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Archive for the ‘Hypopituitarism’ Category

Hypopituitarism Symptoms & Causes | Boston Children’s Hospital

We understand that you may have a lot of questions when your child is diagnosed with hypopituitarism. Is it dangerous? Will it affect my child long term? What do we do next? Weve tried to provide some answers to those questions on this site, and our experts can explain your childs condition fully.

Growth hormone is a protein produced by the pituitary gland, which is located near the base of the brain and attached to the hypothalamus (a part of the brain that helps to regulate the pituitary gland). If the pituitary gland or the hypothalamus is malformed or damaged, it may mean that the pituitary gland cant produce some or all of its hormones.

Hypopituitarism in children may be caused by:

Hypopituitarism can also be idiopathic, meaning that no exact cause can be determined.

The symptoms of hypopituitarism will vary depending on two things: which hormones are lacking, and your childs age. Symptoms that newborn babies may have include:

Older infants and children may have these symptoms:

Because the symptoms of hypopituitarism may resemble other conditions or medical problems, you should always consult your child's physician for a diagnosis.

Q: What is hypopituitarism?

A: Hypopituitarism occurs when the anterior (front) lobe of the pituitary gland loses its ability to make hormones, resulting in multiple pituitary hormone deficiencies. Physical symptoms depend on which hormones are no longer being produced by the gland.

Q: What causes hypopituitarism?

A: Hypopituitarism may be caused by many different conditions, including:

Hypopituitarism can also be idiopathic, meaning that no exact cause can be determined.

Q: Is hypopituitarism treatable?

A: Treating hypopituitarism depends both on its cause and on which hormones are missing. The goal of treatment is to restore normal levels of hormones. Treating the underlying condition thats causing your childs hypopituitarism often leads to a full recovery.

Since your childs body is unable to make some or all of these missing hormones, life-long hormone replacement therapy is necessary. Replacement therapy needs to be monitored and adjusted, but the extent of your childs pituitary deficiency will determine how often he will need to see his doctor.

Q: How safe is treatment?

A: While there are many potential side effects, researchers generally agree that hormone replacement therapy is safe and effective.

You and your family are key players in your childs medical care. Its important that you share your observations and ideas with your childs health care provider and that you understand your providers recommendations.

If your child is experiencing symptoms of hypopituitarism and youve set up an appointment, you probably already have some ideas and questions on your mind. But at the appointment, it can be easy to forget the questions you wanted to ask. Its often helpful to jot them down ahead of time so that you can leave the appointment feeling like you have the information you need.

If your child is old enough, you may want to suggest that she write down what she wants to ask her health care provider, too.

Some of the questions you may want to ask include:

Link:
Hypopituitarism Symptoms & Causes | Boston Children's Hospital

Endocrine Diseases in Pregnancy | GLOWM

INTRODUCTION

Pregnancy is a unique clinical scenario in which several endocrine disorders may be more frequent and/or have specific considerations for diagnosis and treatment. In this review, anterior pituitary insufficiency, adrenal, parathyroid, and thyroid disorders of pregnancy are discussed.

Anterior pituitary insufficiency is an uncommon disease. The etiology includes destruction of the anterior pituitary gland by tumors, infarction (postpartum necrosis or Sheehan's syndrome), idiopathic disease (Simmonds' disease), surgery, and radiotherapy to the pituitary gland. There have also been reports of pituitary necrosis in patients with elevated intracerebral pressure.1 Disease of the hypothalamus affecting the secretion of releasing hormones may produce a similar clinical picture; some cases of Sheehan's syndrome and idiopathic hypopituitarism are due to hypothalamic diseases.2 Finally, congenital hypopituitarism is a rare diagnosis among newborn infants.3

Sheehans syndrome

The most common cause of panhypopituitarism in women of childbearing age is postpartum necrosis, or Sheehan's syndrome.4 The pathogenesis is not clear, although Sheehan in his original description did associate it with severe postpartum hemorrhage.5 Although the classic clinical etiology of Sheehan's syndrome in about 90% of patients is severe bleeding of the anterior pituitary during delivery or immediately postpartum, no catastrophic event can be detected in more than 10% of patients.

Lack of lactation after delivery, amenorrhea, loss of pubic and axillary hair or failure of pubic hair to grow back, anorexia and nausea, lethargy and weakness, and weight loss are typical presenting signs and symptoms. On physical examination, the findings depend on the severity and duration of the disease. Commonly, the skin has a waxy character with fine wrinkles about the eyes and mouth. There is some periorbital edema, and a decrease in pigmentation is often seen. Axillary and pubic hair becomes increasingly sparse. Atrophy of the breast tissue may be present. Even in those patients losing weight, cachexia is not a feature of the disease. Hypotension may be present, and normocytic anemia is common. However, this full constellation of symptoms does not occur in every patient, and it is not unusual for the full-blown picture to take 1020 years to develop. Occasionally, the diagnosis is made when the patient develops acute adrenal insufficiency secondary to a stressful situation (e.g. infection, trauma, surgery).

It was recognized by Sheehan that not all patients with pituitary apoplexy develop panhypopituitarism, and partial pituitary insufficiency is not uncommon. In one retrospective case series of 44 patients in France, only 88% had hypopituitarism, with adrenocorticotropic hormone (ACTH) deficiency most common (70%).6 A few patients with partial hypopituitarism may present with the classic syndrome of acute panhypopituitarism with deficiency of all pituitary hormones. However, after treatment with corticosteroids alone, there is a spontaneous normalization in the menstrual cycle, with a return of thyroid test results to normal limits.

Successful pregnancies following a diagnosis of Sheehan's syndrome have been reported.7, 8, 9 In a few patients, the diagnosis of partial hypopituitarism may occur upon the presentation of a pregnancy. Although several patients conceive after treatment with gonadotropin, others conceive spontaneously, an indication of partial pituitary failure. Placental function is not altered in patients with pituitary insufficiency.

Pituitary adenoma

During normal pregnancy, the pituitary enlarges by approximately one-third of its size.10 Pituitary insufficiency in women of childbearing age may result in the setting of a pituitary tumor, usually in association with increased production of prolactin. The most common symptom is secondary amenorrhea with galactorrhea, although cases of primary amenorrhea have been reported. When there is local expansion of the tumor, patients may have neurologic symptoms, such as headache or bilateral temporal hemianopia. In such cases, other pituitary hormones may become affected with growth hormone, ACTH, and thyrotropin-stimulating hormone (TSH) deficiencies.

The diagnosis is confirmed by the use of appropriate tests to investigate each of the pituitary hormones. Baseline or random determination of serum pituitary hormone concentrations is of no value in the diagnosis of the disease; dynamic tests to evaluate pituitary reserve must be used. The most practical tests are presented in Table 1. However, their use in pregnancy is limited because of the blunted response of many of these tests.

Table 1. Tests of anterior pituitary hormone reserve

Hormone

Test

Normal Response

Response in Pregnancy

GH

L-Dopa, 500 mg, GH levels at 0, 1, 2 hour

by 10 ng/dl

Blunted

Insulin hypoglycemia 0.1 U regular IV/kg, then draw GH at 0, 20, 60, 90 min

by 10 ng/dl

Blunted

ACTH

Insulin hypoglycemia (see above), then draw cortisol at 0, 20, 60, 90 min

by 10 g/dl

Blunted

Metyrapone 750 mg every 4 hour 6

Urinary 17-KGS

Blunted

TSH

Free thyroxine index

Normal

Serum TSH

Normal

Prolactin

Can no longer be tested, given the inavailability of TRH

LH-FSH

Assess by regularity/presence of menses

When anterior pituitary insufficiency develops in pregnancy, the clinical manifestations may be local signs, such as headaches and visual disturbances, which are the consequence of an acute enlargement of, or bleeding into, the pituitary gland.11 The initial manifestations also could be related to endocrine deficiency, mainly hypoglycemia, nausea, vomiting, and hypotension secondary to ACTH deficiency.

Isolated ACTH deficiency is rare and has been infrequently described.12, 13 Acute enlargement of the pituitary gland is characterized by severe, deep, midline headaches (lasting for 23 days) and visual field disturbances. Severe hypoglycemia with convulsions and coma, unresponsive to large doses of glucose, but rapidly reversible after the administration of hydrocortisone, can be seen.

Partial or total hypopituitarism developing in patients with diabetes mellitus has been reported.14 In a review of 31 cases (19 women), the episode was associated with pregnancy in 11 (during the postpartum period in seven and during the antepartum period in four, with three maternal deaths).15 The mean age of the patients in this case series was 27 years, and the mean duration of their diabetes mellitus was 6 years, which makes vascular complication an unlikely cause of pituitary insufficiency. Furthermore, no specific vascular changes were found in the examined pituitary glands. Characteristically, the patients developed severe headaches that lasted for a few days with or without visual field disturbances, and a decrease in insulin requirement was observed. There was a high proportion of women with fetal loss. Although the mechanism supporting the increased risk of hypopituitarism among individuals with diabetes mellitus remains unclear, an association between pituitary antibodies and type 1 diabetes mellitus has been described.16

Lymphocytic hypophysitis

Lymphocytic hypophysitis can be another cause of pituitary dysfunction,17 and in pregnant women, usually presents close to delivery or in the immediate postpartum period.18 Sheehan described lymphocytic infiltration of the pituitary gland in some women with postpartum pituitary insufficiency,19 and it is possible that many of the cases mentioned above were due to lymphocytic hypophysitis.

The clinical presentation may be characterized by headaches and visual disturbances related to pressure from the expanding lesion mimicking a pituitary tumor;20, 21 spontaneous regression of the lesion was seen in several cases.22 diabetes insipidus and galactorrhea. Report of a case and review of the literature) The differential diagnosis between pituitary tumor and hypophysitis can be made only by histologic examination.18 Conversely, the patient may present with signs and symptoms of hypopituitarism, such as protracted hypoglycemia responding to glucocorticoid therapy and hypotension. It can also present in the postpartum period as pituitary insufficiency, similar to Sheehan's syndrome without the history of profound bleeding.22, 23, 24, 25

Involvement of other endocrine glands has been recognized, consistent with the concept of an autoimmune disease,26 in addition to antibodies against pituitary cells.27 It is possible that these cases are typical of the autoimmune polyendocrine deficiency syndrome that may be exacerbated during pregnancy or in the immediate postpartum period.

