Hypopituitarism natural history, complications and prognosis: Difference between revisions
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==Overview== | ==Overview== | ||
The natural history of hypopituitarism depends on the different clinical manifestations. If hypogonadism is left untreated, it will lead to decrease bone density and osteoporosis. Vasopressin deficiency will end up to dehydration and electrolyte imbalance. Complications of hypopituitarism include adrenal crisis, | The natural history of hypopituitarism depends on the different clinical manifestations. If [[hypogonadism]] is left untreated, it will lead to decrease [[bone density]] and [[osteoporosis]]. [[Vasopressin]] deficiency will end up to [[dehydration]] and [[electrolyte imbalance]]. Complications of hypopituitarism include [[adrenal crisis]], [[pseudotumor cerebri]], and [[diabetes mellitus]]. Hypopituitarism has a good prognosis as long as the [[hormonal replacement therapy]] is performed properly. | ||
==Natural History== | ==Natural History== | ||
Hypopituitarism develops different symptoms according to the affected part of the pituitary gland and the deficient hormone. Leaving hypopituitarism without treatment can lead to critical consequences. The natural history depends on the different manifestations of the disease as the following:<ref name="Vance1994">{{cite journal|last1=Vance|first1=Mary Lee|title=Hypopituitarism|journal=New England Journal of Medicine|volume=330|issue=23|year=1994|pages=1651–1662|issn=0028-4793|doi=10.1056/NEJM199406093302306}}</ref> | Hypopituitarism develops different symptoms according to the affected part of the pituitary gland and the deficient hormone. Leaving hypopituitarism without treatment can lead to critical consequences. The natural history depends on the different manifestations of the disease as the following:<ref name="Vance1994">{{cite journal|last1=Vance|first1=Mary Lee|title=Hypopituitarism|journal=New England Journal of Medicine|volume=330|issue=23|year=1994|pages=1651–1662|issn=0028-4793|doi=10.1056/NEJM199406093302306}}</ref> | ||
*'''Hypogonadism''': | *'''Hypogonadism''': | ||
**In both genders, if left untreated, it will lead to decrease bone density and osteoporosis.<ref name="KlibanskiNeer1980">{{cite journal|last1=Klibanski|first1=Anne|last2=Neer|first2=Robert M.|last3=Beitins|first3=Inese Z.|last4=Ridgway|first4=E. Chester|last5=Zervas|first5=Nicholas T.|last6=McArthur|first6=Janet W.|title=Decreased Bone Density in Hyperprolactinemic Women|journal=New England Journal of Medicine|volume=303|issue=26|year=1980|pages=1511–1514|issn=0028-4793|doi=10.1056/NEJM198012253032605}}</ref> | **In both genders, if left untreated, it will lead to decrease [[bone density]] and [[osteoporosis]].<ref name="KlibanskiNeer1980">{{cite journal|last1=Klibanski|first1=Anne|last2=Neer|first2=Robert M.|last3=Beitins|first3=Inese Z.|last4=Ridgway|first4=E. Chester|last5=Zervas|first5=Nicholas T.|last6=McArthur|first6=Janet W.|title=Decreased Bone Density in Hyperprolactinemic Women|journal=New England Journal of Medicine|volume=303|issue=26|year=1980|pages=1511–1514|issn=0028-4793|doi=10.1056/NEJM198012253032605}}</ref> | ||
**In women, there may be increase risk of coronary artery disease due to depletion of the estrogen level in women.<ref name="MatthewsMeilahn1989">{{cite journal|last1=Matthews|first1=Karen A.|last2=Meilahn|first2=Elaine|last3=Kuller|first3=Lewis H.|last4=Kelsey|first4=Sheryl F.|last5=Caggiula|first5=Arlene W.|last6=Wing|first6=Rena R.|title=Menopause and Risk Factors for Coronary Heart Disease|journal=New England Journal of Medicine|volume=321|issue=10|year=1989|pages=641–646|issn=0028-4793|doi=10.1056/NEJM198909073211004}}</ref> | **In women, there may be an increase risk of [[Coronary heart disease|coronary artery disease]] due to depletion of the [[estrogen]] level in women.<ref name="MatthewsMeilahn1989">{{cite journal|last1=Matthews|first1=Karen A.|last2=Meilahn|first2=Elaine|last3=Kuller|first3=Lewis H.|last4=Kelsey|first4=Sheryl F.|last5=Caggiula|first5=Arlene W.|last6=Wing|first6=Rena R.|title=Menopause and Risk Factors for Coronary Heart Disease|journal=New England Journal of Medicine|volume=321|issue=10|year=1989|pages=641–646|issn=0028-4793|doi=10.1056/NEJM198909073211004}}</ref> | ||
**In men, decrease muscle mass due to depletion of the testosterone hormone levels. | **In men, decrease [[muscle mass]] due to depletion of the [[Testosterone|testosterone hormone]] levels. | ||
*'''Vasopressin deficiency''': It will end up to dehydration and electrolyte imbalance like hyponatremia. | *'''Vasopressin deficiency''': It will end up to [[dehydration]] and [[Electrolyte disturbance|electrolyte imbalance]] like [[hyponatremia]]. | ||
