ArtsAutosBooksBusinessEducationEntertainmentFamilyFashionFoodGamesGenderHealthHolidaysHomeHubPagesPersonal FinancePetsPoliticsReligionSportsTechnologyTravel

Clinical Manifestations Of Hypofunction Of Pituitary Gland Disorders: Hypopituitarism

Updated on February 9, 2014

Sheehan's Syndrome

One of the common modes of presentation is Sheehan’s syndrome in which the hyperplastic pituitary of pregnancy which is vulnerable for ischemic damage undergoes infarction due to postpartum hemorrhage and shock.
One of the common modes of presentation is Sheehan’s syndrome in which the hyperplastic pituitary of pregnancy which is vulnerable for ischemic damage undergoes infarction due to postpartum hemorrhage and shock. | Source

A General Overview

When there is failure of one or more cell types of the pituitary to secrete normally, hypopituitarism results. It is unusual to get deficiencies of single hormones. More often several hormones are deficient. The condition commonly presents as dwarfism in children and hypogonadism in adults. Hypopituitarism may result from different pathological processes.

Causes:

  1. Removal of the gland by surgery or irradiation.
  2. Tumours of the pituitary, suprasella tumours or carcinomatous seconday deposits.
  3. Granulomatous diseases- Sarcoidosis, Hand-Schuller Christian disease, eosinophilic granuloma.
  4. Infiltrations- Leukemia, lymphoma.
  5. Infarction- Postpartum necrosis due to hemorrhage (Sheehan’s syndrome), diabetes, sickle cell disease, cavernous sinus thrombosis, temporal arteritis, carotid aneurysm.
  6. Infections- tuberculosis, syphilis
  7. Viperine snake bite- panhypopituitarism has been recorded in many cases, several years after recovery from viper bite.

Adult panhypopituitarism

Symptoms depend on the type and severity of cell failure, age of the patient and the age of onset of the disease. The condition becomes overt only when more than 75% of cells are destroyed. Gonadotropin, growth hormone, thyrotropin and ACTH are all reduced in different proportions. Hypoprolactinemia manifests only during the puerperium as failure of lactation.

Clinical features: One of the common modes of presentation is Sheehan’s syndrome in which the hyperplastic pituitary of pregnancy which is vulnerable for ischemic damage undergoes infarction due to postpartum hemorrhage and shock. The earliest manifestation is failure of lactation. The patient develops amenorrhea, genital atrophy, loss of axillary and pubic hair, and loss of libido. Men with hypopituitarism present with testicular atrophy, loss of libido and absence of spermatogenesis. Failure of ACTH leads to secondary adrenal cortical failure. As the hypopituitarism advances, thyroid hormone deficiency also manifests. It is rare to get classical myxedema. The reduction in growth hormone is not usually evident clinically. The symptoms of GH deficiency include lack of strength due to reduction in muscle mass, increased insulin sensitivity and mild refractory anemia.

Differential diagnosis: Panhypopituitarism has to be differentiated from other causes of dwarfism, general debility and asthenia. Anorexia nervosa which affects young women between the ages of 15 and 30 may mimic hypopituitarism. In anorexia nervosa, all the pituitary hormones except GH are decreased. With weight loss of more than 20% amenorrhea may also develop. Unlike hypopituitarism, the public and axillary hair are retained. Moreover, emaciation is more suggestive of anorexia nervosa.

Hypopituitary

Failure of ACTH leads to secondary adrenal cortical failure. As the hypopituitarism advances, thyroid hormone deficiency also manifests. It is rare to get classical myxedema.
Failure of ACTH leads to secondary adrenal cortical failure. As the hypopituitarism advances, thyroid hormone deficiency also manifests. It is rare to get classical myxedema. | Source

Investigations And Management

Investigations

The diagnosis of panhypopituitarism is established by estimating the pituitary hormones and the hormones of the target glands. Stimulation tests reveal the functional integrity of the target glands.

  1. ACTH secretion: When adrenal response to ACTH is established, metyrapone test or insulin hypoglycemia may be used to test the pituitary reserve of ACTH.
  2. TSH reserve: This can be easily assessed by administration of TRH. This could also elucidate the PRL secretory status of pituitary.

Management

This consists of replacement of the hormones of the target organs. Cortisol deficiency is corrected with 12.5-25mg of cortiso or its equivalent of other synthetic steroids. Glucocorticoids should be replaced before supplementation of thyroxine and gonadotropins in order to avoid the development of adrenal crisis. Glucocorticoid replacement should be increased during periods of acute stress like operations and infections. Mineralocorticoid replacement is not usually needed since this hormone is not markedly deficient in hypopituitarism. Thyroid replacement is best achieved with synthetic thyroxine started in a dose of 50-100 ug/Kg and raised to a dose of 150- 200ug slowly.