Treatment

Patients with partial or total hypopituitarism who become pregnant spontaneously or after treatment with gonadotropins may carry a normal pregnancy with no increase in the dose of corticosteroid replacement therapy. The usual amount of hydrocortisone in patients with pituitary insufficiency is 2030 mg/day (two-thirds of the total amount in the morning and one-third in the evening). In some instances, the amount of hydrocortisone can be decreased by one-third of the total dose because the effect of hydrocortisone is potentiated during pregnancy by estrogen.28 However, this potentiation does not occur when synthetic corticosteroids (i.e. prednisone, dexamethasone) are used. The equivalent amounts of prednisone and dexamethasone, respectively, are 5.07.5 mg daily and 0.50.75 mg daily. Because these patients have ACTH deficiency, aldosterone secretion is normal and there is no need for mineralocorticoid replacement therapy. If thyroid deficiency is present, the amount of levothyroxine needed for replacement is usually 0.10.2 g daily.

Successful pregnancy in cases of isolated growth hormone deficiency has been reported.29, 30 In these patients, lactation was unimpaired and placental function studies and intrauterine growth were normal.

The most common pituitary tumor diagnosed in women of childbearing age is a prolactinoma.31 It can be accompanied by amenorrhea, oligohypomenorrhea, and anovulation, and with or without galactorrhea. Hyperprolactinemia decreases gonadotropin-releasing hormone (GnRH) secretion, accounting for the infertility observed in these patients. Pituitary tumors are divided, according to size, into microadenomas (less than 10 mm in diameter) and macroadenomas (greater than 10 mm in diameter); the latter are further classified according to suprasellar extension and invasion of adjacent structures. Serum prolactin concentrations correlate fairly well with the size of the tumor. Hyperprolactinemia in the absence of a pituitary adenoma (idiopathic hyperprolactinemia) is a common finding.

Complications

Serum prolactin levels in women with prepregnancy hyperprolactinemia, with a few exceptions, remained unchanged during pregnancy. It was shown that prolactin levels did not change significantly in most women with baseline prolactin levels of over 60 pg/dL.32 However, in those patients with prolactin levels of less than 60 pg/dL, the mean level doubled at the end of pregnancy and returned to pretreatment levels at the end of lactation. Therefore, serum prolactin determination during pregnancy is not a predictor of tumor growth and is of no value in monitoring tumor growth.

The incidence of complications during pregnancy in patients with pituitary tumors varies according to tumor size. Due to the stimulatory effect of estrogen on lactotrophs, the size of the tumor increases in 2.7% of microprolactinomas and 22.9% of macroprolactinomas during pregnancy.31 In one study of 56 pregnant women with microprolactinomas, one developed headaches and five showed mild tumor growth.33 In studies of pregnant women with macroprolactinomas, the proportion of women developing neurologic symptoms and visual disturbances is significantly decreased upon treatment.31

Complications can occur at any stage of pregnancy. In patients with microadenomas, visual field examinations are indicated only if there are signs and symptoms of tumor enlargement, in which case an MRI is also indicated. If there is any objective evidence of tumor enlargement, bromocriptine is resumed and continued throughout pregnancy at up to 20 mg/day. If after a few days there is no improvement, dexamethasone 4 mg every 6 hours can be added. Surgery is indicated in those complicated cases not responding to the above therapies, but the recurrence rate is high among those with invasive prolactinomas even after surgery.34

Breastfeeding is not contraindicated in mothers with a diagnosis of prolactinoma. There is no difference in the remission rates of women with prolactinomas managed with dopamine-receptor agonists who breastfeed following delivery versus those who do not.35 It is advisable in patients with microadenomas to measure prolactin levels a few months after delivery and to reinstate bromocriptine therapy in the presence of persistent hyperprolactinemia. A pituitary MRI should be repeated in cases of macroprolactinoma soon after delivery because of the potential for tumor size increase.

Treatment

Once the diagnosis of prolactinoma is made, several types of therapy are available. The choice of therapy depends on tumor size, radiologic classification, local symptoms, and the patient's age and desire for pregnancy or current pregnancy.36

Medical therapy with dopamine-receptor agonists has been very effective in producing ovulation among hyperprolactinemic women37 and restores ovulation in approximately 90% of cases.31 Bromocriptine has historically been the preferred option, and no significant adverse effects have been observed in over 6000 pregnancies managed with bromocriptine.38 Most patients respond to doses of 2.55 mg/day, although occasionally a dose of 7.5 mg/day or more is needed. Bromocriptine is effective not only in normalizing prolactin levels but also in reducing the size of the tumor.31 It is advisable to use mechanical contraception during the first few months of bromocriptine therapy until the rhythm of the menstrual period is established. In those patients who have side effects such as nausea and vomiting, the oral bromocriptine tablet can be administered vaginally.39

Cabergoline is another dopamine-receptor agonist which can be considered.40 Although only 800 pregnancies have been reported with its use, there similarly does not appear to be any increased risks of preterm delivery or congenital malformations associated with this medication.38 In one 10-year observational study of 143 women, carbergoline therapy during pregnancy resulted in the ability of nearly 98% of the women to breastfeed following delivery.41 Once conception takes place, the dopamine-receptor agonist should be discontinued and the patient followed closely. For women in whom the macroprolactinoma is likely to increase, or in whom pressure symptoms occur, therapy during pregnancy should be continued.42

Radiation therapy as the initial and only therapy is seldom indicated, as medical therapy is usually very effective. The duration required for radiation therapy to normalize serum prolactin levels is lengthy and may produce hypopituitarism as a last sequela. Radiation therapy is indicated in those with prolactinomas refractory to conventional therapy.43

Surgical treatment, mainly transsphenoidal adenectomy, has been effective in restoring ovulation in patients with small tumors.32 The cure rate (i.e. sustained normalization of serum prolactin concentrations) is about approximately 70% at both 5 and 10 years of follow up; the associated proportion of successful pregnancy was similar.44 The best results are obtained in patients with microadenomas with low initial serum prolactin levels and lack of abnormal postoperative residual tissue.45

A recommended treatment approach in patients who wish to conceive is summarized in Table 2. It is suggested that treatment with bromocriptine be continued for at least 12 months before conception because it seems to reduce the risk of tumor enlargement during pregnancy.46

Table 2. Management of women with pre-conception hyperprolactinemia

Visual field monthly

*Therapy for 1 year before conception

Acromegaly is a chronic disease caused by hypersecretion of growth hormone by the adenohypophysis of the pituitary gland. It is almost always associated with a benign pituitary tumor and is characterized by slow and progressive enlargement of the acral parts. Facial changes are typical, but they usually develop so gradually that neither the family nor the patient recognizes the changes. As in other endocrine disorders, comparison of the patient's photographs taken over many years may be the only clue to the progression of the disease. Symptoms may be due to local expansion of the tumor (i.e. headaches and visual field disturbances), or they may be due to the somatic effects of chronic excess growth hormone, such as hyperhidrosis, weight gain, arthralgias, and acroparesthesia (carpal tunnel syndrome). Most women with acromegaly have been reported to suffer from oligohypomenorrhea or amenorrhea. In addition to the bony deformities, organomegaly (particularly enlargement of the heart, thyroid, and liver) is not uncommon on physical examination. The skin appears coarse and leathery. Galactorrhea with hyperprolactinemia is a common finding.

Diagnosis

The diagnosis is confirmed by an elevation in plasma insulin-like growth factor 1 (IGF-1) levels and a lack of suppression of growth hormone following the administration of a glucose load.47 However, IGF-1 levels may not be reliable during pregnancy, as they can be physiologically increased48 or decreased during pregnancy.49

Thus, suspected cases of acromegaly among pregnant women should be confirmed with a growth hormone suppression test, which requires determination of plasma growth hormone levels before and 1 and 2 hours after the administration of a solution of 100 g glucose orally. A normal response is characterized by growth hormone levels lower than 1 g/L after glucose administration. Patients with acromegaly typically have elevated baseline IGF-1 levels and respond to the glucose load with no growth hormone suppression of growth hormone concentration or even occasionally with a paradoxical increase.

In patients with acromegaly, there are increased risks of several associated cormorbidities, including hypertension, diabetes mellitus, cardiovascular disease, osteoarthritis, and sleep apnea, which should be evaluated for upon the confirmed diagnosis of acromegaly.47

Treatment

Treatment is mandatory in patients with the disease because the long-term prognosis is poor; untreated individuals have an almost 3-fold increased mortality rate.48 Conventional pituitary irradiation, transsphenoidal hypophysectomy,50 and drug therapy with octreotide (or other somatostatin receptor analogues) or the growth receptor antagonist, pegvisomant51 are used most often and can improve disease survival.52

Acromegaly during pregnancy

There are limited data of successful pregnancies in women with acromegaly. In 1954, Abelove and colleagues reported two normal pregnancies in an acromegalic woman and reviewed 33 reported cases from the world literature.53 Since that time, several other cases have been published, including a recent report of ten pregnancies among eight acromegalic women in Brazil, in which plasma IGF-1 levels were not significantly changed during gestation.54 In most instances, the infants have been reported as being normal. However, in a case described by Fisch et al.,55 the infant was born with acromegalic features. In this infant, growth was above average during the neonatal period, but a normal growth pattern subsequently returned, although no serum laboratory measurements were obtained. The lack of acromegalic features in most cases is in accordance with the report by King and colleagues demonstrating no placental transfer of growth hormone from mother to fetus.56

Historically, bromocriptine has been used as a successful treatment to induce pregnancy in patients with acromegaly.57, 58 In each of these cases, pregnancy occurred in spite of persistent elevated serum growth hormone levels.

The current guidelines for management of acromegalic women during pregnancy have been summarized in the 2014 Endocrine Society guidelines for acromegaly.47 In general, discontinuation of long-acting medical therapy (somatostatin receptor analogues or pegvisomant) is recommended approximately 2 months prior to attempting to conceive; therapy can be replaced with short-acting octreotide instead during the pre-conception period. During gestation, medical therapy should only be administered only for tumor and headache control, and plasma growth hormone and IGF-1 levels should not be monitored.

Diabetes insipidus is an uncommon disease characterized by polyuria and polydipsia due to a deficiency of antidiuretic hormone (central or neurogenic diabetes insipidus) or the peripheral resistance to the antidiuretic hormone at the renal tubules (nephrogenic diabetes insipidus). Central diabetes insipidus may be a result of a lesion at the level of the hypothalamus or pituitary gland. It may arise following hypophysectomy, invasion of the neurohypophysis by tumors, malignant metastasis (i.e. breast cancer), trauma, granulomas, or infection. In 50% of cases, however, it is considered idiopathic, with some causes probably on an autoimmune basis. Nephrogenic diabetes insipidus is a hereditary disorder affecting males; therefore, symptomatic women carriers are extremely rare. Several cases of transient nephrogenic diabetes insipidus during pregnancy and/or postpartum have been reported. A third type of diabetes insipidus, called psychogenic, which is rarely reported in pregnancy,59 is differentiated from the other two in most cases by the results of the water deprivation test.

