19 Questions
What is a common manifestation of GH excess in acromegaly?
Acral enlargement
Which hormone deficiency can lead to fatigue and lethargy?
ACTH deficiency
What is the most common initial treatment for prolactinoma?
Cabergoline
Which demographic group is most affected by gigantism due to GH excess?
Children and adolescents
What is a common local manifestation of acromegaly?
Enlarged sella
Which symptom is NOT typically associated with GH excess in acromegaly?
Photophobia
Which condition is NOT a potential disturbance of other endocrine functions in acromegaly?
Papillomas
What is a characteristic morphological change in the face seen in acromegaly?
Marked macroglossia (OSA)
What is the most commonly used medical treatment for prolactinoma due to its potency and tolerability?
Cabergoline
Which clinical feature is NOT typically seen in adults with a growth hormone deficiency?
Increased appetite
In children with growth hormone deficiency, what is a common manifestation?
Delayed puberty
Which symptom is NOT typically associated with hypogonadotropic deficiency in men?
Increased muscle mass
What is a common clinical feature of TSH deficiency (2° hypothyroidism)?
Constipation
Which clinical feature is commonly observed in ACTH deficiency (2° adrenocortical insufficiency)?
Weight loss
Which of the following is NOT a common sign of hypothyroidism in adults?
Tachycardia
What is a distinctive clinical feature of hypogonadotropic deficiency in women before puberty?
Primary amenorrhea
What is a common presentation of growth hormone excess in adults beyond fatigue and decreased muscle mass?
Development of acromegaly
In children with growth hormone excess, what might be a potential issue if left untreated?
Excessive linear growth
Which symptom is NOT typically associated with acromegaly?
Weight loss
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
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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