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| | __NOTOC__ |
| | {{DiseaseDisorder infobox | |
| | Name =Hypopituitarism | |
| | Image = Illu endocrine system New.png | |
| | Caption = Hypopituitarism - By US Government, Via: Wikimedia.org<ref> <http://training.seer.cancer.gov/module_anatomy/unit6_3_endo_glnds.html>''Public Domain''<https://commons.wikimedia.org/w/index.php?curid=15860440> </ref>| |
| | }} |
| | {{Hypopituitarism}} |
| | {{CMG}}; {{AE}} {{AEL}} {{IQ}} |
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| '''For patient information click [[{{PAGENAME}} (patient information)|here]]''' | | '''For patient information click [[{{PAGENAME}} (patient information)|here]]''' |
| {{SI}}
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| __NOTOC__
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| {{CMG}}
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| {{Editor Join}} | | {{SK}} Pituitary failure, Adenohypophyseal hyposecretion, Panhypopituitarism |
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| | {{Infobox_Disease | |
| | Name = Hypopituitarism | |
| | Image = | |
| | Caption = | |
| | DiseasesDB = 6522| |
| | ICD10 = {{ICD10|E|23|0|e|20}}, {{ICD10|E|89|3|e|70}} | |
| | ICD9 = {{ICD9|253.7}}| |
| | ICDO = | |
| | OMIM = | |
| | MedlinePlus = 000343 | |
| | MeshID = D007018 | |
| | }} |
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| | ==[[Hypopituitarism overview|Overview]]== |
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| == Overview == | | ==[[Hypopituitarism historical perspective|Historical Perspective]]== |
| '''Hypopituitarism''' is a medical term describing the deficiency (''hypo'') of one or more [[hormone]]s of the [[pituitary gland]]. The [[hypothalamus]] regulates pituitary secretion by the production of ''releasing hormones'' and [[posterior pituitary]] hormones and hence its dysfunction can also lead to hypopituitarism.
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| In [[endocrinology]], deficiency of one or multiple hormones of the [[anterior pituitary]] is generally referred to as ''hypopituitarism'', while deficiency of the posterior lobe generally only leads to [[Diabetes insipidus#Pathophysiology|central]] [[diabetes insipidus]]. The deficiency of ''all'' [[anterior pituitary]] hormones is termed '''panhypopituitarism'''.
| | ==[[Hypopituitarism classification|Classification]]== |
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| ==Physiology== | | ==[[Hypopituitarism pathophysiology|Pathophysiology]]== |
| The hormones of the anterior pituitary include 2 [[protein]]s, 3 [[glycoprotein]]s and a polypeptide:
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| #[[prolactin]] (PRL) - stimulates milk production in the [[breast]]
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| #[[growth hormone]] (GH) - growth and [[glucose]] homeostasis
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| #[[luteinizing hormone]] (LH) - [[menstrual cycle]] and reproduction
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| #[[follicle stimulating hormone]] (FSH) - same
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| #[[thyroid stimulating hormone]] (TSH) - stimulates [[thyroxine]] production in the [[thyroid]]
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| #[[adrenocorticotropic hormone]] (ACTH) - stimulates [[glucocorticoid]] production in the [[adrenal gland]]
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| These hormones are secreted in individually characteristic pulsatile patterns, often with distinct [[circadian rhythm]], rather than at steady rates throughout 24 hours.
| | ==[[Hypopituitarism causes|Causes]]== |
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| The posterior pituitary is the site of release of the nonapeptide hormones [[antidiuretic hormone]] (ADH) and [[oxytocin]], the former regulating plasma [[osmolarity]] and the latter regulating [[uterus|uterine]] [[contraction (childbirth)|contractions]] during [[childbirth]] as well milk ejection from the breasts.
| | ==[[Hypopituitarism differential diagnosis|Differentiating Hypopituitarism from other Diseases]]== |
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| ==Multiple hormone deficiencies== | | ==[[Hypopituitarism epidemiology and demographics|Epidemiology and Demographics]]== |
| Deficiency of a single pituitary hormone occurs less commonly than deficiency of more than one hormone. Sometimes referred to as progressive pituitary hormone deficiency or partial hypopituitarism, there is usually a predictable order of hormone loss.
