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Archive for the ‘Hypopituitarism’ Category

Penn Medicine Researchers Receive Distinguished Investigator Awards – Newswise (press release)

Newswise Scott Halpern, MD, PhD, MBE, an associate professor of Medicine, Epidemiology, and Medical Ethics and Health Policy, and director of the Palliative and Advanced Illness Research (PAIR) Center, and Peter J. Snyder, MD, a professor of Medicine in the division of Endocrinology, Diabetes and Metabolism, will be presented with the 2017 Association for Clinical and Translational Science (ACTS) Distinguished Investigator Award for Career Achievement and Contribution to Clinical and Translational Science at Translational Science 2017, the organizations annual meeting, in Washington, D.C. Halpern will also receive the American Federation for Medical Researchs (AFMR) Outstanding Investigator Award at the meeting next month.

The ACTS Distinguished Investigator Award recognizes senior investigators whose innovative research or education leadership has significantly impacted clinical and translational science. The AFMR Outstanding Investigator Award is presented annually to an investigator age 45 or younger in recognition of excellence in biomedical research.

The ACTS Distinguished Investigator Award for Translation from Clinical Use into Public Benefit and Policy & AFMR Outstanding Investigator Award

Dr. Halpern is also the founding director of the Fostering Improvement in End-of-Life Decision Science (FIELDS) program, and deputy director of the Center for Health Incentives and Behavioral Economic (CHIBE). By blending ethical analyses and empirical research, Dr. Halpern’s work promotes the ideals of fairness and value in how scarce healthcare resources, including transplantable organs, ICU beds and services, and clinicians time are allocated to seriously ill patients. The PAIR Center conducts large, pragmatic randomized trials of interventions that seek to improve the lives of all people affected by serious illness. The FIELDS program includes scholars from multiple health-related disciplines who use principles of behavioral economics in an effort to understand and improve upon the healthcare decisions made by seriously ill patients and their family members and clinicians. Finally, his work through the CHIBE develops behavioral economic interventions that motivate smoking cessation, research participation, and reductions in the use of low-value healthcare services, without unduly constraining autonomous choice.

Dr. Halperns research is supported by the National Institutes of Health (NIH) and by a number of foundations. He is an elected member of the American Society of Clinical Investigation, and a member of the editorial boards of the Annals of Internal Medicine and the American Journal of Bioethics. From 2013 2015 he was an anniversary fellow at the Institute of Medicine. He holds a bachelors degree from Duke University, and an MD, PhD, MSCE and MBE from the University of Pennsylvania.

The ACTS Distinguished Investigator Award for Translation from Early Clinical Use to Applicability for Widespread Clinical Practice

Snyders clinical expertise is focused on neuroendocrinology, or the diagnosis and treatment of pituitary adenomas and other pituitary and hypothalamic abnormalities, including excessive and deficient pituitary hormone secretion. These conditions include acromegaly, Cushings disease, hyperprolactinemia, gonadotroph and other clinically nonfunctioning adenomas, other pituitary and hypothalamic tumors, hypopituitarism, and diabetes insipidus. In clinical practice, he also specializes in male reproductive endocrinology, the diagnosis and treatment of hypogonadism and infertility in men.

Over his nearly five-decade career, Snyder has examined the effects of hormones on bone and pituitary adenomas. Most notably, Snyder was the principle investigator of The Testosterone Trials, a multicenter study of seven coordinated trials of the effects of testosterone in elderly men with low testosterone on physical function, vitality, sexual function, cognitive function, anemia, bone and cardiovascular risk.

Snyder is also involved in several professional societies including the American Society for Bone and Mineral Research, the American Society for Clinical Investigation, the Association of American Physicians, and the Endocrine Society. He holds a bachelors degree from Williams College and a medical degree from Harvard University.

### Penn Medicine is one of the world’s leading academic medical centers, dedicated to the related missions of medical education, biomedical research, and excellence in patient care. Penn Medicine consists of the Raymond and Ruth Perelman School of Medicine at the University of Pennsylvania (founded in 1765 as the nation’s first medical school) and the University of Pennsylvania Health System, which together form a $6.7 billion enterprise.

Newswise The Perelman School of Medicine has been ranked among the top five medical schools in the United States for the past 20 years, according to U.S. News & World Report’s survey of research-oriented medical schools. The School is consistently among the nation’s top recipients of funding from the National Institutes of Health, with $392 million awarded in the 2016 fiscal year.

The University of Pennsylvania Health System’s patient care facilities include: The Hospital of the University of Pennsylvania and Penn Presbyterian Medical Center — which are recognized as one of the nation’s top “Honor Roll” hospitals by U.S. News & World Report — Chester County Hospital; Lancaster General Health; Penn Wissahickon Hospice; and Pennsylvania Hospital — the nation’s first hospital, founded in 1751. Additional affiliated inpatient care facilities and services throughout the Philadelphia region include Good Shepherd Penn Partners, a partnership between Good Shepherd Rehabilitation Network and Penn Medicine.

Penn Medicine is committed to improving lives and health through a variety of community-based programs and activities. In fiscal year 2016, Penn Medicine provided $393 million to benefit our community. Contacts

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Penn Medicine Researchers Receive Distinguished Investigator Awards – Newswise (press release)

Fighting Cancer With Fundraising: Meet Milwaukee’s Dr. John Hanson – Milwaukee Magazine

Dr. John Hanson has a colorful, stylish office in the Cudahy Tower, converted from an old apartment, reducing his morning commute to a short stroll from a condominium in the building. A retired oncologist, Hanson now spends his time spearheading his 5-year-old John P. Hanson Foundation for Cancer and Cellular Research, which supports research into cell therapy and other forms of cancer immunotherapy, advanced treatments that direct the power of the bodys immune system (including T-cells) against unwanted cancer cells. Hanson is currently gathering funding to support up to three young researchers at the cutting-edge Robert H. Lurie Comprehensive Cancer Center at Northwestern University, with hopes of one day endowing a professorship.

