Updated: 11/26/2020

Hypopituitarism

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Questions
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Snapshot
  • A 25-year-old woman presents with her 4-day-old girl, born at full-term via spontaneous vaginal delivery complicated by postpartum hemorrhage, for a follow-up pediatric visit. She reports that she has not been breastfeeding, as her milk never “came in.” She has been feeding only with formula. (Sheehan syndrome)
Introduction
  • Introduction
    • clinical definition
      • hypopituitarism
        • ↓ secretion of pituitary hormones  
    • etiologies
      • pituitary adenoma
      • craniopharyngioma
      • brain damage
      • radiation therapy
      • Sheehan syndrome
      • empty sella syndrome
      • pituitary apoplexy
  • Studies
    • morning serum levels of pituitary hormones
      • insulin-like growth factor
      • luteinizing hormone (LH)
      • follicle-stimulating hormone (FSH)
      • sex steroids
        • testosterone
        • estradiol
      • thyroid-stimulating hormone (TSH)
      • free thyroxine (T4)
      • cortisol
      • adrenocorticotropic hormone (ACTH)
      • prolactin
  • Treatment
    • hormone replacement therapy
      • corticosteroids
      • sex steroids
      • growth hormone
      • thyroxine
Sheehan Syndrome
  • Sheehan syndrome
    • definition
      • pituitary infarction due to postpartum bleeding
    • pathogenesis
      • pregnancy causes increased pituitary size, predisposing the gland to hypoperfusion and ischemia
      • secondary to hypovolemic shock from postpartum bleeding
  • Presentation
    • prolactin deficiency
      • breast involution and failure to lactate
      • amenorrhea
    • hypothyroidism
      • cold intolerance
  • Imaging
    • head magnetic resonance imaging (MRI)
      • infarction of pituitary gland
Empty Sella Syndrome
  • Empty sella syndrome
    • definition
      • atrophy or compression of the pituitary gland
    • pathogenesis
      • often idiopathic
    • risk factors
      • obesity
      • female
    • associated conditions
      • idiopathic intracranial hypertension
  • Presentation
    • headache
    • fatigue
    • may be asymptomatic
  • Imaging
    • head MRI
      • pituitary fossa is replaced with cerebrospinal fluid rather than tissue
  • Treatment
    • often do not require treatment if asymptomatic
Pituitary Apoplexy
  • Pituitary apoplexy
    • definition
      • hemorrhage or infarction of pituitary gland
      • often in the setting of an existing pituitary adenoma
    • demographics
      • male > female
      • adults
  • Presentation
    • sudden-onset severe headache
    • visual disturbance
      • bilateral hemianopia
      • diplopia
    • altered mental status
  • Imaging
    • head computed tomography (CT)
      • intrasellar mass with hemorrhage
  • Treatment
    • corticosteroids 
    • may require surgery

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Questions (1)

(M2.EC.15.4404) A 28-year-old G2P1 female with a history of hypertension presents to the emergency room at 33 weeks with headache and blurry vision. On exam, her vitals include BP 186/102 mmHg, HR 102 beats per minute, RR 15 breaths per minute, and T 98.9 degrees Fahrenheit. She undergoes an immediate Caesarian section, and although she is noted to have large-volume blood loss during the procedure, the remainder of her hospital course is without complications. Four weeks later, the patient returns to her physician and notes that she has had blurry vision and has not been able to lactate. A prolactin level is found to be 10 ng/mL (normal: 100 ng/mL). Which of the following is the most appropriate next step?

QID: 106965
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Galactogram

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(0/20)

2

Observation of maternal-child interactions

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3

Brain MRI

65%

(13/20)

4

Head CT

30%

(6/20)

5

Breast ultrasound

0%

(0/20)

M 6 E

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