Diagnosis

Link:
Endocrine Diseases in Pregnancy | GLOWM

Non-Functioning Tumors (Endocrine-Inactive Tumors …

As their name indicates, these relatively common pituitary adenomas do not result in excess hormone production. Instead they typically cause symptoms because of increasing size and pressure effect on the normal pituitary gland and on structures near the pituitary such as the optic nerves and chiasm. The major symptoms of patients with endocrine-inactive tumors are those of pituitary failure (hypopituitarism), visual loss and headache. Hypopituitarism may manifest itself as nausea, vomiting, weakness, decreased mental function, loss of sexual drive, infertility and in women, irregular or absent periods (amenorrhea). The vast majority of these tumors are benign. Most are macroadenomas (over 1 cm in size) when finally diagnosed. Occasionally, they grow quite large and into the cavernous sinus causing nerve compression and double vision. Some patients with large tumors may have acute hemorrhage into the tumor (pituitary apoplexy) causing relatively sudden onset of headache, visual loss, double vision, and/or pituitary failure. Endocrine-inactive adenomas may also be discovered incidentally during an evaluation for another problem, such as a head injury. Almost half of endocrine-inactive adenomas secrete part of a hormone called the alpha-subunit, which is not hormonally active but can be measured in the blood.

In patients with symptoms suggestive of pituitary failure (hypopituitarism), a complete endocrinological evaluation should be performed. These blood tests should include:

Based on the results of these tests, additional hormonal studies may be ordered.

For patients with visual complaints, an ophthalmologist (preferably a neuro-ophthalmologist should evaluate the patient. This evaluation should include acuity testing of each eye and formal visual field testing to determine if there is loss of peripheral vision.

An MRI of the pituitary without and with gadolinium (contrast agent) is the preferred study for visualizing a pituitary tumor. In most instances, a CT scan without and with contrast will also detect an adenoma. In a minority of cases instances it may be difficult to distinguish an adenoma of the pituitary from other masses. These masses include:

For the great majority of patients with symptomatic endocrine-inactive adenomas, transsphenoidal surgery and adenoma removal is the preferred and most effective therapy. The long-term cure or control rate is approximately 70-80% overall. The cure rate is generally higher for smaller tumors and those that do not invade the cavernous sinus; conversely, the cure rate is lower for larger tumors (over 3 cm) and those that do invade the cavernous sinus. Overall, transsphenoidal tumor resection results in an improvement in visual acuity and visual field deficits in 75-90% of patients, headache resolution in 80-90% of patients, and improvement in hypopituitarism in only 10-30% of patients. Patients who do not have hormonal recovery after surgery will require long-term hormone replacement therapy. Because the transsphenoidal approach is so effective and relatively safe, it is rare that even large macroadenomas warrant a transcranial operation as the initial procedure.

There is no known effective medical therapy that reliably slows or stops growth of endocrine inactive adenomas.

Radiation is generally used as a second line therapy for endocrine-inactive tumors. For patients who have residual tumor after the initial surgery, radiation or repeat transsphenoidal surgery or both are generally indicated if the tumor grows as seen on subsequent MRIs. Both conventional (external beam) and stereotactic radiosurgery are relatively effective in controlling growth, but stereotactic radiation can deliver a higher radiation dose to the tumor more safely. Consequently it is the preferred radiation technique. Also, external beam radiation reliably causes loss of remaining normal pituitary function over 5 to 10 years. Stereotactic radiosurgery may also cause loss of pituitary function, but less frequently then external beam radiation.

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Non-Functioning Tumors (Endocrine-Inactive Tumors ...

Steroid Replacement Doses for Hypopituitary Patients …

Question: I am completely hypopituitary and had a bilateral adrenalectomy to control my Cushings. I now have Nelsons Syndrome and am on 30mg/day of hydrocortisone replacement. I still have uncontrollable diabetes, muscle weakness and look and feel like I still have Cushings. Is this normal for Nelsons or could my replacement dose be too high?

Answer: Patients who have had a bilateral adrenalectomy for treatment of Cushings disease and are on adequate hydrocortisone replacement should not have any persistent symptoms of Cushings syndrome. Nelson syndrome which occurs when there is an ACTH-secreting pituitary tumor is associated with increased pigmentation of the skin and if the tumor has enlarged, symptoms of tumor growth affecting vision. The problem that may arise on hydrocortisone is that the dose may be excessive for the patients optimal replacement and this hydrocortisone then causes symptoms of Cushings. Patients with hypopituitarism frequently have decreased clearance of cortisol and require a lower dose for maintenance. A good way of determining the right replacement dose of hydrocortisone is to measure urine free cortisol while taking the dose of hydrocortisone in question. Values should be in the middle of the normal reference range. Occasionally patients with hypopituitarism who need hydrocortisone replacement require only small doses of hydrocortisone, from 10 to 15 mg daily.

By Dr. David E. Schteingart MD (Summer, 2005)

Continue reading here:
Steroid Replacement Doses for Hypopituitary Patients ...

Hypopituitarism | UCLA Health

Definition: Hypopituitarism is a condition caused by low levels of pituitary hormones.

Alternative Names: Pituitary insufficiency

Causes, incidence, and risk factors: The pituitary gland is a small structure that is located just below the brain. It is attached by a stalk to the hypothalamus, the area of the brain that controls its function.

The hormones secreted by the pituitary gland (and their functions) are:

In hypopituitarism, there is an absence of one or more pituitary hormones. Lack of the hormone leads to loss of function in the gland or organ that it controls. For example, loss of thyroid stimulating hormone leads to loss of function in the thyroid gland.

Hypopituitarism may be caused by tumors of the pituitary gland or hypothalamus, head trauma, brain tumor, radiation, brain surgery, stroke, subarachnoid hemorrhage (from a burst aneurysm), or infections of the brain and the tissues that support the brain. Occasionally, hypopituitarism is due to uncommon immune system or metabolic diseases, such as sarcoidosis, histiocytosis X, and hemochromatosis.

Hypopituitarism is also a rare complication following pregnancy, a condition called Sheehan's syndrome. The cause of this type of hypopituitarism is unknown.

Symptoms:

Note: Symptoms may develop slowly and may vary greatly, depending upon the severity of the disorder, the number of deficient hormones, and their target organs.

Additional symptoms that may be associated with this disease:

Signs and tests:

Diagnosis of hypopituitarism must confirm low hormone levels due to an abnormality of the pituitary gland. The diagnosis must also rule out disease of the organ affected by this hormone.

In some cases, one of the hormones produced by the pituitary may be elevated in the blood stream if a patient has a pituitary tumor which is producing an excessive amount of that hormone. The tumor itself may be crushing the rest of the cells of the pituitary, leading to low levels of other hormones.

Treatment: If hypopituitarism is caused by a tumor, treatment by surgical removal, with or without radiation therapy, may be indicated. Replacement of deficient hormones is often required even after successful treatment of a pituitary tumor.

Hormone therapy is needed to replace hormones that are no longer made by the organs under the control of the pituitary gland. These may include corticosteroids (cortisol), thyroid hormone, sex hormones (testosterone for men and estrogen for women), and growth hormone. Drugs are also available to treat associated infertility in men and women.

Support Groups:

Expectations (prognosis): Hypopituitarism is usually permanent and requires life-long treatment; however, a normal life span can be expected.

Complications: Side effects of drug therapy can develop.

Calling your health care provider: Call your health care provider if symptoms of hypopituitarism develop.

Prevention: In most cases, the disorder is not preventable. Awareness of risk may allow early diagnosis and treatment.

Read more:
Hypopituitarism | UCLA Health

Hypopituitarism Disease Reference Guide – Drugs.com

Medically reviewed on August 22, 2017

Hypopituitarism is a rare disorder in which your pituitary gland either fails to produce one or more of its hormones or doesn't produce enough of them.

The pituitary gland is a small bean-shaped gland situated at the base of your brain, behind your nose and between your ears. Despite its size, this gland secretes hormones that influence nearly every part of your body.

In hypopituitarism, you have a short supply of one or more of these pituitary hormones. This deficiency can affect any number of your body's routine functions, such as growth, blood pressure and reproduction.

You'll likely need medications for the rest of your life to treat hypopituitarism, but your symptoms can be controlled.

Hypopituitarism is often progressive. Although the signs and symptoms can occur suddenly, they more often develop gradually. They are sometimes subtle and may be overlooked for months or even years.

Signs and symptoms of hypopituitarism vary, depending on which pituitary hormones are deficient and how severe the deficiency is. They may include:

See your doctor if you develop signs and symptoms associated with hypopituitarism.

Contact your doctor immediately if certain signs or symptoms of hypopituitarism develop suddenly or are associated with a severe headache, visual disturbances, confusion or a drop in blood pressure. Such signs and symptoms could represent sudden bleeding into the pituitary gland (pituitary apoplexy), which requires prompt medical attention.

Hypopituitarism may be the result of inherited disorders, but more often it's acquired. Hypopituitarism frequently is triggered by a tumor of the pituitary gland. As a pituitary tumor increases in size, it can compress and damage pituitary tissue, interfering with hormone production. A tumor can also compress the optic nerves, causing visual disturbances.

The cause of hypopituitarism can also be other diseases and events that damage the pituitary, such as:

Diseases of the hypothalamus, a portion of the brain situated just above the pituitary, also can cause hypopituitarism. The hypothalamus produces hormones of its own that directly affect the activity of the pituitary.

In some cases, the cause of hypopituitarism is unknown.

The pituitary gland and the hypothalamus are situated within the brain and control hormone production.

The endocrine system includes the pituitary gland, thyroid gland, parathyroid glands, adrenal glands, pancreas, ovaries (in females) and testicles (in males).

If your doctor suspects a pituitary disorder, he or she will likely order several tests to check levels of various hormones in your body. Your doctor may also want to check for hypopituitarism if you've had a recent head injury or radiation treatment that might have put you at risk of damage to your pituitary gland.