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| Generally, growth hormone is lost first, then luteinizing hormone deficiency follows. The loss of follicle-stimulating hormone, thyroid stimulating hormone, adrenocorticotopic hormones and prolactin typically follow much later. The progressive loss of pituitary hormone secretion is usually a slow process, which can occur over a period of months or years. Hypopituitarism does occasionally start suddenly with rapid onset of symptoms
| | ==[[Hypopituitarism risk factors|Risk Factors]]== |
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| Most people with hypopituitarism lack growth hormone as well as one or more others. As for the posterior pituitary, antidiuretic hormone deficiency is the main problem, while oxytocin deficiency rarely causes clinically significant problems.
| | ==[[Hypopituitarism screening|Screening]]== |
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| ==Causes== | | ==[[Hypopituitarism natural history, complications and prognosis|Natural History, Complications and Prognosis]]== |
| Hypopituitarism and panhypopituitarism can be congenital or acquired. A partial list of causes and forms:
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| * Congenital hypopituitarism
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| **Hypoplasia of the pituitary
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| ***Isolated idiopathic congenital hypopituitarism
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| ***Associated with other congenital [[syndrome]]s and [[birth defect]]s
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| ****[[Septo-optic dysplasia]]
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| ****[[Holoprosencephaly]]
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| ****[[Chromosome 22 deletion syndrome]]
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| ****Rapaport syndrome
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| ** Single gene defect forms of anterior pituitary hormone deficiency
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| * Acquired hypopituitarism (Simmonds' disease)
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| ** [[Physical trauma|trauma]] (e.g., skull base fracture)
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| ** [[surgery]] (e.g., removal of pituitary neoplasm)
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| ** [[tumor]] - secretory and non-secretory (20%) [[Pituitary adenoma|pituitary]] or hypothalamic neoplasms, cause hypopituitarism by compressing the remaining tissue
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| ** [[inflammation]] (e.g. [[sarcoidosis]] or autoimmune hypophysitis)
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| ** [[radiation]] (e.g., after cranial irradiation for childhood [[leukemia]])
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| ** [[Shock (medical)|shock]]
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| *** ([[Sheehan's syndrome]] is hypopituitarism after heavy [[hemorrhage|bleeding]] in [[childbirth]])
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| ** [[haemochromatosis|hemochromatosis]]
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| * other diseases.
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| ==Diagnosis== | | ==Diagnosis== |
| Hypopituitarism may come to medical attention by symptoms or features of pituitary hormone deficiency (e.g., poor [[growth]], [[hypoglycemia]], [[micropenis]], [[delayed puberty]], [[polyuria]], [[impaired libido]], [[Fatigue (physical)|fatigue]], and many others), or because the physician has diagnosed one of the many disorders and conditions associated with hypopituitarism listed above and tests for it. A provocative test ([[triple bolus test]]) measures the secretory response of the pituitary to a stimulus (other hormones, drugs, exercise, etc.) by measuring serum levels of the hormone involved. | | [[Hypopituitarism history and symptoms| History and Symptoms]] | [[Hypopituitarism physical examination | Physical Examination]] | [[Hypopituitarism laboratory findings|Laboratory Findings]] | [[Hypopituitarism electrocardiogram|Electrocardiogram]] | [[Hypopituitarism x ray|X Ray]] | [[Hypopituitarism CT|CT]] | [[Hypopituitarism MRI|MRI]] | [[Hypopituitarism ultrasound|Ultrasound]] | [[Hypopituitarism other imaging findings|Other Imaging Findings]] | [[Hypopituitarism other diagnostic studies|Other Diagnostic Studies]] |
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| ==Complete differential diagnosis for hypopituitarism== | | ==Treatment== |
| *[[Anorexia Nervosa]]
| | [[Hypopituitarism medical therapy|Medical Therapy]] | [[Hypopituitarism surgery|Surgery]] | [[Hypopituitarism primary prevention|Primary Prevention]] | [[Hypopituitarism secondary prevention|Secondary Prevention]] | [[Hypopituitarism cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Hypopituitarism future or investigational therapies|Future or Investigational Therapies]] |
| *[[Bulimia Nervosa]]
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| *Changes in body weight
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| *[[Congestive Heart Failure]]
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| *Emotional disorders
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| *[[Empty Sella Syndrome]]
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| *Habitual exercise
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| *Head Trauma
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| *[[Hemochromatosis]]
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| *Infection
