism

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Because ACTH/cortisol deficiency can be potentially life-threatening, the hypothalamic-pituitary axis should always be assessed in patients suspected of having hypopituitarism and should be assessed before other axes. An 8 AM measurement of a patient’s serum cortisol level is helpful in diagnosing ACTH deficiency (see Disorders of the Adrenal Glands). Cortisol deficiency must always be addressed first in patients who have hypopituitarism because doing so can be life-saving. If thyroid hormone is replaced before cortisol, the former would speed the body’s metabolism so that the small amount of cortisol that could be made would be metabolized more rapidly, and the patient could potentially go into a hypoadrenal crisis. Despite conventional hormone replacement, there is a twofold excess mortality in patients with hypopituitarism.

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is helpful in diagnosing ACTH deficiency

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An 8 AM measurement of a patient’s serum cortisol level is helpful in diagnosing ACTH deficiency (see Disorders of the Adrenal Glands).

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must always be addressed first in patients who have hypopituitarism because doing so can be life-saving.

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Cortisol deficiency must always be addressed first in patients who have hypopituitarism because doing so can be life-saving. If thyroid hormone is replaced before cortisol, the former would speed the body’s metabolism so that the small amount of cortisol that could be made would be metabolized more rapidly, and the patient could potentially go into a hypoadrenal crisis. Despite conventional hormone replacement, there is a twofold excess mortality in patients with hypopituitarism.

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Cortisol deficiency must always be addressed first in patients who have hypopituitarism because

Back 11

Cortisol deficiency must always be addressed first in patients who have hypopituitarism because doing so can be life-saving. If thyroid hormone is replaced before cortisol, the former would speed the body’s metabolism so that the small amount of cortisol that could be made would be metabolized more rapidly, and the patient could potentially go into a hypoadrenal crisis. Despite conventional hormone replacement, there is a twofold excess mortality in patients with hypopituitarism.