Tests your doctor may order include:

Successful treatment of the underlying condition causing hypopituitarism may lead to a complete or partial recovery of your body's normal production of pituitary hormones. Treatment with the appropriate hormones is often the first step. These drugs are considered as "replacement," rather than treatment, because the dosages are set to match the amounts that your body would normally manufacture if it didn't have a pituitary problem. Treatment may be lifelong.

Treatment for pituitary tumors may involve surgery to remove the growth. In some instances, doctors also recommend radiation treatment.

Hormone replacement medications may include:

If you've become infertile, LH and FSH (gonadotropins) can be administered by injection to stimulate ovulation in women and sperm production in men.

A doctor who specializes in endocrine disorders (endocrinologist) may monitor the levels of these hormones in your blood to ensure you're getting adequate but not excessive amounts.

Your doctor will advise you to adjust your dosage of corticosteroids if you become seriously ill or experience major physical stress. During these times, your body would ordinarily produce extra cortisol hormone. The same kind of fine-tuning of dosage may be necessary when you have the flu, experience diarrhea or vomiting, or have surgery or dental procedures. Adjustments in dosage may also be necessary during pregnancy or with marked changes in weight. You may need periodic CT or MRI scans as well to monitor a pituitary tumor or other diseases causing the hypopituitarism.

Wear a medical alert bracelet or pendant, and carry a special card, notifying others in emergency situations, for example that you're taking corticosteroids and other medications.

You're likely to start by seeing your family doctor or a general practitioner. However, in some cases, when you call to set up an appointment, you may be referred to a specialist called an endocrinologist.

Here's some information to help you prepare for your appointment.

Create a list of questions before your appointment so that you can make the most of your time with your doctor. For hypopituitarism, some basic questions to ask your doctor include:

Don't hesitate to ask any questions you have during your appointment.

Your doctor is likely to ask you some questions, such as:

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Hypopituitarism Disease Reference Guide - Drugs.com

Hypopituitarism Treatment & Causes | Lurie Children’s

Hypopituitarism (an underactive pituitary gland) is rare in children. When a child has hypopituitarism, the pituitary gland has lost its ability to make one, some or all pituitary hormones. The condition is often permanent, but very treatable.

The pituitary gland in the middle of the head and brain is the bodys master gland. The table below describes what each hormone made by the pituitary gland does, what happens when each hormone is missing and medication that can replace each hormone.

In children, hypopituitarism is usually caused by something congenital (the child is born with the problem) or by a pituitary tumor. The tumor interferes with the gland. Sometimes, the cause cannot be determined.

Sometimes, the cause was present before the child was born. Often, we see that the pituitary gland is under-developed. A genetic error may be the reason the gland doesnt work well.

Children withsepto-optic dysplasia have varying degrees of hypopituitarism. Their vision is usually impaired because the optic nerves are under-developed. The eyes can move irregularly or wander. This disorder can affect the pituitary gland and other structures in the brain. Often, these children have diabetes insipidus and not enough growth hormone.

There are other forms of congenital hypopituitarism. Sometimes, the pituitary gland doesnt make enough growth hormone. Sometimes, the thyroid gland is underactive, or the adrenal gland doesnt work well. In Kallman syndrome, not enough of the hormones that stimulate the testes or ovaries are made, puberty is late or doesnt happen, and the sense of smell is affected.

A tumor can cause hypopituitarism. The tumor may grow in the pituitary gland or outside the gland, compressing the normal tissue. Parents worry that the tumor may be cancer, but thats unlikely.

Rarely, one of these conditions leads to this hormone problem:

Some hormone deficiencies cause complications over time. Our experienced doctors help you understand any long-term or serious effects of the missing hormones. For example:

Signs and symptoms vary, depending on which hormones are lacking and the childs age.

Common symptoms in newborns:

Commonsymptomsin older infants and children:

The symptoms you see may be due to other conditions and medical problems. Always talk to your childs doctor if you have a concern.

Our approach to diagnosing hypopituitarism is very thorough. We take one step at a time andminimizeinvasive procedures.

We can use other tests as needed. For example:

We know that the weeks of waiting for the full picture can be difficult. Our compassionate team and family-friendly environment support your family while we progress toward the answers and plan the right treatment. As soon as possible, youll receive a call from a doctor or nurse about what weve found and the next steps to take.

We treat the cause of the condition and replace the hormones the body isnt making.

Hormone replacement therapy mimics the bodys natural production. The medicines can be continued as long as needed, during childhood and adulthood. These medications are tolerated very well when the right amounts of hormones are replaced. The following are examples of hormone replacement therapy:

Some tumors respond to medicine that is swallowed. Other tumors need to be removed with surgery. Usually, the hormone deficiencies remain after a tumor is removed. Hormone therapy works for this.

To be effective, hormone replacement must be supported with ongoing care. Throughout childhood, we need to adjust the hormone doses to accommodate the growing childs needs and changes in symptoms. We evaluate the childs growth and development frequently and develop a working relationship with parent and child.

Our resources help bring the right specialists into your childs care to make sure the child gets the best treatment possible. Our endocrinologists and neurosurgeons co-manage patients in our hospital. Tools such as our electronic health record help nurses and doctors throughout the team work closely together.

We care for children with all forms of hypopituitarism. We treat each hormone deficiency to maintain the childs health and normal development. With the right care plan, children with hypopituitarism usually enjoy a normal life. We help the child to develop normally, interact with peers and feel well.

Learn more about pituitary disorders by visiting these physician-recommended websites:

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Hypopituitarism Treatment & Causes | Lurie Children's

Hypopituitarism | You and Your Hormones from the Society for …

Alternative names for hypopituitarism

Hypopit; pituitary insufficiency; partial hypopituitarism; panhypopituitarism (pan referring to all pituitary hormones being affected); anterior hypopituitarism

Hypopituitarism is failure of the pituitary gland to produce one, some, or all of the hormones it normally produces. The pituitary gland has two parts, the anterior pituitary and the posterior pituitary, and hormone production can be affected in both parts.

Below are listed some of the causes of hypopituitarism:

The signs and symptoms of hypopituitarism depend on which of the pituitary gland hormones are involved, to what extent and for how long. It also depends on whether the hormone deficiencies began as a child or later in adult life. Symptoms can be slow at the start and vague.It is worth understanding the normal function and effects of these hormones in order to understand the signs and symptoms of hypopituitarism. (See the article on pituitary gland.) There may also be additional symptoms due to the underlying cause of the hypopituitarism, such as the effects of pressure from a tumour.

Symptoms can include:

Hypopituitarism is rare. At any given time, between 300 and 455 people in a million may have hypopituitarism. A number of endocrinologists believe that hypopituitarism is quite common after brain injuries. If this belief is confirmed, then hypopituitarism may be significantly more common than previously believed.

Most cases of hypopituitarism are not inherited.However, there are some very rare genetic abnormalities than can cause hypopituitarism.

Blood tests are required to check the level of the hormones, which are either produced by the pituitary gland itself, or by peripheral endocrine glands controlled by the pituitary gland. These blood tests may be one-off samples or the patient may require more detailed testing on a day-unit. These are called dynamic tests and they measure hormone levels before and after stimulation to see if the normal pituitary gland is working properly.They usually last between1 to 4 hours.

If it is suspected that there is a lack of anti-diuretic hormone, the doctor may organise a water deprivation test. The patient will be deprived of water for a period of eight hours under very close supervision with regular blood and urine tests.The test may be extended to a 24 hour period if needed, which means an overnight stay in hospital.

Other tests may also be organised to try and identify the underlying cause of the hypopituitarism. These could include blood tests, scans such as computerised tomography (CT) or magnetic resonance imaging (MRI) scans, and tests for vision.

Hypopituitarism is treated by replacing the deficient hormones. Treatment will be tailored to the individual depending on which hormones they are deficient in:

Since the treatment of hypopituitarism only involves replacing hormones that the body should be making but is unable to, there should be no side-effects if the appropriate amounts of hormones are replaced.Patients will be monitored to ensure they are receiving the correct amount of replacement hormones. Some side-effects can occur from hormone replacement if the amount replaced is higher than the individuals body requirements.If the patient has any concerns, they should discuss them with their doctor.

People with long-term hypopituitarism will need to take daily medication and will require regular checks with an endocrinologist at an outpatients clinic.

People with hypopituitarism may have an impaired quality of life.Hypopituitarism is associated with an increased risk of heart disease and strokes as a result of the physical changes that occur in body fat, cholesterol and circulation. Healthy living, a balanced diet and exercise to prevent becoming overweight are essential to reduce this risk.

People with hypopituitarism also have a higher risk of developing osteoporosis or brittle bones and, therefore, have a higher risk of developing fractures from minor injuries. A diet that is rich in calcium and vitamin D along with moderate amounts of weight-bearing exercise and training are helpful in decreasing this risk.

Appropriate pituitary hormone replacement therapy can reduce all these risks.

Last reviewed: Jan 2015

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Hypopituitarism | You and Your Hormones from the Society for ...

Panhypopituitarism: Practice Essentials, Pathophysiology …

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Panhypopituitarism: Practice Essentials, Pathophysiology ...

Hypopituitarism | Lifespan

What is hypopituitarism?

Hypopituitarism happens when your pituitary gland is not active enough. As a result the gland does not make enough pituitary hormones.

The pituitary is a small gland at the base of your brain. It is one of several glands that make hormones. Hormones are chemicals that send information and instructions from one set of cells to another. The pituitary gland makes many types of hormones. These hormones affect many things, including bone and tissue growth, your thyroid gland, and sexual development and reproduction.

Causes can directly affect the pituitary gland. Or they can indirectly affect the glandthrough changes inthe hypothalamus. This is a part of the brain that is just above the pituitary gland.

Direct causes include:

Indirect causes include:

Symptoms are different for each person. They may happen over time or right away. They depend on which hormones the pituitary gland is not making enough of. These hormone deficiencies, and the symptoms they cause, include:

These symptoms may look like other health problems. Always see your healthcare provider for a diagnosis.

Your healthcare provider will ask about your medical history. You will also need an exam. Other tests you may need include:

Your healthcare provider will figure out the best treatment for you based on:

Treatment depends on what is causing the condition. The treatment goal is to have the pituitary gland work as it should. Treatment may include:

Tell your healthcare provider if your symptoms get worse or you have new symptoms.

