-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