Should cancer patients challenge their doctors?I think thats fine. Theres no cure. There might be two or three different options. And the next thing is, is there a clinical trial or an attempt to improve on standard practices available? Its all about the patient getting better.

Must the immune system miss something for a tumor to form? No. Its not missing something. What happens is the cancer outfoxes everyone. Instead of supporting the body, it begins to support itself and becomes self-aggrandizing.

Cell therapy sounds great. Does it have limitations?It works extremely well with melanoma because there are large genetic differences. Breast cancer has been treated successfully. A few colon cases have been treated successfully. A pancreatic cancer has been treated successfully, one or two [times]. The imperative is you must develop this [approach] for common cancers because theyre what kill people. It works extremely well with melanoma because there are large genetic differences. Breast cancer has been treated successfully. A few colon cases have been treated successfully. A pancreatic cancer has been treated successfully, one or two [times]. The imperative is you must develop this [approach] for common cancers because theyre what kill people.

During immunotherapy, can the immune system target things other than cancer? That does happen. Diabetes can occur. Hypothyroidism can occur. Hypopituitarism can occur, and bowel diseases can happen. Its a reaction to the immune system being turned on too much.

What was it like to work with cancer patients? Did you find it rewarding? Oh sure. You can help the sick. The art is to listen to what the patient wants. If you listened enough early on, you could say, This is what you want, and this is what I can do. If they wanted to do something high risk, we would talk about it for a week or two to make sure they got it and understood what the risks were. The goal was, I am going to get you through this. You can do this, and you will do this. We have to get to the end of a course [of treatment] to see if it works. Theres a sorrow at death, but we tried as best we could. Can we learn something to help the other families, the other patients? Almost always we do. Was it worth it? Absolutely. Every human being who has cancer wants to live.

Why hasnt immunotherapy taken over the field?Doctors are committed to the life and well-being of patients, and theyre not convinced it works. But youre dealing with people who are dying and sick. I think theres an imperative. You cant keep putting up with the same old shit. Its not in human nature to accept that what is [is beyond improvement]. You have to try.

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Fighting Cancer With Fundraising: Meet Milwaukee’s Dr. John Hanson – Milwaukee Magazine

Thymomas Trigger Newly Described Autoimmune Endocrine Disease – Oncology Nurse Advisor


Oncology Nurse Advisor
Thymomas Trigger Newly Described Autoimmune Endocrine Disease
Oncology Nurse Advisor
Thymomas, a rare type of cancer in the thymus gland, can result in a newly described autoimmune disease, potentially leading to hypopituitarism, according to a recent study in Scientific Reports. Understanding the underlying mechanisms could improve …

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Thymomas Trigger Newly Described Autoimmune Endocrine Disease – Oncology Nurse Advisor

Cold Springs FCCLA brings home state awards – Cullman Times Online

Cold Springs FCCLA students took home an array of honors at state conference, with one student advancing to compete nationally.

On March 9-10, 2017, Cold Springs FCCLA students attended the FCCLA State Meeting in Montgomery. Members throughout Alabama gathered to increase their leadership skills, explore career options, compete in the state FCCLA STAR Events and elect a new team of state officers. With FCCLA there are unlimited opportunities for our youth.

This year Cold Springs had a student, Matthew Blair, to run for the FCCLA Executive Council Officer position. Matthew ran for this office with 10 other young adults from all over Alabama. Only six are chosen for the Executive Council. Matthew gave his speech and answered an on stage question to over 800 members, advisors, and guests. Matthew was voted in by his peers. He will be required to represent the state of Alabama at state and national meetings.

Cold Springs FCCLA had five students to complete the Power of One projects and be recognized at the state meeting: Rachel Haynes, Jessica Roden, Andrew Blair, Matthew Blair, and Stormy Schmidt received a certificate of completion.

Power of One helps students find and use their personal power. Each youth created a Power of One project that relates to one of the following five units:

A better you: Improve personal traits.

Family ties: Get along better with family members.

Working on working: Explore work options, prepare for a career, or sharpen skills useful in business.

Take the lead: Develop leadership qualities.

Speak out for FCCLA: Tell others about positive experiences in FCCLA.

Cold Springs students also competed in the FCCLA STAR Events Competition. These are competitive events in which members are recognized for proficiency and achievement in chapter and individual projects, leadership skills, and career preparation.

Rachel Haynes competed in the Career Investigation category and won gold. Her project title was Labor Lawyer. She will be representing the state of Alabama in this category at Nationals this summer in Nashville.

Matthew Blair, Raegan Lindsey, and Stormy Schmidt won gold in the Illustrated Talk category. They presented about teen depression and suicide.

Jessica Roden placed silver in the Life Event Planning category. Her topic was, Dedication to a Preacher. She planned, organized, and presented her project.

Kylie Gann and Samantha Willcutt won bronze in the Focus on Children category. They discussed and presented the topic of Living with Hypopituitarism. The girls wanted other students to understand what it is like to live with this. One of the girls cousins was born with this.

FCCLA has provided unlimited possibilities for our young adults at Cold Springs and other area schools. Its helps prepare todays teens for tomorrows workforce. It provides personal growth, leadership development, and career preparation opportunities for students in Family and Consumer Sciences. Advisor is Stephanie Blair.