Tips to help you get the most from a visit to your healthcare provider:

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Hypopituitarism | Lifespan

OMIM Entry – # 146510 – PALLISTER-HALL SYNDROME; PHS

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Galasso, C., Scire, G., Fabbri, F., Spadoni, G. L., Killoran, C. E., Biesecker, L. G., Boscherini, B. Long-term treatment with growth hormone improves final height in a patient with Pallister-Hall syndrome. Am. J. Med. Genet. 99: 128-131, 2001. [PubMed: 11241471] [Full Text: http://onlinelibrary.wiley.com/resolve/openurl?genre=article&sid=nlm:pubmed&issn=0148-7299&date=2001&volume=99&issue=2&spage=128%5D

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Kang, S., Graham, J. M., Jr., Abbott, M., Schaffer, A., Green, E. D., Rosenberg, M., Allen, J., Clericuzio, C., Grebe, T., Haskins-Olney, A., Biesecker, L. G. Autosomal dominant Pallister-Hall syndrome maps to 7p13. (Abstract) Am. J. Hum. Genet. 59 (suppl.): A17 only, 1996.

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Kletter, G. B., Biesecker, L. G. Male-to-male transmission of the Pallister-Hall syndrome. (Abstract) Am. J. Hum. Genet. 51 (suppl.): A100 only, 1992.

Kuller, J. A., Cox, V. A., Schonberg, S. A., Golabi, M. Pallister-Hall syndrome associated with an unbalanced chromosome translocation. Am. J. Med. Genet. 43: 647-650, 1992. [PubMed: 1605268] [Full Text: http://onlinelibrary.wiley.com/resolve/openurl?genre=article&sid=nlm:pubmed&issn=0148-7299&date=1992&volume=43&issue=3&spage=647%5D

Low, M., Moringlane, J. R., Reif, J., Barbier, D., Beige, G., Kolles, H., Kujat, C., Zang, K. D., Henn, W. Polysyndactyly and asymptomatic hypothalamic hamartoma in mother and son: a variant of Pallister-Hall syndrome. Clin. Genet. 48: 209-212, 1995. [PubMed: 8591673] [Full Text: http://onlinelibrary.wiley.com/resolve/openurl?genre=article&sid=nlm:pubmed&issn=0009-9163&date=1995&volume=48&issue=4&spage=209%5D

Lurie, I. W. Pallister-Hall and McKusick-Kaufmann syndromes. (Letter) J. Med. Genet. 32: 668-672, 1995. [PubMed: 7473667] [Full Text: http://jmg.bmj.com/cgi/pmidlookup?view=long&pmid=7473667%5D

Lurie, I. W., Wulfsberg, E. A. The McKusick-Kaufmann syndrome: phenotypic variation observed in familial cases as a clue for the evaluation of sporadic cases. Genet. Counsel. 5: 275-281, 1994. [PubMed: 7811428]

Narumi, Y., Kosho, T., Tsuruta, G., Shiohara, M., Shimazaki, E., Mori, T., Shimizu, A., Igawa, Y., Nishizawa, S., Takagi, K., Kawamura, R., Wakui, F., Fukushima, Y. Genital abnormalities in Pallister-Hall syndrome: report of two patients and review of the literature. Am. J. Med. Genet. 152A: 3143-3147, 2010. [PubMed: 21108399] [Full Text: https://dx.doi.org/10.1002/ajmg.a.33720%5D

Ondrey, F., Griffith, A., Van Waes, C., Rudy, S., Peters, K., McCullagh, L., Biesecker, L. G. Asymptomatic laryngeal malformations are common in patients with Pallister-Hall syndrome. Am. J. Med. Genet. 94: 64-67, 2000. [PubMed: 10982485] [Full Text: http://onlinelibrary.wiley.com/resolve/openurl?genre=article&sid=nlm:pubmed&issn=0148-7299&date=2000&volume=94&issue=1&spage=64%5D

Pallister, P. D., Hecht, F., Herrman, J. Three additional cases of the congenital hypothalamic 'hamartoblastoma' (Pallister-Hall) syndrome. (Letter) Am. J. Med. Genet. 33: 500-501, 1989. [PubMed: 2596511] [Full Text: http://onlinelibrary.wiley.com/resolve/openurl?genre=article&sid=nlm:pubmed&issn=0148-7299&date=1989&volume=33&issue=4&spage=500%5D

Penman Splitt, M., Wright, C., Perry, R., Burn, J. Autosomal dominant transmission of Pallister-Hall syndrome. Clin. Dysmorph. 3: 301-308, 1994. [PubMed: 7894735]

Sama, A., Mason, J. D. T., Gibbin, K. P., Young, I. D., Hewitt, M. The Pallister-Hall syndrome. (Letter) J. Med. Genet. 31: 740 only, 1994. [PubMed: 7815447] [Full Text: http://jmg.bmj.com/cgi/pmidlookup?view=long&pmid=7815447%5D

Say, B., Gerald, P. S. A new polydactyly--imperforate-anus--vertebral-anomalies syndrome? (Letter) Lancet 292: 688 only, 1968. Note: Originally Volume II. [PubMed: 4175523] [Full Text: https://linkinghub.elsevier.com/retrieve/pii/S0140-6736(68)92549-X%5D

Sills, I. N., Rapaport, R., Desposito, F., Lieber, C. Familial Pallister-Hall syndrome: three affected offspring. (Letter) Am. J. Med. Genet. 52: 251 only, 1994. [PubMed: 7802025] [Full Text: http://onlinelibrary.wiley.com/resolve/openurl?genre=article&sid=nlm:pubmed&issn=0148-7299&date=1994&volume=52&issue=2&spage=251%5D

Sills, I. N., Rapaport, R., Robinson, L. P., Lieber, C., Shih, L. Y., Horlick, M. N. B., Schwartz, M., Desposito, F. Familial Pallister-Hall syndrome: case report and hormonal evaluation. Am. J. Med. Genet. 47: 321-325, 1993. [PubMed: 8135274] [Full Text: http://onlinelibrary.wiley.com/resolve/openurl?genre=article&sid=nlm:pubmed&issn=0148-7299&date=1993&volume=47&issue=3&spage=321%5D

Stoll, C., de Saint Martin, A., Donato, L., Alembik, Y., Sauvage, P., Messer, J. Pallister-Hall syndrome with stenosis of the cricoid cartilage and microphallus without hypopituitarism. Genet. Counsel. 12: 231-235, 2001. Note: Erratum: Genet. Counsel. 13: 69 only, 2002. [PubMed: 11693785]

Thomas, H. M., Todd, P. J., Heaf, D., Fryer, A. E. Recurrence of Pallister-Hall syndrome in two sibs. J. Med. Genet. 31: 145-147, 1994. [PubMed: 8182722] [Full Text: http://jmg.bmj.com/cgi/pmidlookup?view=long&pmid=8182722%5D

Topf, K. F., Kletter, G. B., Kelch, R. P., Brunberg, J. A., Biesecker, L. G. Autosomal dominant transmission of the Pallister-Hall syndrome. J. Pediat. 123: 943-946, 1993. [PubMed: 8229528]

Unsinn, K. M., Neu, N., Krejci, A., Posch, A., Menardi, G., Gassner, I. Pallister-Hall syndrome and McKusick-Kaufmann (sic) syndrome: one entity? J. Med. Genet. 32: 125-128, 1995. [PubMed: 7760322] [Full Text: http://jmg.bmj.com/cgi/pmidlookup?view=long&pmid=7760322%5D

Verloes, A. Numerical syndromology: a mathematical approach to the nosology of complex phenotypes. Am. J. Med. Genet. 55: 433-443, 1995. [PubMed: 7762583] [Full Text: http://onlinelibrary.wiley.com/resolve/openurl?genre=article&sid=nlm:pubmed&issn=0148-7299&date=1995&volume=55&issue=4&spage=433%5D

Verloes, A., David, A., Ngo, L., Bottani, A. Stringent delineation of Pallister-Hall syndrome in two long surviving patients: importance of radiological anomalies of the hands. J. Med. Genet. 32: 605-611, 1995. [PubMed: 7473651] [Full Text: http://jmg.bmj.com/cgi/pmidlookup?view=long&pmid=7473651%5D

Verloes, A., Gillerot, Y., Langhendries, J.-P., Fryns, J.-P., Koulischer, L. Variability versus heterogeneity in syndromal hypothalamic hamartoblastoma and related disorders: review and delineation of the cerebro-acro-visceral early lethality (CAVE) multiplex syndrome. Am. J. Med. Genet. 43: 669-677, 1992. [PubMed: 1621756] [Full Text: http://onlinelibrary.wiley.com/resolve/openurl?genre=article&sid=nlm:pubmed&issn=0148-7299&date=1992&volume=43&issue=4&spage=669%5D

Verloes, A., Narcy, F., Fallet-Bianco, C. Syndromal hypothalamic hamartoblastoma with holoprosencephaly sequence, microphthalmia, pulmonary malformations, radial hypoplasia and mullerian regression: further delineation of a new syndrome? Clin. Dysmorph. 4: 33-37, 1995. [PubMed: 7735503]

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OMIM Entry - # 146510 - PALLISTER-HALL SYNDROME; PHS

Hypopituitarism in Children | Children’s Hospital of Philadelphia

Hypopituitarism is a condition in which the pituitary gland in the brain is not working properly. Normally, the pituitary gland produces hormones some of which affect growth, blood pressure, blood sugar and other body processes. Effects of hypopituitarism may be gradual, or sudden and dramatic.

Hypopituitarism, in children, is often caused by a benign (noncancerous) pituitary tumor, an injury, an autoimmune process, or an infection. Often, no exact cause can be determined.

Symptoms vary depending on what hormones are insufficiently producedfrom the pituitary gland. The symptoms of hypopituitarism may resemble other conditions or medical problems. Always consult yourdoctor for a diagnosis. Common symptoms include:

Small penis in males

Very low blood sugar (hypoglycemia)

Slowed growth and short stature

Slowed sexual development

Prolonged jaundice at birth

Poor appetite

Weight loss or weight gain

Sensitivity to cold

Facial puffiness

The symptoms of several underactive glands may help your child'sdoctor diagnose hypopituitarism. In addition to a complete medical history and physical exam, diagnostic procedures for hypopituitarism may include:

Computed tomography scan (also called a CT or CAT scan).A diagnostic imaging procedure that uses a combination of X-rays and computer technology to producehorizontal, or axial,images (often called slices)of the body. A CT scan shows detailed images of any part of the body, including the bones, muscles, fat, and organs. CT scans are more detailed than general X-rays.

Magnetic resonance imaging (MRI).A diagnostic procedure that uses a combination of large magnets, radiofrequencies, and a computer to produce detailed images of organs and structures within the body.

Blood tests. Blood tests are used to measure hormone levels.

