Pituitary Gland Disorders: Hypopituitarism
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Questions and Answers

What is a common manifestation of GH excess in acromegaly?

  • Hyperhidrosis
  • Photophobia
  • Weight gain
  • Acral enlargement (correct)
  • Which hormone deficiency can lead to fatigue and lethargy?

  • Growth hormone deficiency
  • Gonadotropin deficiency
  • TSH deficiency
  • ACTH deficiency (correct)
  • What is the most common initial treatment for prolactinoma?

  • Transsphenoidal procedure
  • Cabergoline (correct)
  • Bromocriptine
  • Surgical removal
  • Which demographic group is most affected by gigantism due to GH excess?

    <p>Children and adolescents</p> Signup and view all the answers

    What is a common local manifestation of acromegaly?

    <p>Enlarged sella</p> Signup and view all the answers

    Which symptom is NOT typically associated with GH excess in acromegaly?

    <p>Photophobia</p> Signup and view all the answers

    Which condition is NOT a potential disturbance of other endocrine functions in acromegaly?

    <p>Papillomas</p> Signup and view all the answers

    What is a characteristic morphological change in the face seen in acromegaly?

    <p>Marked macroglossia (OSA)</p> Signup and view all the answers

    What is the most commonly used medical treatment for prolactinoma due to its potency and tolerability?

    <p>Cabergoline</p> Signup and view all the answers

    Which clinical feature is NOT typically seen in adults with a growth hormone deficiency?

    <p>Increased appetite</p> Signup and view all the answers

    In children with growth hormone deficiency, what is a common manifestation?

    <p>Delayed puberty</p> Signup and view all the answers

    Which symptom is NOT typically associated with hypogonadotropic deficiency in men?

    <p>Increased muscle mass</p> Signup and view all the answers

    What is a common clinical feature of TSH deficiency (2° hypothyroidism)?

    <p>Constipation</p> Signup and view all the answers

    Which clinical feature is commonly observed in ACTH deficiency (2° adrenocortical insufficiency)?

    <p>Weight loss</p> Signup and view all the answers

    Which of the following is NOT a common sign of hypothyroidism in adults?

    <p>Tachycardia</p> Signup and view all the answers

    What is a distinctive clinical feature of hypogonadotropic deficiency in women before puberty?

    <p>Primary amenorrhea</p> Signup and view all the answers

    What is a common presentation of growth hormone excess in adults beyond fatigue and decreased muscle mass?

    <p>Development of acromegaly</p> Signup and view all the answers

    In children with growth hormone excess, what might be a potential issue if left untreated?

    <p>Excessive linear growth</p> Signup and view all the answers

    Which symptom is NOT typically associated with acromegaly?

    <p>Weight loss</p> Signup and view all the answers

    Study Notes

    Hypopituitarism

    • Manifested by diminished or absent secretion of one or more pituitary hormones
    • Development of signs and symptoms is often slow and insidious
    • May be a single hormone deficiency or multiple hormone deficiencies
    • Treatment and prognosis depend on the extent of hypofunction, the underlying cause, and the location of the lesion

    GH Deficiency

    • In children: short stature
    • In adults: fatigue, decreased muscle mass, loss of libido

    Hypogonadotropic Deficiency (Hypogonadism)

    • In women:
      • Before puberty: primary amenorrhea and failure of puberty development
      • After puberty: secondary amenorrhea and regression of sexual characteristics
      • Infertility
    • In men:
      • Before puberty: failure of puberty development
      • After puberty: decreased libido or impotence, loss of secondary sexual characteristics
      • Infertility

    TSH Deficiency (2° Hypothyroidism)

    • Clinical features of hypothyroidism:
      • Cold intolerance
      • Dry skin
      • Loss of hair
      • Mental dullness
      • Constipation

    ACTH Deficiency (2° Adrenal Insufficiency)

    • Clinical features of adrenal insufficiency:
      • Weakness
      • Nausea and vomiting
      • Anorexia
      • Weight loss
      • Postural hypotension

