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Panhypopituitarism

Updated on April 22, 2020
idarainyang profile image

Idara is a medical doctor currently working with the ministry of health in Jamaica

Definition

Panhypopituitarism is a pituitary disorder caused by any condition that compresses or damages to the pituitary gland.

Panhypopituitarism

Causes

Examples of condition that damages the pituitary gland includes:

  • Tumors like meningioma, craniopharyngioma or lymphoma

  • Trauma and radiations can cause damage to pituitary gland

  • Autoimmune diseases like hemochromatosis, sarcoidosis, histiocytosis x.

  • Infections like fungi and parasites.

Causes of panhypopituitarism includes tumor, trauma, radiation, autoimmune diseases

Presentation


How does panhypopituitarism presents itself?

The symptoms are based on which hormone is deficient



Specific deficiencies

1)Prolactin deficiency

  • Men: This deficiency has no symptoms in men

  • Women: They will not be able to breastfeed after childbirth because lactation is inhibited.

2)Follicle-stimulating hormone FSH and Luteinizing hormone (LH)

  • Men: They will not be able to make testosterone and sperm. They will also experience erectile dysfunction and decreased muscle mass.

  • Women: This presents as amenorrhea; they will not be able to ovulate or menstruate.

Both men and women experience decreased libido, infertility and decrease in body hair, axillary hair and pubic hair.


An associated disorder here is a disorder called Kallmann syndrome which is characterized by:

  • decreased FSH and LH with adequate GnRH number

  • Anosmia which is a loss of the sense of smell

  • Renal agenesis in 50%

Kallman Syndrome

-Decreased FSH and LH

-Decreases GnRH

-Anosmia

-Renal agenesis

3)Growth hormone (GH) deficiency

  • Children: presents with short stature and dwarfism

  • Adults: have few subtle symptoms because they have hormones like cortisol, glucagon and catecholamines as stress hormones to cushion the effect.

The subtle symptoms include:

  • Central obesity

  • Increase in LDL and cholesterol levels

  • Reduced lean muscle mass

Diagnostic tests


Now let’s talk about the diagnostic tests involved.

  • Hyponatremia: is a condition in which there is a decrease in the level of sodium (Na) in the body.This is common in secondary hypothyroidism and isolate underproduction of glucocorticoid. Potassium level is unaffected here because it’s an isolated even and aldosterone isn’t affected.

  • MRI detects compressed muscle Lesions on the pituitary gland.

Specific Diagnostic Tests For Each Hormone

(click column header to sort results)
Standard Blood Tests  
Abnormality Confirmed With  
Low thyroid-stimulating hormone (TSH) and low thyroxine levels.
Decreased TSH response to thyrotropin-releasing hormone (TRH)
Decreased adrenocorticotropic hormone (ACTH) and decreased cortisol level.
Normal response to cosyntropin stimulation of the adrenal.Cortisol will rise (adrenal is normal) in recent disease, but abnormal in chronic disease because of adrenal atrophy.An elevated baseline cortisol level excludes pituitary insufficiency.
Decreased luteinizing hormone (LH) and follicle stimulating hormone (FSH) levels.Decreased testosterone level
No confirmatory test
Growth hormone (GH) levels low, but this finding is not helpful because GH is pulsatile and maximum at night.
No response to arginine stimulation. No response to GH releasing hormone (GHRH).
Prolactin level low, but not helpful.
No response to thyrotropin-releasing hormone (TRH)

Older and less useful tests

  • Insulin stimulation: Insulin converts glucose to glucagon, therefore, an increase in insulin leads to a decrease in the levels of glucose and an increase in the level of growth hormone (GH). Failure of GH to rise in response to insulin administration indicates pituitary insufficiency.

  • Metyrapone: Metyrapone inhibits 11 beta hydroxylase which decreases the adrenal gland output. This then increases the adrenocorticotropic hormone (ACTH) level in response to the decrease in cortisol. So, if the ACTH levels still remains low on administration of metyrapone, this indicates pituitary disorder.

Treatment

In treating these disorders, you basically have to replace the deficient hormone.

Treatment includes

  • Cortisone: in the case of cortisol deficiency

  • Thyroxine: in the case of thyroid hormone deficiency

  • Testosterone and estrogen

  • Recombinant human growth hormone: in the case of growth hormone deficiency.


Replace cortisone before starting thyroxine

Posterior Pituitary

The 2 hormones produced by the posterior pituitary gland are antidiuretic hormone (ADH) and oxytocin.

  • Oxytocin: This hormone helps in uterine contraction during delivery, but delivery will still occur even if it is absent because of the presence of other hormones like progesterone. There is no deficiency disease associated with oxytocin


  • Antidiuretic hormone (ADH): Deficiency of this hormone leads to central diabetes insipidus (CDI) characterised by decrease in the volume of urine, decreased blood concentration and increased urine concentration.

Conclusion

We talked about the definition, causes and signs and symptoms of Panhypopituitarism. We also looked at the different specific diagnostic tests and treatments available.

If you have any experience related to this condition that you will love to share, please feel free to.

Thank you!


This presentation contains images that were used under a Creative Commons License. Click here to see the full list of images and attributions:

https://link.attribute.to/cc/939457


This content is for informational purposes only and does not substitute for formal and individualized diagnosis, prognosis, treatment, prescription, and/or dietary advice from a licensed medical professional. Do not stop or alter your current course of treatment. If pregnant or nursing, consult with a qualified provider on an individual basis. Seek immediate help if you are experiencing a medical emergency.

© 2020 idara inyang

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