Bone X-rays of the hand. X-rays of the left hand and wrist willdetermine bone age, which is often delayed compared with chronologic age inchildren with hypopituitarism..

Specific treatment for hypopituitarism will be determined by your child'sdoctor based on:

Your child's age, overall health, and medical history

Extent of the disease

Your child's tolerance for specific medications, procedures, or therapies

Expectations for the course of the disease

Your opinion or preference

Treatment of hypopituitarism depends on its cause. The goal of treatment is to restore the pituitary gland to normal function, producing normal levels of hormones. Treatment may include specific hormone replacement therapy, surgical tumor removal, and/or radiation therapy.

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Hypopituitarism in Children | Children's Hospital of Philadelphia

What is hypopituitarism? | The Pituitary Foundation

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The pituitary gland produces a number of hormones or chemicals which are released into the blood to control other glands in the body. If the pituitary is not producing one or more of these hormones, or not producing enough, then this condition is known as hypopituitarism.

The term Multiple Pituitary Hormone Deficiency (MPHD) is sometimes used to describe the condition when the pituitary is not producing two or more of these hormones. If all the hormones produced by the pituitary are affected this condition is known as panhypopituitarism.

Hypopituitarism is most often caused by a benign (i.e. not cancerous) tumour of the pituitary gland, or of the brain in the region of the hypothalamus. Pituitary underactivity may be caused by the direct pressure of the tumour mass on the normal pituitary or by the effects of surgery or radiotherapy used to treat the tumour. Less frequently, hypopituitarism can be caused by infections (such as meningitis) in or around the brain or by severe blood loss, by head injury, or by various rare diseases such as sarcoidosis (an illness which resembles tuberculosis).

More information about conditions which result in hypopituitarism can be found in the Rarer Disorders section.

Each of the symptoms described above occur in response to the loss of one or more of the hormones produced by the pituitary. Decrease in the production of only one hormone would not lead to all the symptoms described above.

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What is hypopituitarism? | The Pituitary Foundation

Hypopituitarism – Diagnosis and treatment – Mayo Clinic

Diagnosis

If your doctor suspects a pituitary disorder, he or she will likely order several tests to check levels of various hormones in your body. Your doctor may also want to check for hypopituitarism if you've had a recent head injury or radiation treatment that might have put you at risk of damage to your pituitary gland.

Tests your doctor may order include:

Successful treatment of the underlying condition causing hypopituitarism may lead to a complete or partial recovery of your body's normal production of pituitary hormones. Treatment with the appropriate hormones is often the first step. These drugs are considered as "replacement," rather than treatment, because the dosages are set to match the amounts that your body would normally manufacture if it didn't have a pituitary problem. Treatment may be lifelong.

Treatment for pituitary tumors may involve surgery to remove the growth. In some instances, doctors also recommend radiation treatment.

Hormone replacement medications may include:

If you've become infertile, LH and FSH (gonadotropins) can be administered by injection to stimulate ovulation in women and sperm production in men.

A doctor who specializes in endocrine disorders (endocrinologist) may monitor the levels of these hormones in your blood to ensure you're getting adequate but not excessive amounts.

Your doctor will advise you to adjust your dosage of corticosteroids if you become seriously ill or experience major physical stress. During these times, your body would ordinarily produce extra cortisol hormone. The same kind of fine-tuning of dosage may be necessary when you have the flu, experience diarrhea or vomiting, or have surgery or dental procedures. Adjustments in dosage may also be necessary during pregnancy or with marked changes in weight. You may need periodic CT or MRI scans as well to monitor a pituitary tumor or other diseases causing the hypopituitarism.

Wear a medical alert bracelet or pendant, and carry a special card, notifying others in emergency situations, for example that you're taking corticosteroids and other medications.

You're likely to start by seeing your family doctor or a general practitioner. However, in some cases, when you call to set up an appointment, you may be referred to a specialist called an endocrinologist.

Here's some information to help you prepare for your appointment.

Create a list of questions before your appointment so that you can make the most of your time with your doctor. For hypopituitarism, some basic questions to ask your doctor include:

Don't hesitate to ask any questions you have during your appointment.

Your doctor is likely to ask you some questions, such as:

Aug. 22, 2017

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Hypopituitarism - Diagnosis and treatment - Mayo Clinic

Hypopituitarism in Kids: Definition, Symptoms, Treatment

What is Hypopituitarism in Children?

The pituitary gland sends signals to other glands to produce hormones (for example, it makes thyroid stimulating hormone (TSH - which regulates production of thyroid hormone by the thyroid gland). The hormones released by the pituitary and other glands have a significant impact on important bodily functions, such as growth, reproduction, blood pressure, and metabolism (the physical and chemical processes of the body). When levels of one or more of these hormones are not properly balanced, the body's normal functions can be affected.

The pituitary gland produces several hormones.

In hypopituitarism, the level of one or more of these pituitary hormones is insufficient. The lack of hormone results in a loss of function of the gland or organ that it controls.

The most common pituitary hormone deficiency is growth hormone deficiency. In the United States, growth hormone deficiency occurs rarely with a frequency of less than 1 in 3,480 children.

Hypopituitarism in Children Causes

Hypopituitarism may be congenital (a condition present at birth) and caused by:

Hypopituitarism can also be acquired (a condition that develops later in life) and may be caused by:

Hypopituitarism in Children Symptoms

Symptoms vary depending on the child's age, underlying cause, and the involved hormone. Signs and symptoms may develop gradually and may not be specific.

Signs and symptoms that may be present in newborn babies include:

When to Seek Medical Care fo Hypopituitarism

Call the doctor or health care practitioner if the child develops symptoms.

Exams and Tests for Hypopituitarism

Blood tests may be performed to determine which hormone is low or absent.

The doctor may obtain an MRI of the brain to assess the structure of the pituitary or to detect a tumor.

Hypopituitarism Treatment

Treatment primarily involves hormone replacement therapy.

Medications

Drugs used to treat hypopituitarism replace the deficient hormone.

Hypopituitarism Surgery

Surgery may be performed if a tumor is present within or near the pituitary gland, depending on the type and location of the tumor, and depending on the symptoms being experienced.

Hypopituitarism Follow-up

The doctor or health care practitioner may schedule routine checkups every three months to monitor growth and development.

Frequent checkups for children on growth hormone replacement therapy may be scheduled to monitor progress and side effects.

A doctor who specializes in studying hormones (a pediatric endocrinologist) should supervise the treatment of children with hypopituitarism.

Outlook for Hypopituitarism

With appropriate treatment, the prognosis is very good.

John A. Seibel, MD; Board Certified Internal Medicine with a subspecialty in Endocrinology & Metabolism

REFERENCE:

"Causes and clinical manifestations of central adrenal insufficiency in children"UpToDate.com

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Hypopituitarism in Kids: Definition, Symptoms, Treatment

Hypopituitarism | Hormone Health Network

More about Rare Diseases

Hypopituitarism (also called pituitary insufficiency) is a rare condition in which your pituitary gland doesn't make enough of certain hormones. Your body can't work properly when important glands, such as your thyroid gland and adrenal gland, don't get the hormones they need from your pituitary gland. Hypopituitarism can develop very slowly, over several months or even over several years.

Hypopituitarism can be caused by:

Sometimes, the cause is unknown.

Symptoms can include one or more of the following:

Your doctor will check your hormone levels with blood tests. You may have other tests, such as an MRI of your pituitary gland, to help find the cause of your hypopituitarism.

Treatment usually includes taking the hormones you're missing, sometimes for life. Your doctor also will teach you how to take extra cortisone (a hormone) when you are sick or under stress. If a tumor is causing your hypopituitarism, you might need surgery to remove it and/or possibly radiation treatment. If needed, you can take medicine for infertility.

You will need to get regular check-ups. It's wise to wear medical identification, such as a bracelet or pendant, which provides information about your condition in case of an emergency.

You can expect a normal life span, as long as you regularly take the medications recommended by your doctor.

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Hypopituitarism | Hormone Health Network

Hypopituitarism – Symptoms, Causes, Diagnosis and Treatment – Prime Health Channel

[Total: 0 Average: 0/5] What is Hypopituitarism ?

Hypopituitarism refers to a rare clinical syndrome that is characterized by the low secretion of one or more hormones secreted by the pituitary gland. It is a condition primarily affecting the anterior lobe of the pituitary gland. The hormones that are produced by the pituitary glands and may be affected by hypopituitarism are Adrenocorticotrophic Hormone (ACTH), Antidiuretic Hormone (ADH), Follicle-Stimulating Hormone (FSH), Thyroid-Stimulating Hormone (TSH), Luteinizing Hormone (LH), Growth Hormone (GH) and Prolactin. When any one of these hormones is affected, one is considered to suffer from Partial Hypopituitarism and the case involving several hormones at a time is known as Panhypopituitarism. The German physician, Dr.Morris Simmonds can be credited to have detected and described the first such condition as early as 1914. Both children and adults may suffer from hypopituitarism which may be caused by a number of reasons affecting the pituitary glands. An underactive pituitary gland affects the normal body functions. One who is affected with hypopituitarism since birth or inherits the same, is said to suffer from congenital or postpartum hypopituitarism. However, like hypoparathyroidism, hypopituitarism is a disease that is most likely to last for life, so its treatment also lasts long.

The symptoms of hypopituitarism basically depend on the deficiency of a particular hormone secreted by the pituitary glands and its severity as well as the underlying cause responsible for it as. The signs and symptoms of hypopituitarism are usually subtle in nature but may also appear very suddenly.

In cases such as insufficient gonadotropins production that is actually secreted by the follicle-stimulating hormone and the luteinizing hormone, one may experience sexual problems such as hot flashes, infertility, impotence, loss of pubic hair, decreased sperm production, drying of the vagina, shriveling of the testes, amenorrhea or the absence of menstrual cycle in women and altogether a decreased sex drive. It may also cause osteoporosis in adults. The deficiency of such a hormone may be responsible for delaying puberty in children.

Insufficient production of the growth hormone caused by hypopituitarism in adults usually has no specific symptoms. But growth hormone deficiency may cause hypopituitarism dwarfism in children. This kind of specific hormone deficiency is more associated with people already suffering from tumor in the pituitary glands. One may suffer from the enlargement of the limbs or acromegaly, headaches, autoimmune inflammation of the pituitary glands or lymphocytic hypophysitis, and pituitary apoplexy or stroke.