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Cold Springs FCCLA brings home state awards – Cullman Times Online

Hypopituatarism – a lesser-known effect of traumatic brain injury – Lexology (registration)

Our understanding as to how the brain works has developed over the years with medical research. It is an extremely complex organ and when trauma happens it can be very unpredictable as to how the injured person will be affected and what treatment they will require. The problems that can occur are generally split into three areas:

Another area which can be affected following a brain injury which is less commonly understood is hormonal. The pituitary gland is found at the base of the brain. It is approximately the size of a pea and is attached to the brain by a thin stalk. This gland is often referred to as the master gland and is very important in that as well as producing hormones it regulates and controls the other glands in the body which produce hormones.

The pituitary gland is vulnerable to damage if someone suffers trauma to their brain given its location at the base of the brain. Damage to the pituitary gland can result in the gland failing to produce sufficient amount of hormones and this is known as hypopituitarism.

Symptoms of hypopituitarism

It is often not immediately apparent that someone has suffered damage to the pituitary gland and developed hypopituitarism. This is because the symptoms may not develop for a number of weeks, months or even years.

When the symptoms become apparent it is often the case that these can overlap with those suffered as a result of the actual brain injury and be overlooked and therefore misdiagnosed. The symptoms are often subtle and difficult to distinguish meaning treatment can therefore be delayed.

The most common symptoms of hypopituitarism are:

If you display some of these symptoms and your doctor suspects you may be suffering from hypopituitarism they can carry out blood tests to identify any abnormalities. A CT scan may also be carried out to rule out the possibility of a growth or tumour on the pituitary gland. You may then be referred to an endocrinologist a specialist doctor who diagnoses and treats hormone imbalances. Dependant on the particular imbalance you are suffering from, the treatment should aim to return the balance to your hormone levels.

You may be prescribed hormone replacement medication. The endocrinologist will then have to monitor your hormone levels regularly to ensure the levels are kept at a normal level and hopefully ensuring normal hormonal function can resume. Medication may require adjustment to ensure the correct dosage is found and the prescribed treatment acts in conjunction with any other medication which the person may be prescribed to deal with the other symptoms of their brain injury. Hormone replacement treatment will likely be life-long if the damage to the pituitary gland is significant.

Our understanding as to the frequency at which hypopituatarism develops following traumatic brain injury is still in its early stages. We do not yet have accurate statistics to illustrate the likelihood of developing hypopituitarism following brain injury however it is beginning to become clear that it may be more common than previously thought. It is important that patients are warned prior to discharge from hospital following a brain injury to be vigilant as to the symptoms of hypopituitarism. The danger of misdiagnosis or delayed diagnosis could lead to serious consequences however, if identified, hormone replacement treatment is often very successful.

If you have any concerns that you are experiencing symptoms of hypopituitarism following a brain injury it is important that you speak to your GP or other treating doctors. The blood test is quick and easy to undertake to diagnose the condition.

If you have been diagnosed with this condition as a result of an accident, and have suffered a traumatic brain injury, then this condition ought to be taken into account when bringing your personal injury claim. If your medical team have delayed in diagnosing or misdiagnosed your hypopituitarism then you may have a claim for medical negligence.

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Hypopituatarism – a lesser-known effect of traumatic brain injury – Lexology (registration)

Joanna Lane:: Brain injury can cause treatable pituitary disorder – Madison.com

Dear Editor: I am writing this after reading Karl Curtis’ column on brain injuries in the hope that it may be helpful to some of your readers.

Our son Chris committed suicide eight years ago at the age of 31. He’d had a head injury long ago, in childhood, which he’d seemed to recover from fine. But we discovered after his death that he’d never been able to have full sex with his girlfriend, and also that his depression had been far worse than we knew, going back 10 years at least.

We looked it up and found that head injury, even mild (which Chris’ wasn’t; he fractured his skull) can cause damage to the pituitary gland, and the effects can be depression, lost sex drive, lost fertility, obesity and chronic fatigue, plus less serious symptoms like intolerance of heat or cold. The pituitary disorder (post-traumatic hypopituitarism or PTHP) may show immediately, or not until many years later. It is treatable by replacing the hormones which the pituitary can no long make.

Cranial irradiation can cause hypopituitarism also.

Growth hormone replacement can restore clear thought and energy levels, and may reduce weight. It can also help fatigue and depression. The other pituitary hormones that may need replacing are ACTH, LH/FSH, and TSH. LH/FSH replacement can restore sex drive and fertility.

For more detail plus the research see my book “Mother of a Suicide” available from Amazon.

Joanna Lane

London, UK

Send your letter to the editor to tctvoice@madison.com. Include your full name, hometown and phone number. Your name and town will be published. The phone number is for verification purposes only. Please keep your letter to 250 words or less.

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Joanna Lane:: Brain injury can cause treatable pituitary disorder – Madison.com

Hypopituitarism – familydoctor.org

How is hypopituitarism treated?

Your doctor will treat the condition that is the cause of your hypopituitarism first. This can help restore your pituitary glands ability to produce hormones.

If a tumor on your pituitary gland is causing your hypopituitarim, your doctor may recommend surgery to remove it or radiation therapy to shrink it.

If your body does not produce enough of one or more pituitary hormones after treating the underlying condition, your doctor may prescribe a hormone replacement medicine to add to your bodys hormone production.

Hormone replacement medicines include:

If you are taking hormone replacement medicine, your doctor may want to monitor the levels of hormones in your blood to make sure youre getting the right amount of replacement hormones.

If you become very sick (such as with the flu) or go through a stressful time, your doctor may adjust the dose of replacement hormone you take to act the way a normally functioning pituitary gland would act in response to these situations. You might also need a dose adjustment if you become pregnant or have a significant change in weight.

You should carry a medical alert card and bracelet at all times so that emergency medical workers know what kind of care you need in case of emergency.