*'''Growth hormone deficiency''': It may lead to serious vascular conditions and may lead to death.<ref name="pmid1973979">{{cite journal| author=Rosén T, Bengtsson BA| title=Premature mortality due to cardiovascular disease in hypopituitarism. | journal=Lancet | year= 1990 | volume= 336 | issue= 8710 | pages= 285-8 | pmid=1973979 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1973979 }} </ref> | *'''Growth hormone deficiency''': It may lead to serious [[vascular]] conditions and may lead to death.<ref name="pmid1973979">{{cite journal| author=Rosén T, Bengtsson BA| title=Premature mortality due to cardiovascular disease in hypopituitarism. | journal=Lancet | year= 1990 | volume= 336 | issue= 8710 | pages= 285-8 | pmid=1973979 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1973979 }} </ref> | ||
==Complications== | ==Complications== | ||
Complications that can develop as a result of hypopituitarism are: | Complications that can develop as a result of hypopituitarism are: | ||
*Adrenal crisis: | *[[Adrenal crisis]]: | ||
**The most | **The most serious complication of hypopituitarism. It occurs in case of improper [[glucocorticoids]] replacement therapy. | ||
*Complications of growth hormone replacement therapy:<ref name="pmid16456485">{{cite journal| author=Bowlby DA, Rapaport R| title=Safety and efficacy of growth hormone therapy in childhood. | journal=Pediatr Endocrinol Rev | year= 2004 | volume= 2 Suppl 1 | issue= | pages= 68-77 | pmid=16456485 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16456485 }} </ref> | *Complications of growth hormone replacement therapy:<ref name="pmid16456485">{{cite journal| author=Bowlby DA, Rapaport R| title=Safety and efficacy of growth hormone therapy in childhood. | journal=Pediatr Endocrinol Rev | year= 2004 | volume= 2 Suppl 1 | issue= | pages= 68-77 | pmid=16456485 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16456485 }} </ref> | ||
**Pseudotumor | **[[Pseudotumor cerebri]] | ||
**Benign intracranial hypertension. | **[[Intracranial hypertension|Benign intracranial hypertension.]] | ||
**Slipped capital femoral epiphyses. | **Slipped capital femoral [[epiphyses]]. | ||
**Diabetes mellitus due to insulin resistance. | **[[Diabetes mellitus]] due to [[insulin resistance]]. | ||
==Prognosis== | ==Prognosis== | ||
*Hypopituitarism prognosis is controversial as it depends on the treatment therapies. | *Hypopituitarism prognosis is controversial as it depends on the treatment therapies. | ||
*It has good prognosis as long as the hormonal replacement therapy is performed properly.<ref name="Vance1994">{{cite journal|last1=Vance|first1=Mary Lee|title=Hypopituitarism|journal=New England Journal of Medicine|volume=330|issue=23|year=1994|pages=1651–1662|issn=0028-4793|doi=10.1056/NEJM199406093302306}}</ref> | *It has a good prognosis as long as the [[hormonal replacement therapy]] is performed properly.<ref name="Vance1994">{{cite journal|last1=Vance|first1=Mary Lee|title=Hypopituitarism|journal=New England Journal of Medicine|volume=330|issue=23|year=1994|pages=1651–1662|issn=0028-4793|doi=10.1056/NEJM199406093302306}}</ref> | ||
*Hypopituitarism is often associated with vascular conditions and has high mortality rate.<ref name="pmid16597813">{{cite journal| author=Prabhakar VK, Shalet SM| title=Aetiology, diagnosis, and management of hypopituitarism in adult life. | journal=Postgrad Med J | year= 2006 | volume= 82 | issue= 966 | pages= 259-66 | pmid=16597813 | doi=10.1136/pgmj.2005.039768 | pmc=2585697 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16597813 }} </ref> | *Hypopituitarism is often associated with [[vascular]] conditions and has a high [[mortality rate]].<ref name="pmid16597813">{{cite journal| author=Prabhakar VK, Shalet SM| title=Aetiology, diagnosis, and management of hypopituitarism in adult life. | journal=Postgrad Med J | year= 2006 | volume= 82 | issue= 966 | pages= 259-66 | pmid=16597813 | doi=10.1136/pgmj.2005.039768 | pmc=2585697 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16597813 }} </ref> | ||
==References== | ==References== | ||
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Ahmed Elsaiey, MBBCH [2]
Overview
The natural history of hypopituitarism depends on the different clinical manifestations. If hypogonadism is left untreated, it will lead to decrease bone density and osteoporosis. Vasopressin deficiency will end up to dehydration and electrolyte imbalance. Complications of hypopituitarism include adrenal crisis, pseudotumor cerebri, and diabetes mellitus. Hypopituitarism has a good prognosis as long as the hormonal replacement therapy is performed properly.
