Panhypopituitarism (hypopituitarism)

General or Other | - Others | Panhypopituitarism (hypopituitarism) (Disease)


Description

Hypopituitarism is a clinical syndrome of deficiency in pituitary hormone production. This may result from disorders involving the pituitary gland, hypothalamus, or surrounding structures. Panhypopituitarism refers to involvement of all pituitary hormones; however, only 1 or more pituitary hormones are often involved, resulting in isolated or partial hypopituitarism.

These medically replaced patients are generally asymptomatic but require increased doses of glucocorticoids following any form of stress, emotional or physical. The most common stressor is infection. Not matching glucocorticoid dose to stress causes acute decompensation. These patients present with nausea and vomiting and may be hypotensive and ill-appearing. A patients initial presentation of undiagnosed hypopituitarism may be with this life-threatening decompensated state under stress.

Causes and Risk factors

An adrenal crisis (acute cortisol insufficiency) is life threatening and should be treated promptly. When hypothyroidism occurs concurrently with cortisol insufficiency, glucocorticoid replacement should precede thyroid hormone replacement. This reduces the likelihood of possible cortisol insufficiency resulting from increased demands due to enhanced metabolism.

Patients with hypopituitarism are maintained on hormone replacement therapies for life, unless the causative disorder is reversed by treatment or by natural history. This condition is most often caused by damage to the gland. In children, damage to the pituitary gland may be caused by infection, stroke, genetic factors, tumor on the pituitary gland, cancer that has spread, injury, no known cause.

Diagnosis and Treatment

Therapy consists of replacing the missing hormones. The medications used include: corticosteroids, thyroid hormone, sex hormones, growth hormone, DDAVP (desmopressin). ...