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Hypopituitarism – familydoctor.org

New autoimmune disease triggered by thymomas – Science Daily


Science Daily
New autoimmune disease triggered by thymomas
Science Daily
A Japanese research group has discovered that a newly-identified autoimmune endocrine disease that leads to hypopituitarism is caused by thymomas (a type of tumor originating from the thymic gland). These underlying mechanisms could help to …

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New autoimmune disease triggered by thymomas – Science Daily

Fundraiser Sunday to benefit Creek infant – Daily Union

JOHNSON CREEK That Jackson Piskula is alive today already is a miracle. But keeping him here and healthy is going to take a lot of work and support.

Jackson, 8 months old, of Johnson Creek, has been diagnosed with a rare genetic disorder called Oral Facial Digital Syndrome, which kills almost all of the boys who are born with it.

In fact, Jackson initially was a twin, but his sibling, likely a brother, died in the womb at just 16 weeks gestation, probably because of this disorder.

Nicole Piskula said that when Jackson was born, he seemed like a perfectly healthy baby. She and husband Randy were ecstatic and so happy to add this little guy to their growing family, which includes Jacksons 5-year-old brother Noah, who lives with them, and stepbrother Robert, 9, who joins the family on weekends.

However, it soon became apparent that something wasnt right with little Jackson.

His parents noticed that Jacksons eyes were misaligned most of the time, which was different from what theyd experienced with their older children.

Jackson initially was diagnosed with Sixth Nerve Palsy and required surgery.

When doctors did a brain scan, they found he had a defective pituitary gland, leading to a condition called Hypopituitarism. Right now, the gland is functioning fine, but as he grows, it will have trouble, and even with lifelong hormone therapies, it is not expected to be able to function normally.

Jackson also has a hole in his heart. A lot of people have this condition and are able to function just fine, but with all of Jacksons other challenges, its just another troubling factor.

Were just taking it one day at a time, Nicole said.

In addition, doctors found Jackson had a couple of tumors, which are common with his main diagnosis. Ones on his tongue and is not causing much trouble, but the other, in his brain, could be life-threatening.

The tumor, located on the hypothalamus, is connected to the pituitary stem and is inoperable. Jackson is expected to undergo laser treatments his whole life to shrink it. The treatment is harsh and causes multiple and other undesirable effects, but is necessary to save his life.

This little guy has had one successful operation, with many more in his future, Nicole said.

Meanwhile, Jackson is experiencing seizures and is under heavy medication to try to get those under control.

When the Daily Union talked with Nicole on Wednesday, the family had just returned from a several-day stay at Childrens Hospital of Wisconsin in the Milwaukee area.

We thought we had the seizures under control, but I had to take him into the ER a couple of times in the last week. There was one time he stopped breathing and was unresponsive, Nicole said.

On Friday, Jackson was admitted to Childrens Hospital of Wisconsin, where a team of specialists has been overseeing his case.

This disorder is usually lethal to males, Nicole said. Our doctors are searching worldwide to see if there is any case we can base his treatment on for a better outcome.

With intensive treatment and high doses of medication, doctors were able to stabilize Jackson and bring him back to normal.

As of Wednesday, he had not suffered a seizure since Sunday, Nicole said.

Hes on two medications, pretty high doses, but he is back to himself, she said. Hes tired, but hes back home and doing pretty well.

The Piskula family has lived in Johnson Creek for the past year-and-a-half and Nicole said they have found the little Crossroads community to be very warm and welcoming.

Due to Jacksons medical problems, Nicole is focusing all her energy on being a stay-at-home mom right now, while her husband, Randy, works long hours at the Tools Inc. machining business in Sussex.

Nicole also is expecting their daughter, Charlotte, is due to be born in two months and she is doing everything she can to stay healthy for the entire family.

As one can imagine, the Piskulas medical bills are pretty high.

Insane, is what Nicole calls them. Family and friends have started a Go Fund Me page to raise money for Jacksons care. Recently, her cousin, Jenny Meinders, joined with Kades Klassic President Jill Donnelly to set up a fundraiser that will take place this Sunday afternoon at the Johnson Creek Community Center, located at 417 Union St. in Johnson Creek.

Donnelly, who runs the Kades Klassic nonprofit based in Elkhorn, said that her organization usually puts on a golf outing once a year for a deserving family.

When she heard about Jackson, his situation didnt quite fit the bill for what Kades Klassic usually does, but it was urgent and she wanted to help on an individual basis.

So she worked with Meinders to help coordinate Sundays fundraiser.

Donnelly is coordinating the silent auction and raffle, while Meinders is pulling together a spaghetti dinner.

The event will run from noon to 4 p.m. Sunday, with all-you-can eat dinners going for $10 for adults or $5 for children age 12 and under.

We (Kades Klassic) have all the stuff to put on a raffle and silent auction, so there was no need for anyone to go out and buy something, Donnelly said.

In the meantime, supporters have donated tons of food and other materials for the spaghetti dinner, meaning the costs of putting on the event will be less, and there will be more proceeds.

All proceeds will go directly to the Piskula family to offset Jacksons medical costs, Donnelly said.

Meinders said that all of the community support coordinators already have seen has been great. Nicole said their neighbors and community members have been really wonderful, as well.

People around town know us, and I get a lot of comments on the little helmet that Jackson wears, Nicole said.

The best thing about this whole thing is all of the people who have reached out to us to express their support or to help in whatever way they can, the mom said. Whether its locally or online, Ive heard from a lot of people. They share their own stories. Theyre praying for Jackson in church …

Nicole had special praise for the local emergency medical technicians, who have gotten to know Jackson through his trials, coming out to assist a couple of times just in the past week.