The deficiency or the poor secretion of the TSH may be signaled by the gain or loss of weight, puffiness or the drying of the skin, sensitivity towards cold, constipation and even cretinism. The poor functioning of the pituitary glands to produce the ACTH or the prolactin results in low blood pressure, fatigue, stress, low blood sugar, anemia and the lack of production of breast milk in women after the birth of a child. On a more general sense, people with hypopituitarism may suffer from skin, nail and hair problems.

The causes of hypopituitarism are quite a few in number and also quite distinct by nature. The most common cause of hypopituitarism is the development of tumor in any of the pituitary glands. Such a condition is also known as pituitary adenomas in which case the normal tissues in the gland are compressed and it may also cause brain tumors, namely, craniopharyngiomas, glioma, chordoma, metastasis, ependymoma, and meningioma that are actually derivatives from pituitary gland problems. Cancer may also aggravate hypopituitarism.

Other common causes of hypopituitarism include hypophysis trauma, brain injury, ill effects of neurosurgical operations and ionizing radiation therapies to cure brain tumors and transsphenoidal adenomectomy.

Infections of the brain or the pituitary glands such as meningitis, brain abscess, syphilis, and encephalitis may also be responsible for causing hypopituitarism. Inflammatory diseases like amyloidosis and sarcoidosis are other causes of hypopituitarism. Diseases associated with infiltration by abnormal cells, histiocytosis and neurosarcoidosis may also be held responsible for hypopituitarism. Autoimmune diseases such as lymphocytic hypophysitis, empty sella syndrome that causes the disappearance of the pituitary tissues, and hemochromatosis or excessive iron content in the body may also be attributed to the occurrence of hypopituitarism.

Vascular hypopituitarism is a disease that affects pregnant women when their pituitary gland is harmed due to hemorrhage or infarction, or excessive bleeding following a delivery, a condition known as Sheehanss Syndrome. Pituitary apoplexy and strokes may also be held responsible for the same. On the other hand, congenital hypopituitarism is a disorder that affects a child since his/her birth. It may arise as a result of genetic complications or complications related to the birth. Certain specific gene mutations may cause the poor development of the pituitary glands to such an extent that they even be on the verge of dysfunction. The condition related to the insufficient development of the glands is called hypoplasia. Congenital hypopituitarism may also be caused by the Kallmann Syndrome which causes a deficiency of the sex hormones.

Certain other syndromes such as Prader-Willi and Biedl, chronic metabolic and autoimmune syndromes such as diabetes insipidus may also be responsible for causing hypopituitarism. Any other kind of damage to the nerves or the vessels by either internal or external factors may also cause the deficiency of the pituitary hormones.

Some of the symptoms of hypopituitarism are so obvious and serious that may facilitate the easy diagnosis of the disorder. But for discerning the exact reason behind hypopituitarism, one must go through the proper clinical tests, which shall help in the proper diagnosis of the ailment.

Blood tests are the most common form of clinical test that is beneficial in the proper diagnosis of just not hypopituitarism but for most of the diseases and disorders. The blood tests are usually of two types, namely, basal level tests and dynamic tests. Basal level tests have a specific timing for the collection of blood samples, mostly early morning when one is not stimulated before being injected. One the other hand, dynamic tests requires one to get injected by a stimulant before conducting the actual blood test. Basal level tests are conducted in the case of the measurement of the FSH, TSH and prolactin. Whereas, low levels of growth hormone and ACTH can be detected by the dynamic blood test.

Another way to detect the cause of hypopituitarism is to undergo an x-ray of the neck, hand or the wrist. This is a way most common in cases related to hypopituitarism in children. However, if this method does not prove to be helpful, one may take recourse to the other imaging tests such as CT scan or an MRI.

CT scan or Computed Tomography and MRI are non-invasive diagnosis procedures that helps to detect any kind of abnormality just not associated with the pituitary glands but the body as a whole.

In addition to these, vision tests are conducted specially on children to conform if hypopituitarism tumor has caused any kind of impairment to the eyes. Moreover, in case of congenital hypopituitarism, one may be asked to undergo a genetic test in order to discern the exact cause of hypopituitarism. Urine specific gravity test is used for patients with hypopituitarism and diabetes. All of these diagnostic procedures facilitate the treatment of hypopituitarism.

The treatment for hypopituitarism depends on the underlying cause of the disease that has been detected through the various ways of diagnosis. Some of the treatment methods that are adopted include medicines, drugs, hormone replacement therapy, and radiation therapy. Surgeries and radiation therapies are usually performed in case of pituitary tumors.

The hormone replacement medications perform the similar functions that insulin is supposed to perform in case of diabetes. Such medications help the pituitary glands to artificially produce the hormones that it is deficient in. Some of the most commonly prescribed medications are corticosteroids such as prednisone and hydrocortisone, levothyroxine like synthroid and levoxyl, desmopression, sex hormones, namely, testosterone, progesterone and estrogen, and artificial growth hormones like the somatropin. Corticosteroids help in making up for ACTH deficiency, Levothyroxines help in replacing deficient TSH. Desmopression (DDAVP) or Vasopressin helps in the case of ADH deficiency and also to treat diabetes insipidus. The sex hormones are administered either through the skin to compensate for the deficiency of sex hormones in case of hypopituitarism. In fact, in case of severe hypopituitarism due to FSH and LH deficiency, one may have to be administered gonadotropins to stimulate the production of the sex hormones. The artificially produced growth hormones help in raising the height of children who had to suffer from a stunted growth due to hypopituitarism.

A surgery is usually conducted if one detects a tumor in the vicinity of the pituitary glands. Radiation therapies also serve the purpose of damaging the tumor through powerful radiations.

However, hypopituitarism is a disorder from which one cant escape till ones death. So, one need to go through routine tests in order to monitor the effects of the disorder and take precautions to thwart away the complications involved with hypopituitarism. So, undertaking the treatment for hypopituitarism under the supervision of an endicronologist is the best way to keep it on tabs.

References :

Wikipedia

http://www.emedicinehealth.com

http://www.mayoclinic.com

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Hypopituitarism - Symptoms, Causes, Diagnosis and Treatment - Prime Health Channel

Hypopituitary: Hypopituitarism Causes, Symptoms & Treatment

What is Hypopituitaryism?

What Causes Hypopituitary?

A loss of function of the pituitary gland or hypothalamus results in low or absent hormones. Tumors can cause damage to the pituitary gland or hypothalamus and can therefore result in a loss of function. Damage to the pituitary gland can also be caused by radiation, surgery, infections (eg, meningitis), or various other conditions. In some cases, the cause is unknown.

What Are the Symptoms of Hypopituitary?

Some persons may have no symptoms or a gradual onset of symptoms. In other persons, the symptoms may be sudden and dramatic. The symptoms depend on the cause, rapidity of onset, and the hormone that is involved.

When to See a Doctor for Hypopituitary

Call the doctor or health care practitioner if any symptoms develop.

What Exams and Tests Diagnose Hypopituitary?

The doctor or health care practitioner may perform blood tests to determine which hormone level is low and to rule out other causes. The following tests may be performed:

An MRI or CT scan of the pituitary gland may be obtained to determine if a tumor is present.

In children, X-rays of the hands may be taken to determine if bones are growing normally.

What Is the Treatment for Hypopituitary?

Medical treatment consists of hormone replacement therapy and treatment of the underlying cause.

What Are the Medications Used to Treat Hypopituitary?

Drugs used to treat hypopituitarism replace the deficient hormone.

Is Surgery a Treatment Option for Hypopituitary?

Surgery may be performed depending on the type, size, and location of the tumor.

What Is the Follow-up for Hypopituitary?

Checkups with the doctor or health care practitioner are important. The doctor may need to adjust the dose of hormone replacement therapy.

What Is the Outlook for Hypopituitary?

If hormone replacement therapy is adequate, the prognosis is good. Complications are often related to the underlying disease.

Reviewed on 1/3/2018

Medically reviewed by John A. Daller, MD; American Board of Surgery with subspecialty certification in surgical critical care

REFERENCE:

"Clinical manifestations of hypopituitarism"

UpToDate.com

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Hypopituitary: Hypopituitarism Causes, Symptoms & Treatment

Generalized Hypopituitarism – Endocrine and Metabolic …

Generalized hypopituitarism refers to endocrine deficiency syndromes due to partial or complete loss of anterior lobe pituitary function. Various clinical features occur depending on the specific hormones that are deficient. Diagnosis involves imaging tests and measurement of pituitary hormone levels basally and after various provocative stimuli. Treatment depends on cause but generally includes removal of any tumor and administration of replacement hormones.

Hypopituitarism is divided into

Primary: Caused by disorders that affect the pituitary gland

Secondary: Caused by disorders of the hypothalamus

The different causes of primary and secondary hypopituitarism are listed in the table below (see Table: Causes of Hypopituitarism).

Causes primarily affecting the pituitary gland (primary hypopituitarism)

Infarction or ischemic necrosis

Hemorrhagic infarction (pituitary apoplexy)

Vascular thrombosis or aneurysm, especially of the internal carotid artery

Meningitis (tubercular, other bacterial, fungal, malarial)

Idiopathic isolated or multiple pituitary hormone deficiencies

Drugs (eg hypophysitis due to antimelanoma monoclonal antibodies)

Causes primarily affecting the hypothalamus (secondary hypopituitarism)

Neurohormone deficiencies of the hypothalamus

Surgical transection of the pituitary stalk

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Generalized Hypopituitarism - Endocrine and Metabolic ...

Hypopituitarism – Symptoms and causes – Mayo Clinic

Overview

Hypopituitarism is a rare disorder in which your pituitary gland either fails to produce one or more of its hormones or doesn't produce enough of them.

The pituitary gland is a small bean-shaped gland situated at the base of your brain, behind your nose and between your ears. Despite its size, this gland secretes hormones that influence nearly every part of your body.

In hypopituitarism, you have a short supply of one or more of these pituitary hormones. This deficiency can affect any number of your body's routine functions, such as growth, blood pressure and reproduction.

You'll likely need medications for the rest of your life to treat hypopituitarism, but your symptoms can be controlled.

Hypopituitarism is often progressive. Although the signs and symptoms can occur suddenly, they more often develop gradually. They are sometimes subtle and may be overlooked for months or even years.

Signs and symptoms of hypopituitarism vary, depending on which pituitary hormones are deficient and how severe the deficiency is. They may include:

See your doctor if you develop signs and symptoms associated with hypopituitarism.

