-IBIS-1.5.0-
tx
endocrine system
pituitary dysfunction
diagnoses

definition and etiology

definition:
Pituitary hormones include GH; prolactin; FSH; LH; TSH; ACTH; MSH.
Changes in behavior of the target organs may point to a problem with the pituitary.

etiology:
The most common cause is pituitary adenoma, followed by idiopathic causes and hypothalamic problems.

signs and symptoms

Generally, expect to see changes in target organ function.

hyperpituitarism: if a tumor exists:
• enlarged sella turcica
• frontal headache
• vision change: bitemporal hemianopsia due to impingement on optic chiasm
• galactorrhea
• loss of libido
• giantism or acromegaly
• hyperproteinemia

hypopituitarism:
• growth retardation in children
• weakness, fatigue
• skin waxy, depigmented, wrinkled, with hair loss
• anorexia
• infertility in females
• impotence in males
• low blood pressure, with postural hypotension and small heart
• low fasting blood sugar
• loss of lactation
• dull expression, apathy, and personality changes

lab findings:
• assay hormone levels - thyroid, estrogen, testosterone, cortisol

course and prognosis

• depends upon nature of dysfunction, hypofunction or hyperfunction; 90-95% of the pituitary must be destroyed to produce clear-cut evidence of pituitary insufficiency.
The first hormones to be lost are usually GH and LH-FSH.

differential diagnosis

Rule out other causes of end-organ dysfunction, such as hormone-elaborating tumors in other locations e.g. ectopic ACTH syndrome.

• Hypothalamic-pituitary axis dysfunction.
• Sheehan's syndrome: postpartum necrosis of pituitary.
• Benign tumor.
• Granulomasarcoid.
• Infections: TB, mycosis, bacterial.
• Lipoidosis: Hans-Schuller-Christian disease.
• Ischemic pituitary infarction.
• Trauma.


footnotes