The Johnson Creek EMT team is awesome, Nicole said. They brought equipment just his size. They knew just what to do, and they worked with me and accommodated our familys needs.

Meanwhile, coordinators said they hope to see a lot of people come out to the Johnson Creek Community Center Sunday to support the Piskula family and raise money for Jacksons care.

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Fundraiser Sunday to benefit Creek infant – Daily Union

Hopsital apologises to mother for parking fines caused by faulty system – View News

YEOVIL Hospital has apologised to the mother of disabled girl who keeps getting fined by a faulty car parking system as she takes her daughter for treatment.

Nicky Fordon regularly drives daughter Rebecca to the hospital as she has learning disabilities and suffers from the rare condition diabetes insipidus and hypopituitarism.

Nicky visits Yeovil Hospital more than once a week to make sure Rebeccas sodium levels are sufficient because she cant retain liquids.

Nicky, 52, has a blue badge and her car registration is registered with the hospital yet she has racked up fines of 400 in the last two months.

On each occasion she has protested and the ticket has been cancelled but only after she has had to make yet another journey to the hospital to deal with it in person. The hospitals cameras monitoring the car parking entrance keep registering her as parking there and not in a disabled parking bay.

Mum-of-three Nicky said: Its stressful, time-consuming and completely unnecessary.

When I had the first one I was really worried I couldnt work out what Id done. It showed my car and registration and it said Id stopped there for an hour and a half but it could only have been for a few seconds while I waited for a parking bay to be free or to let someone out. I was in the car and the brake lights were on.

I feel like I spend my life at the hospital so its a real pain to have to go back with the tickets. Theres no number you can phone to talk to anyone, Ive got to go in person.

I think there must be loads of elderly people who just pay without questioning it.

A Yeovil Hospital spokeswoman said: We would like to apologise for the inconvenience caused to this lady who has received these fines in error.

The spaces out of the front of the hospital are controlled by ParkingEye, which uses number-plate recognition cameras.

We have assisted with dealing with each ticket on an individual basis but this issue will now be escalated to Parking Eye for them to investigate.

This is an unusual case and we would encourage this lady to get back into contact with us so we can address her concerns.

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Hopsital apologises to mother for parking fines caused by faulty system – View News

Hyperprolactinaemia: diagnosis and management – GP online

Raised prolactin levels and their management, including clinical presentations, recent research on dopamine agonists and when surgery may be indicated.

Coloured CR scan showing a side view of a tumour (orange) of the pituitary gland (Picture: Science Photo Library)

Hyperprolactinaemia is a raised level of prolactin in the blood. This hormone stimulates breast epithelial cell proliferation and induces milk production. However, excessive production of prolactin can lead to infertility and gonadal dysfunction.1

Prolactin suppresses gonadotrophin-releasing hormone (GnRH), resulting in suppression of ovulation in females and reduced testosterone levels and hypogonadism in males.

Prolactin levels are normally high during pregnancy and lactation. Levels also increase after meals, after exercise and during stress, as well as during sleep.

Abnormally high levels of prolactin may be caused by a prolactin-secreting pituitary tumour (prolactinoma), or by a non-secreting pituitary tumour that prevents dopamine (a prolactin release-inhibiting hormone) from reaching normal prolactin-producing cells.

Common and rarer causes

Prolactinomas are the most common cause of hyperprolactinaemia, although it has many different causes. They are benign tumours that account for 40% of pituitary tumours and are the most common type of pituitary adenomas. More than 90% are intrasellar microprolactinomas (

Primary hypothyroidism may lead to hyperprolactinaemia as a consequence of increased synthesis of thyrotropin-releasing hormone, which stimulates prolactin production.

Severe liver disease and chronic renal failure can also be causes. Head injuries, brain surgery and cranial radiotherapy can also cause hyperprolactinaemia.

Drugs

The commonest medications to cause hyperprolactinaemia are antipsychotic drugs. Antidepressants, opiates, verapamil and oestrogens can also lead to hyperprolactinaemia.

Mildly increased prolactin levels (400-600mu/L) may be physiological and asymptomatic but higher levels are usually pathological. Very elevated levels (above 5,000mu/L) usually imply a prolactin-secreting pituitary tumour. Most patients with a prolactinoma are women.

The clinical presentation in women is more obvious and so occurs earlier than in men. Women present most commonly with galactorrhoea (up to 90% of cases), menstrual disturbance, reduced fertility and libido. Men present with galactorrhoea (10-20% of men), loss of libido, erectile dysfunction and occasionally, reduced fertility and gynaecomastia.

In both sexes, a macroadenoma (>10 mm in diameter) can cause mass effects, which may result in visual-field defects or headache.

In both sexes, long-standing hyperprolactinaemia can lead to low bone mineral density with an increased risk of developing osteoporosis.

A single measurement of prolactin level is usually adequate to diagnose hyperprolactinaemia. However, when the result is borderline, the test should be repeated. The pain/stress of venepuncture can actually elevate prolactin levels. Obviously, pregnancy must be excluded, if relevant. Renal and thyroid function tests should also be performed.

When other causes of hyperprolactinaemia have been excluded, the diagnosis of a prolactinoma is usually confirmed by a pituitary MRI scan.

Patients with macroadenomas that extend beyond the sella should undergo testing to exclude visual field defects, and also dynamic testing of the anterior pituitary function to exclude hypopituitarism.

Treatment of hyperprolactinaemia will vary according to the cause – for example, a drug review may be required where it is drug-related. The aim of treatment is to improve symptoms and avoid the long-term effects of oestrogen deficiency in women or testosterone deficiency in men.