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| :*Fungal
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| :*[[Malaria]]
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| :*[[Meningitis]]
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| :*[[Syphillis]]
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| :*[[Tuberculosis]]
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| *Ischemic nerosis of the pituitary
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| :*Anticoagulant therapy
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| :*[[Arteriosclerosis]]
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| :*[[Arteritis temporalis]]
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| :*Blood dyscrasias
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| :*Brain Trauma
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| :*[[Diabetes Mellitus]]
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| :*Eclampsia
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| :*Increased cranial pressure
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| :*[[Sheehan's Syndrome]]
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| :*[[Sickle Cell Anemia]]
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| :*Tumor
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| *Latrogenic
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| *Parasellar tumor/pituitary compression
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| :*Craniopharyngioma
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| :*Chromophobe adenoma
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| :*Intracranial cartoid branch aneurysm
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| :*Lymphoma
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| :*Meningioma
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| :*Metasteses
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| :*Optic nerve neurinoma
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| *Pituitary adenomas
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| *[[Renal Failure]]
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| *[[Sarcoidosis]]
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| *[[Wegener's Granulomatosis]]
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| ==Replacement therapy== | | ==Case Studies== |
| Hypopituitarism and panhypopituitarism are treated by replacement of appropriate hormones. Since most of the anterior pituitary hormones are [[protein]]s or [[glycoprotein]]s released in pulsatile patterns, whose functions are to induce secretion of smaller molecule hormones ([[thyroid]] hormones and [[steroid]]s), it is simpler and less expensive for most purposes to simply replace the target gland hormones. There are a few exceptions, such as fertility induction.
| | [[Hypopituitarism case study one|Case#1]] |
| *[[growth hormone|GH]] is replaced with [[growth hormone treatment|growth hormone]].
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| *TSH is replaced with [[thyroxine]].
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| *ACTH is usually replaced with [[hydrocortisone]] but any [[glucocorticoid]] may be used.
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| *LH and FSH are most often replaced by supplying the appropriate [[sex steroid]]s (e.g., [[testosterone]] or [[estrogen]] and [[progestin]]). Virtually all people who need T or E2 replacement for hypopituitarism rarely have spontaneous, effective [[spermatogenesis]] or [[ovarian follicle|follicular]] maturation. Both [[GnRH]] by subcutaneous pump and [[gonadotropin]]s (Pergonal) by daily subcutaneous injections have been used effectively to induce [[infertility|fertility]].
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| *Prolactin is not usually replaced, as [[infant formula]] is readily available, simpler, and much cheaper.
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| *ADH is replaced most commonly with oral, nasal, and sometimes intravenous or subcutaneous [[desmopressin]].
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| *[[Oxytocin]] is most important during labor and delivery at the end of pregnancy, and can be replaced in that circumstance by pitressin.
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| ==See also== | | ==Related Chapters== |
| * [[growth hormone deficiency]] | | * [[Growth hormone deficiency]] |
| * [[pituitary gland]] | | * [[Pituitary gland]] |
| * [[Kallmann syndrome]] | | * [[Kallmann syndrome]] |
| * [[Empty sella syndrome]] | | * [[Empty sella syndrome]] |
| * [[Insulin tolerance test]] | | * [[Insulin tolerance test]] |
| | * [[Hypothyroidism]] |
| | * [[Hypogonadism]] |
| | * [[Sheehan's syndrome]] |
| | * [[Diabetes insipidus]] |
| | * [[Adrenal insufficiency (patient information)|Adrenal insufficiency]] |
| | * [[Pituitary apoplexy]] |
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| ==External links== | | ==References== |
| * [http://www.hypopituitarism.info/ All about Hypopituitarism]
| | {{reflist|2}} |
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| {{Endocrine pathology}} | | |
| {{SIB}} | | {{WS}} |
| | {{WH}} |
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| [[Category:DiseaseState]] | | [[Category:Medicine]] |
| [[Category:Endocrinology]] | | [[Category:Endocrinology]] |
| | | [[Category:Up-To-Date]] |
| [[de:Hypophyseninsuffizienz]] | |
| [[es:Hipopituitarismo]]
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| [[no:Hypotyreose]]
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| [[sv:Hypofysinsufficiens]]
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