    Causes of Hypopituitarism

    • Infarction: postpartum necrosis (Sheehan syndrome), vascular disease, head trauma
    • Infections: tuberculosis, fungi, pyogenic, syphilis, toxoplasmosis
    • Granulomas: sarcoidosis, histiocytosis
    • Autoimmune lymphocytic hypophysitis
    • Neoplasms: pituitary adenoma, craniopharyngioma, metastasis or primary carcinoma (rare)
    • Aneurysm of internal carotid artery
    • Hemochromatosis
    • Idiopathic or genetic: deficient production of pituitary hormone, synthesis of abnormal hormone
    • Iatrogenic: stalk section, radiation, hypophysectomy
    • Primary hypothalamic disorders: tumors (craniopharyngioma), granulomas (histiocytosis x), genetic or idiopathic, head trauma, structural anomalies of hypothalamus

    Diagnostic Evaluation of Hypothalamic-Pituitary-Target Gland Hypofunction

    • Evaluate GH in children
    • Measure prolactin if hypogonadism suspected

    Treatment of Hypopituitarism

    • Deficient hormone therapy:
      • TSH: L-thyroxine
      • ACTH: hydrocortisone
      • LH&FSH:
        • Men: testosterone
        • Women: cyclic estrogen and progesterone
      • GH: GH therapy

    Hyperpituitarism

    • Pituitary tumors
      • Account for 10% of intracranial neoplasm
      • Most sellar region masses are pituitary adenomas (85%), followed by craniopharyngiomas, Rathke cleft cysts, meningiomas, and metastases

    Growth Hormone Secreting Adenoma

    • Leads to gigantism in childhood and adolescence
    • Leads to acromegaly in adults
    • Clinical features:
      • Acral enlargement
      • Soft tissue overgrowth
      • Hyperhidrosis
      • Hypertrichosis
      • Lethargy or fatigue
      • Goiter
      • Weight gain
      • Hypertension
      • Paresthesia
      • Cardiomegaly
      • Joint pain
      • Renal calculi
    • Laboratory findings:
      • Increased plasma glucose and insulin
      • Elevated serum phosphate and hypercalciuria
      • Elevated GH

    Acromegaly

    • Clinical features:
      • Frontal bossing
      • Chin protrusion
      • Hunched back (kyphosis)
      • Large hands
      • Hypothyroidism
      • Galactorrhea
      • Gynecomastia
      • Hypoadrenalism
      • Marked macroglossia (OSA)
      • Skin tags
    • Laboratory findings:
      • Increased plasma glucose and insulin
      • Elevated serum phosphate and hypercalciuria
      • Elevated GH

    Prolactinomas

    • Constitute about 60% of all pituitary adenoma
    • More common in women
    • Clinical features:
      • In women: amenorrhea, oligomenorrhea with anovulation, or infertility, galactorrhea
      • In men: decreased libido, impotence, infertility, galactorrhea

    Causes of Hyperprolactinemia

    • Physiological:
      • Pregnancy
      • Nursing
      • Nipple stimulation
      • Exercise
      • Stress (hypoglycemia)
      • Sleep
      • Seizures
      • Neonatal
    • Pathologic:
      • Pituitary tumors
      • Hypothalamic/pituitary stalk lesions
      • Neuraxis irradiation
      • Chest wall lesions
      • Spinal cord lesions
      • Hypothyroidism
      • Chronic kidney disease
      • Severe liver disease
    • Pharmacologic:
      • TRH
      • Estrogen
      • Vasoactive intestinal peptide
      • Dopamine antagonists (phenothiazines, haloperidol, risperidone, metoclopramide, reserpine, methyldopa, amoxapine, opioids)
      • MAO inhibitors
      • Verapamil
      • Licorice

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    Description

    Explore the manifestations, slow development of signs, single or multiple hormone deficiencies, and treatment options for Hypopituitarism. Understand the symptoms of GH deficiency in children and adults.

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