Dopamine agonists suppress prolactin in most patients, normalise gonadal function and stop galactorrhoea. In patients with prolactinomas, they reduce the size of the tumour.2

Cabergoline and bromocriptine are both ergot-based dopamine receptor agonists. Cabergoline is the first-line treatment for prolactinomas as it has greater efficacy in suppressing prolactin secretion. It is better tolerated and has a more convenient dosing regimen when compared with bromocriptine.

The MHRA issued a warning in the past about the safety of dopamine agonists for treating hyperprolactinaemia, due to concerns about an association with chronic pleuropulmonary, pericardial and retroperitoneal fibrosis, and particularly fibrotic valvular heart disease.3

However, recent studies have not shown a clinically significant association between the use of ergot-derived dopamine agonist drugs for the treatment of hyperprolactinaemia and valvulopathy.4,5

In some patients with microprolactinomas, withdrawal of treatment can be tried after three years, as microprolactinomas can spontaneously resolve, especially after the menopause or pregnancy. Transsphenoidal surgery is an option in infertile patients who cannot tolerate or are resistant to dopamine agonists. It may also be performed if a macroadenoma does not shrink with drug treatment.

Definitive treatment depends on the size of the tumour and the patient’s wishes (including future fertility).

Over 90% of microadenomas remain stable or gradually reduce their secretion of prolactin. One third of patients with idiopathic hyperprolactinaemia improve without treatment. This is more common in women around their menopause.

However, recurrence rates of hyperprolactinaemia are as high as 80 per cent, and therefore the majority of patients require long-term medical treatment.

This is an updated version of an article that was first published in September 2009.

Useful website: Pituitary Foundation -www.pituitary.org.uk

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Hyperprolactinaemia: diagnosis and management – GP online

Yeovil Hospital sorry for charges of over 400 wrongly sent to stressed mum of disabled girl – Somerset Live

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Imagine you’re a busy mother-of-three with a daughter who has profound disabilities.

You have to visit Yeovil Hospital quite often on more than one occasion every week – you have a blue badge, your car registration is registered with the hospital.

And yet you keep getting issued with parking charges.

That’s what’s happened to Nicky Fordon from Ash six times in the last couple of months – the charges she has faced total more than 400.

On each occasion the ticket has been cancelled – but after she’s had to make yet another journey there to deal with it in person.

“It’s stressful, time-consuming and completely unnecessary,” said Mrs Fordon, 52.

“When I had the first one I was really worried – I couldn’t work out what I’d done.”

The hospital has admitted there is a problem with the system and apologised, but Mrs Fordon says she’s worried about vulnerable and elderly people who may be shelling out unnecessarily.

MORE: Yeovil Hospital’s new multi-storey car park opening is delayed for another two months

She was shocked to get the first ticket and studying it closely she realised that somehow the camera monitoring the entrance to the hospital had registered her as parking there and not in a disabled parking bay.

“It showed my car and registration and it said I’d stopped there for an hour and a half – but it could only have been for a few seconds while I waited for a parking bay to be free or to let someone out.

“I mean I was in the car and the brake lights were on!”

Mrs Fordon has to regularly visit the hospital with her daughter Rebecca who has learning disablities and suffers from a rare condition called diabetes insipidus and hypopituitarism.

It means she has to have regular appointments at Yeovil hospital to make sure her sodium levels are sufficient because she can’t retain liquids.

If they’re too low this can be dangerous and mean a trip to the Bristol Royal Infirmary.

MORE: New Boots branch to open in Yeovil Hospital later this month

“I feel like I spend my life at the hospital so it’s a real pain to have to go back with the tickets – there’s no number you can phone to talk to anyone, I’ve got to go in person.

“I think there must be loads of elderly people who just pay without questioning it.

“What’s going to happen when they open the new car park? Is it going to get any better?”

A Yeovil Hospital spokeswoman said: “We would like to apologise for the inconvenience caused to this lady who has received these fines in error.

“The spaces out of the front of the hospital are controlled by ParkingEye who use number-plate recognition cameras. We have assisted with dealing with each ticket on an individual basis but this issue will now be escalated to ParkingEye for them to investigate.

“This is an unusual case and we would encourage this lady to get back into contact with us so we can address her concerns.”

READ NEXT: Tributes to ‘an amazing’ Yeovil Town supporter, 103, who had soft spot for Terry Skiverton’s legs

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Yeovil Hospital sorry for charges of over 400 wrongly sent to stressed mum of disabled girl – Somerset Live

Evaluation of ICD-10 algorithms to identify hypopituitary patients in the Danish National Patient Registry – Dove Medical Press

Agnethe Berglund,1 Morten Olsen,2 Marianne Andersen,3 Eigil Husted Nielsen,4 Ulla Feldt-Rasmussen,5 Caroline Kistorp,6 Claus Hjbjerg Gravholt,1,7 Kirstine Stochhholm1,8

1Department of Endocrinology and Internal Medicine, 2Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, 3Department of Endocrinology, Odense University Hospital, Odense, 4Department of Endocrinology, Aalborg University Hospital, Aalborg, 5Department of Endocrinology, Rigshospitalet, Copenhagen University,Copenhagen, 6Department of Endocrinology, Herlev Hospital, Herlev, 7Department of Molecular Medicine, 8Department of Pediatrics, Center of Rare Diseases, Aarhus University Hospital, Aarhus, Denmark

