Hypopituitary Syndromes

Panhypopituitarism

• Etiologies

Primary: surgery, radiation, tumors (primary or metastatic), infection, infiltration (sarcoid, hemochromatosis), autoimmune, ischemia (including Sheehan s syndrome caused by pituitary infarction intrapartum), carotid aneurysms, cavernous sinus thrombosis, trauma

Secondary (hypothalamic dysfunction or stalk interruption): tumors (including craniopharyngioma), infection, infiltration, radiation, surgery, trauma

• Clinical manifestations

Hormonal: weakness, easy fatigability, hypotension, bradycardia, sexual dysfunction, loss of axillary & pubic hair, hypotension, polyuria. & polydipsia

Mass effect: headache, visual field As. cranial nerve palsies, galactorrhea

Apoplexy (pituitary hemorrhage or infarction, usually w underlying pituitary adenoma): sudden headache. N V, visual field As. cranial nerve palsies, meningismus. A MS. hypoglycemia, hypotension

• Diagnostic studies

Hormonal studies chronic 1 target gland hormone + I or normal trophic pituitary hormone ocute: target gland hormonal studies may be normal partial hypopituitarism is more common than panhypopituitarism

Pituitary MRI

Replace deficient target gland hormones

Most important deficiencies to recognize and treat in inpatients are adrenal insufficiency and hypothyroidism; if both present, treat with glucocorticoids first, then replace thyroid hormone so as not to precipitate adrenal crisis

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