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Updated: Aug 21 2022

Hypopituitarism

Images
https://upload.medbullets.com/topic/120097/images/indianjendocrmetab_2011_15_7_203_84869_f4.jpg
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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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