Objective: Routinely collected health data may be valuable sources for conducting research. This study aimed to evaluate the validity of algorithms detecting hypopituitary patients in the Danish National Patient Registry (DNPR) using medical records as reference standard. Study design and setting: Patients with International Classification of Diseases (10th edition [ICD-10]) diagnoses of hypopituitarism, or other diagnoses of pituitary disorders assumed to be associated with an increased risk of hypopituitarism, recorded in the DNPR during 20002012 were identified. Medical records were reviewed to confirm or disprove hypopituitarism. Results: Hypopituitarism was confirmed in 911 patients. In a candidate population of 1,661, this yielded an overall positive predictive value (PPV) of 54.8% (95% confidence interval [CI]: 52.457.3). Using algorithms searching for patients recorded at least one, three or five times with a diagnosis of hypopituitarism (E23.0x) and/or at least once with a diagnosis of postprocedural hypopituitarism (E89.3x), PPVs gradually increased from 73.3% (95% CI: 70.675.8) to 83.3% (95% CI: 80.785.7). Completeness for the same algorithms, however, decreased from 90.8% (95% CI: 88.792.6) to 82.9% (95% CI: 80.385.3) respectively. Including data of hormone replacement in the same algorithms PPVs increased from 73.2% (95% CI: 70.675.7) to 82.6% (95% CI: 80.184.9) and completeness decreased from 94.3% (95% CI: 92.695.7) to 89.7% (95% CI: 87.591.6) with increasing records of E23.0x. Conclusion: The DNPR is a valuable data source to identify hypopituitary patients using a search criteria of at least five records of E23.0x and/or at least one record of E89.3x. Completeness is increased when including hormone replacement data in the algorithm. The consequences of misclassification must, however, always be considered.

Keywords: ICD-10 algorithms, registry health data, hypopituitarism

This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License. By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms.

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Evaluation of ICD-10 algorithms to identify hypopituitary patients in the Danish National Patient Registry – Dove Medical Press

Hypopituitarism in Children Causes, Symptoms, Treatment …

Hypopituitarism in Children (cont.) Hypopituitarism Treatment

Treatment primarily involves hormone replacement therapy.

Drugs used to treat hypopituitarism replace the deficient hormone.

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.

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.

With appropriate treatment, the prognosis is very good.

The Magic Foundation

The Hormone Foundation

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

Medically Reviewed by a Doctor on 12/24/2015

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Hypopituitarism in Children Causes, Symptoms, Treatment …

What is Hypopituitarism, Pituitary Insufficiency | Hormone.org

What Is Hypopituitarism?

The pituitary gland is one of the smallest parts of the endocrine system, yet it is also one of the most important. Without this tiny gland functioning as it should, your body is not going to function well either. Hypopituitarism, also known as pituitary insufficiency, is one condition that affects this important gland and can impact the health and well-being of your entire body.

The pituitary gland is a small gland that sits at the base of the brain, right behind the nose and between the ears. This gland may be small, but its powerful hormones affect almost every area of the body. In fact, the gland is so important to the overall function of the body that it is sometimes called the “master gland.” The pituitary gland signals other glands in the body to produce their own hormones, and as such has a role to play in almost every bodily function. A deficiency in these hormones can affect many different functions, including reproduction, sexual health, growth and blood pressure.

Hypopituitarism is a condition that occurs when the pituitary gland does not produce enough of its important hormones. Because the hormones are lacking, the condition is sometimes called pituitary insufficiency. It can occur for a variety of reasons and cause a wide range of symptoms because of the far-reaching effects of the pituitary gland.

Hypopituitarism has a wide range of causes. Sometimes, tumors, also known as adenomas, in the pituitary gland can interfere with the production of pituitary hormones. While these tumors are rarely cancerous, they can have far-reaching effects.

Some patients who have undergone radiation treatment to remove pituitary gland tumors may notice a poor function of the gland. This occurs because the pituitary gland tissue is destroyed during the radiation treatment. Similarly, chemotherapy can destroy the tissue and leave the pituitary gland without proper function.

Patients who have had brain surgery or a traumatic brain injury may have a pituitary insufficiency. Severe bleeding on the brain or loss of blood, especially if it occurs during childbirth, can also have this impact. Patients who have had meningitis or tuberculosis may have damaged pituitary glands. In a small portion of patients, the cause is never found.

Pituitary insufficiency is a rare condition, but for those who have it, this disease can be life changing. While it can be controlled with medication, it must be dealt with consistently to ensure that the patient suffers no ill effects from the hormonal insufficiencies.

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What is Hypopituitarism, Pituitary Insufficiency | Hormone.org

Hypopituitarism-Panhypopituitarism

The pituitary gland produces a number of hormones, which are released into the blood to control other glands in the body (thyroid, adrenal, ovary or testicles). If the pituitary is not producing one or more of these hormones, the condition is called hypopituitarism. If all the hormones produced by the anterior pituitary are decreased, the condition is called panhypopituitarism. Hypopituitarism is most often caused by large benign tumors 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 tumor mass on the normal pituitary or by the effects of surgery or radiotherapy used to treat the pituitary tumors.

Less frequently, hypopituitarism can be caused by infections in or around the brain (such as meningitis) or by severe blood loss, by head injury, or by other rare diseases. Some of the clinical features that may be associated with hypopituitarism include excessive tiredness and decreased energy, irregular periods (oligomenorrhea) or loss of normal menstrual function (amenorrhea), impotence (in men), infertility, increased sensitivity to cold, constipation, dry skin, low blood pressure and lightheadedness upon standing (postural hypotension). Treatment of hypopituitarism consists of long-term hormone replacement therapy, since pituitary hormone deficits are rarely reversed after tumor removal.

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Hypopituitarism-Panhypopituitarism

Hypopituitarism (Panhypopituitarism): Background …

Causes of pituitary insufficiency include pituitary adenomas or other intrasellar and parasellar tumors, inflammatory and infectious destruction, surgical removal, radiation-induced destruction of pituitary tissue, traumatic brain injury (TBI), subarachnoid hemorrhage, and postpartum pituitary necrosis (Sheehan syndrome). Similar diseases originating in the hypothalamus or pituitary stalk may also result in pituitary insufficiency.