Natural History
Hypopituitarism develops different symptoms according to the affected part of the pituitary gland and the deficient hormone. Leaving hypopituitarism without treatment can lead to critical consequences. The natural history depends on the different manifestations of the disease as the following:[1]
- Hypogonadism:
- In both genders, if left untreated, it will lead to decrease bone density and osteoporosis.[2]
- In women, there may be an increase risk of coronary artery disease due to depletion of the estrogen level in women.[3]
- In men, decrease muscle mass due to depletion of the testosterone hormone levels.
- Vasopressin deficiency: It will end up to dehydration and electrolyte imbalance like hyponatremia.
- Growth hormone deficiency: It may lead to serious vascular conditions and may lead to death.[4]
Complications
Complications that can develop as a result of hypopituitarism are:
- Adrenal crisis:
- The most serious complication of hypopituitarism. It occurs in case of improper glucocorticoids replacement therapy.
- Complications of growth hormone replacement therapy:[5]
- Pseudotumor cerebri
- Benign intracranial hypertension.
- Slipped capital femoral epiphyses.
- Diabetes mellitus due to insulin resistance.
Prognosis
- Hypopituitarism prognosis is controversial as it depends on the treatment therapies.
- It has a good prognosis as long as the hormonal replacement therapy is performed properly.[1]
- Hypopituitarism is often associated with vascular conditions and has a high mortality rate.[6]
References
- ↑ 1.0 1.1 Vance, Mary Lee (1994). "Hypopituitarism". New England Journal of Medicine. 330 (23): 1651–1662. doi:10.1056/NEJM199406093302306. ISSN 0028-4793.
- ↑ Klibanski, Anne; Neer, Robert M.; Beitins, Inese Z.; Ridgway, E. Chester; Zervas, Nicholas T.; McArthur, Janet W. (1980). "Decreased Bone Density in Hyperprolactinemic Women". New England Journal of Medicine. 303 (26): 1511–1514. doi:10.1056/NEJM198012253032605. ISSN 0028-4793.
- ↑ Matthews, Karen A.; Meilahn, Elaine; Kuller, Lewis H.; Kelsey, Sheryl F.; Caggiula, Arlene W.; Wing, Rena R. (1989). "Menopause and Risk Factors for Coronary Heart Disease". New England Journal of Medicine. 321 (10): 641–646. doi:10.1056/NEJM198909073211004. ISSN 0028-4793.
- ↑ Rosén T, Bengtsson BA (1990). "Premature mortality due to cardiovascular disease in hypopituitarism". Lancet. 336 (8710): 285–8. PMID 1973979.
- ↑ Bowlby DA, Rapaport R (2004). "Safety and efficacy of growth hormone therapy in childhood". Pediatr Endocrinol Rev. 2 Suppl 1: 68–77. PMID 16456485.
- ↑ Prabhakar VK, Shalet SM (2006). "Aetiology, diagnosis, and management of hypopituitarism in adult life". Postgrad Med J. 82 (966): 259–66. doi:10.1136/pgmj.2005.039768. PMC 2585697. PMID 16597813.