Testosterone replacement improves vigour, vitality and libido. The oral preparation is methyl testosterone. Alternatively, testosterone can be given intramuscularly as depot injections. Estrogen and progesterone therapy prevent atrophy of the breasts and vaginal mucosa and osteroporosis.

Finally, Gonadotropin replacement is essential for return of ovulation and spermatogenesis. Short courses of a mixture of FSH and LH (menotropins) followed by human chorionic gonadotropins (HCG) are used to induce ovulation.

© 2014 Funom Theophilus Makama

Comments

    0 of 8192 characters used
    Post Comment

    No comments yet.

    working

    This website uses cookies

    As a user in the EEA, your approval is needed on a few things. To provide a better website experience, hubpages.com uses cookies (and other similar technologies) and may collect, process, and share personal data. Please choose which areas of our service you consent to our doing so.

    For more information on managing or withdrawing consents and how we handle data, visit our Privacy Policy at: https://hubpages.com/privacy-policy#gdpr

    Show Details
    Necessary
    HubPages Device IDThis is used to identify particular browsers or devices when the access the service, and is used for security reasons.
    LoginThis is necessary to sign in to the HubPages Service.
    Google RecaptchaThis is used to prevent bots and spam. (Privacy Policy)
    AkismetThis is used to detect comment spam. (Privacy Policy)
    HubPages Google AnalyticsThis is used to provide data on traffic to our website, all personally identifyable data is anonymized. (Privacy Policy)
    HubPages Traffic PixelThis is used to collect data on traffic to articles and other pages on our site. Unless you are signed in to a HubPages account, all personally identifiable information is anonymized.
    Amazon Web ServicesThis is a cloud services platform that we used to host our service. (Privacy Policy)
    CloudflareThis is a cloud CDN service that we use to efficiently deliver files required for our service to operate such as javascript, cascading style sheets, images, and videos. (Privacy Policy)
    Google Hosted LibrariesJavascript software libraries such as jQuery are loaded at endpoints on the googleapis.com or gstatic.com domains, for performance and efficiency reasons. (Privacy Policy)
    Features
    Google Custom SearchThis is feature allows you to search the site. (Privacy Policy)
    Google MapsSome articles have Google Maps embedded in them. (Privacy Policy)
    Google ChartsThis is used to display charts and graphs on articles and the author center. (Privacy Policy)
    Google AdSense Host APIThis service allows you to sign up for or associate a Google AdSense account with HubPages, so that you can earn money from ads on your articles. No data is shared unless you engage with this feature. (Privacy Policy)
    Google YouTubeSome articles have YouTube videos embedded in them. (Privacy Policy)
    VimeoSome articles have Vimeo videos embedded in them. (Privacy Policy)
    PaypalThis is used for a registered author who enrolls in the HubPages Earnings program and requests to be paid via PayPal. No data is shared with Paypal unless you engage with this feature. (Privacy Policy)
    Facebook LoginYou can use this to streamline signing up for, or signing in to your Hubpages account. No data is shared with Facebook unless you engage with this feature. (Privacy Policy)
    MavenThis supports the Maven widget and search functionality. (Privacy Policy)
    Marketing
    Google AdSenseThis is an ad network. (Privacy Policy)
    Google DoubleClickGoogle provides ad serving technology and runs an ad network. (Privacy Policy)
    Index ExchangeThis is an ad network. (Privacy Policy)
    SovrnThis is an ad network. (Privacy Policy)
    Facebook AdsThis is an ad network. (Privacy Policy)
    Amazon Unified Ad MarketplaceThis is an ad network. (Privacy Policy)
    AppNexusThis is an ad network. (Privacy Policy)
    OpenxThis is an ad network. (Privacy Policy)
    Rubicon ProjectThis is an ad network. (Privacy Policy)
    TripleLiftThis is an ad network. (Privacy Policy)
    Say MediaWe partner with Say Media to deliver ad campaigns on our sites. (Privacy Policy)
    Remarketing PixelsWe may use remarketing pixels from advertising networks such as Google AdWords, Bing Ads, and Facebook in order to advertise the HubPages Service to people that have visited our sites.
    Conversion Tracking PixelsWe may use conversion tracking pixels from advertising networks such as Google AdWords, Bing Ads, and Facebook in order to identify when an advertisement has successfully resulted in the desired action, such as signing up for the HubPages Service or publishing an article on the HubPages Service.
    Statistics
    Author Google AnalyticsThis is used to provide traffic data and reports to the authors of articles on the HubPages Service. (Privacy Policy)
    ComscoreComScore is a media measurement and analytics company providing marketing data and analytics to enterprises, media and advertising agencies, and publishers. Non-consent will result in ComScore only processing obfuscated personal data. (Privacy Policy)
    Amazon Tracking PixelSome articles display amazon products as part of the Amazon Affiliate program, this pixel provides traffic statistics for those products (Privacy Policy)