Contact your doctor immediately if certain signs or symptoms of hypopituitarism develop suddenly or are associated with a severe headache, visual disturbances, confusion or a drop in blood pressure. Such signs and symptoms could represent sudden bleeding into the pituitary gland (pituitary apoplexy), which requires prompt medical attention.

Hypopituitarism may be the result of inherited disorders, but more often it's acquired. Hypopituitarism frequently is triggered by a tumor of the pituitary gland. As a pituitary tumor increases in size, it can compress and damage pituitary tissue, interfering with hormone production. A tumor can also compress the optic nerves, causing visual disturbances.

The cause of hypopituitarism can also be other diseases and events that damage the pituitary, such as:

Diseases of the hypothalamus, a portion of the brain situated just above the pituitary, also can cause hypopituitarism. The hypothalamus produces hormones of its own that directly affect the activity of the pituitary.

In some cases, the cause of hypopituitarism is unknown.

Aug. 22, 2017

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Hypopituitarism - Symptoms and causes - Mayo Clinic

Hypopituitarism: Causes, Symptoms, and Treatment

Whatis an underactive pituitary gland?

Your pituitary gland is located on the underside of your brain. It releases eight hormones. Each of these hormones plays a role in how your body function. These functions range from stimulating bone growth to prompting your thyroid gland to release hormones that control your metabolism.

Hormones produced by the pituitary gland include:

Hypopituitarism occurs when your pituitary gland does not release enough of one or more of these hormones.

What causes an underactive pituitary gland?

Trauma may cause your pituitary gland to stop producing enough of one or more of its hormones. For example, if you had brain surgery, a brain infection, or a head injury, may affect your pituitary gland.

Certain tumors can also affect the function of this gland. These include:

Some other possible causes of hypopituitarism include:

There may also be other causes of hypopituitarism. And in some cases hypopituitarism, the cause may be unknown.

What are the symptoms of an underactive pituitary gland?

The symptoms of hypopituitarism depend on which hormones your pituitary gland is not producing enough of. For example, if the pituitary gland does not produce enough growth hormone in a child, they may have a permanently short stature. If it doesnt produce enough follicle-stimulating hormone or luteinizing hormone, it might cause problems with sexual function, menstruation, and fertility.

How is an underactive pituitary gland diagnosed?

If your doctor thinks you may have hypopituitarism, they will use a blood test to check your levels of the hormones the pituitary gland produces. They may also check for hormones your pituitary gland stimulates other glands to release.

For example, your doctor may check your T4 levels. Your pituitary gland doesnt produce this hormone, but it releases TSH, which stimulates your thyroid gland to release T4. Having low levels of T4 indicates you may have a problem with your pituitary gland.

Your doctor may prescribe specific medications before doing blood tests. These medications will stimulate your bodys production of specific hormones. Taking them before the test can help your doctor better understand your pituitary gland function.

Once your doctor determines which hormone levels are low, they must check the parts of your body (target organs) those hormones affect. Sometimes, the problem isnt with your pituitary gland, but rather with the target organs.

Your doctor may also perform imaging tests, such as a CT scan or MRI scan on your brain. These tests can help your doctor figure out if a tumor on your pituitary gland is affecting its function.

How is an underactive pituitary gland treated?

This condition is best managed by an endocrinologist. There is no single course of treatment because this condition may affect a number of hormones. In general, the goal of treatment is to bring all your hormone levels back to normal.

This may involve taking medications to replace the hormones your pituitary gland is not producing properly. In this case, your doctor will need to check your hormone levels regularly. This allows your doctor to adjust the doses of medications youre taking to make sure youre getting the correct dose.

If a tumor is causing your pituitary problems, surgery to remove the tumor may restore your hormone production to normal. In some cases, getting rid of a tumor will also involve radiation therapy.

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Hypopituitarism: Causes, Symptoms, and Treatment

LABOKLIN (UK)| Genetic Diseases | Dogs| Dwarfism …

Dwarfism (Pituitary Dwarfism / Hypopituitarism)

Test number: 8142

DWARFISM

clear

100% clear

clear

carrier

50% clear + 50% carriers

clear

affected

100% carriers

carrier

clear

50% clear + 50% carriers

carrier

carrier

25% clear + 25% affected + 50% carriers

carrier

affected

50% carriers + 50% affected

affected

clear

100% carriers

affected

carrier

50% carriers + 50% affected

affected

affected

100% affected

Clear

Genotype: N / N [ Homozygous normal ]

The dog is noncarrier of the mutant gene.

Carrier

Genotype: N / DWARFISM [ Heterozygous ]

The dog carries one copy of the mutant gene and one copy of the normal gene.

Carriers should only be bred to clear dogs.

Avoid breeding carrier to carrier because 25% of their offspring is expected to be affected (see table above)

Affected

Genotype: DWARFISM / DWARFISM [ Homozygous mutant ]

The dog carries two copies of the mutant gene and therefore it will pass the mutant gene to its entire offspring.

By DNA testing, the responsible mutation can be shown directly. This method provides a test with a very high accuracy. It offers the possibility to distinguish not only between affected and clear dogs, but also to identify clinically healthy carriers. This is an essential information for controlling the condition in the breed, as carriers are able to spread the disease in the population.

test will be performed at a partner laboratory

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LABOKLIN (UK)| Genetic Diseases | Dogs| Dwarfism ...

Prevalence of Hypopituitarism in Veterans 42% A NEW …

Why are they not doing something with this information? At least 2 million of our Veterans are needlessly suffering when treatment is available!!

Research showsabout 24% of US Veterans who return home from war suffer from PTSD. (With21.8 million veterans of the U.S. armed forces as of 2014, that means about 5.2 million Veterans suffer from PTSD.)Research shows42% of those Veterans who come home with PTSD actually have Hypopituitarism, and when treated, their PTSD symptoms (including depression, and other mental and physical health disorders) actually go away!

That means atleast 2 million Veterans in the United States are needlessly suffering from undiagnosed hypopituitarism. And of Veterans diagnosed with a Traumatic Brain Injury from war, the percent who may have hypopituitarism could be as high as 80%.

What is hypopitutarism? Its when the brain is not able to send signals to cells throughout the body to control all things homeostasis. Everything metabolic. Everything that makes you human. Blood, heart, bone, and muscle function, mental health, sleep cycle, reproductive function, ability to heal and fight infection, and much more. Without these brain signals, you are always unwell, and sentenced to a life of illness and certainlyan early death.

When you google Veterans and PTSD, about 25millionresults come back. When you google Veterans and Hypopituitarism, only 226,000 results come back. Yet nearly half of Veterans with PTSD actually have hypopituitarism. This awareness should spread like wildfire, 2 million veterans may get their lives back.

So why arent they getting a diagnosis? Because doctors dont know to lookfor the symptoms and they dont know the proper tests. The only doctors who are taught about Hypopit are endocrinologists, and they are taught that it is rare. They are misinformed by their textbooks and, admittedly, due to lack of research, there is gross missing information. Hypopit patients find medical professionals actually know very little about diagnosis, testing and treatment. Often times, Hypopit patients are put on anti-anxiety pills and antidepressants, instead of the treatment they need. A bandaid doesnt fix a bullet hole, it may cover it up for a little while, but the problem still exists. We need the textbooks to teach doctors that Hypopit is not rare and we need to teach them that anyone who has symptoms and has experienced a traumatic event should be properly tested.

2010 A recommendation was made by AMSUS (the Society of the Federal Health Professional) for hormonal testing of veterans who sustained and sort of traumatic brain injury.

Military Medicine Recent civilian data obtained in those sustaining head injuries, has found a high prevalence of pituitary dysfunction. Currently, there is no data available in the military population. We reviewed the literature for traumatic brain injury (TBI)-related hypopituitarism and found that the prevalence of anterior hypopituitarism may be as high as 3080% after 2436 months. Since many of the symptoms of hypopituitarism are similar to those of TBI, it is important to make clinicians caring for combat veterans aware of its occurrence. Herein, we provide an overview of the literature and recommendations for hormonal testing when TBI-related hypopituitarism is suspected.Read the full article here:

http://publications.amsus.org/doi/abs/10.7205/MILMED-D-09-00189

2013- Science Daily reported, Up to 20 percent of veterans returning from Afghanistan and Iraq have experienced at least one blast concussion. New research suggests that nearly half these veterans may have a problem so under-recognized that even military physicians may fail to look for it. A new study conducted by Charles W. Wilkinson, Elizabeth A. Colasurdo, Kathleen F. Pagulayan, Jane. B. Shofer, and Elaine R. Peskind, all of the VA Puget Sound Health Care System and the University of Washington in Seattle, has found that about 42 percent of screened veterans with blast injuries have irregular hormone levels indicative of hypopituitarism.View the article here:

http://www.sciencedaily.com/releases/2013/04/130422102029.htm

2013 American Physiological Society (APS). Nearly half of U.S. veterans found with blast concussions might have hormone deficiencies. .

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Pituitary Disorders – labtestsonline.org

NOTE: This article is based on research that utilizes the sources cited here as well as the collective experience of the Lab Tests Online Editorial Review Board. This article is periodically reviewed by the Editorial Board and may be updated as a result of the review. Any new sources cited will be added to the list and distinguished from the original sources used. To access online sources, copy and paste the URL into your browser.

Sources Used in Current Review

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Pituitary Disorders - labtestsonline.org

Severe hyponatremia due to hypopituitarism with adrenal …

Objective: Adrenal insufficiency due to hypopituitarism can lead to severe hyponatremia with potentially fatal consequences. Prompt diagnosis and adequate hormonal replacement therapy are essential to block an otherwise unfavorable course and to re-establish a healthy life. Unfortunately, this condition is often misdiagnosed. Design: Case report. Setting: Intensive Care Unit of a teaching hospital. Patient: A 76-yr-old man with refractory hypotension, acute myocardial infarction, and left ventricular dysfunction, secondary to severe chronic pan-hypopituitarism, associated with severe hyponatremia. Methods and main results: The patient underwent mechanical ventilation and continuous venous-venous hemodiafiltration, for severe respiratory and renal insufficiency. A hormonal replacement therapy with T4, hydrocortisone, and nandrolone was started and the patient was discharged to a rehabilitation facility after 31 days of hospitalization. Conclusions: Hypopituitarism with secondary adrenal insufficiency is often misdiagnosed at an early stage and a high degree of suspicion is necessary for early diagnosis. Determination of plasma cortisol level in patients with hyponatremia not explained by other causes should always be obtained.

Key-wordsHyponatremiapan-hypopituitarismadrenal insufficiencymyocardial infarctionhypothyroidism

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