Pituitary tumors, or adenomas, are the most common cause of hypopituitarism in adults, although traumatic brain injury as a cause is being more frequently recognized.

Hypopituitarism resulting from pituitary adenomas is due to impaired blood flow to the normal tissue, compression of normal tissue, or interference with the delivery of hypothalamic hormones via the hypothalamus-hypophysial portal system.

In primary pituitary destruction, the anterior pituitary is destroyed, causing a deficiency in some or all pituitary hormones, including prolactin. Disease involving the hypothalamus or pituitary stalk may cause pituitary hormone deficiency with an elevated serum prolactin. Pituitary tumors, or adenomas, can be secretory or nonsecretory. Approximately 30% of all macroadenomas larger than 10 mm produce at least 1 hormone.

Hypothalamic disease involves destruction of the hypothalamus. This causes a deficiency or loss of hypothalamic regulatory hormone input to the pituitary, which leads to the loss of anterior pituitary hormone secretion, with an elevated serum prolactin level. Loss of antidiuretic hormone (ADH) may have concomitant diabetes insipidus.

Hypersecretion of the secretory pituitary tumor hormone is suggestive of an adenoma. Another indication of a pituitary adenoma is a deficiency in some pituitary hormones with concomitant hyperprolactinemia. Normally, dopamine, produced in the hypothalamus, inhibits prolactin secretion by the anterior pituitary. Compressing the pituitary stalk decreases the inhibitory effect of dopamine and increases prolactin levels.

Longstanding target gland disease may result in hyperplasia of the relevant pituitary cell secreting the tropic hormone, the level of which would be elevated, with an enlarged pituitary gland simulating a mass. Although uncommon, this may appear to be a pituitary adenoma, but the target gland is not hyperfunctioning.

Another common intracranial tumor is craniopharyngioma, a squamous cell tumor that arises from remnants of the Rathke pouch. One third of these tumors extend into the sella, while approximately two thirds remain suprasellar.

Sheehan syndrome occurs with a large volume of postpartum hemorrhage. During pregnancy, the pituitary gland enlarges due to hyperplasia and hypertrophy of the lactotroph cells, which produce prolactin. The hypophyseal vessels, which supply the pituitary, constrict in response to decreasing blood volume, and subsequent vasospasm occurs, causing necrosis of the pituitary gland. The degree of necrosis correlates with the severity of the hemorrhage.

As many as 30% of women experiencing postpartum hemorrhage with hemodynamic instability may develop some degree of hypopituitarism. These patients can develop adrenal insufficiency, hypothyroidism, amenorrhea, diabetes insipidus, and an inability to breastfeed (an early symptom). Lymphocytic hypophysitis occurs most commonly in the postpartum state and may appear as Sheehan syndrome with postpartum hypopituitarism.

Pituitary apoplexy denotes the sudden destruction of the pituitary tissue resulting from infarction or hemorrhage into the pituitary. The most likely cause of the apoplexy is brain trauma; however, it can occur in patients with diabetes mellitus, pregnancy, sickle cell anemia, blood dyscrasias or anticoagulation, or increased intracranial pressure. Apoplexy usually spares the posterior pituitary and solely affects the anterior pituitary. In patients with such underlying diseases, Sheehan syndrome can occur with lesser degrees of postpartum hemorrhage or hypotension.

Head trauma from a motor vehicle accident, a fall, or a projectile can cause hypopituitarism by direct damage to the pituitary or by injuring the pituitary stalk or the hypothalamus. Hypopituitarism may occur immediately, or it may develop months or years later. Recovery is uncommon. Many studies show an incidence of 15-40%, [2] but a study by Kokshoorn et al found the incidence of posttraumatic hypopituitarism to be low. [3]

Other causes of hypopituitarism include empty sella syndrome and infiltrative diseases. Empty sella syndrome occurs when the arachnoid herniates into the sella turcica through an incompetent sellar diaphragm and flattens the pituitary against bone, but resulting pituitary insufficiency is uncommon. Infiltrative diseases, such as Wegener granulomatosis and sarcoidosis, can cause destruction of the anterior pituitary. Lymphocytic hypophysitis is an autoimmune destructive disease that may be directed towards the pituitary or its stalk.

Physiologic or psychological states can influence the hypothalamus by impairing synthesis and secretion of regulating hormones. For example, poor nutrition may impair the hypothalamic secretion of gonadotropin-releasing hormone (GnRH), resulting in reversible pituitary gonadotropin deficiency. Medications may affect measured hormone levels, such as opioids decreasing serum LH and testosterone.

The degree of hormone deficiency varies greatly and depends on the extent of the process and its location. Some functional causes include emotional disorders, changes in body weight, habitual exercise, anorexia, bulimia, congestive heart failure (CHF), renal failure, and certain medications.

Hypopituitarism occurs in adult patients after cranial radiotherapy performed to treat nonpituitary tumors. Thus, patients who undergo cranial radiotherapy should be periodically assessed for pituitary functions. [4]

Additional causes of hypopituitarism include the following:

With regard to item 9 above, in a study of 435 patients, Fatemi et al found evidence that the likelihood of hypopituitarism development after transsphenoidal adenoma removal is higher when the tumor is larger than 20 mm. [6] In contrast, some with hypopituitarism prior to adenomectomy may have improved pituitary function following surgery, if the cause of the hypopituitarism was increased suprasellar pressure resulting from the mass itself.

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Hypopituitarism (Panhypopituitarism): Background …

Suzy’s story – hypopituitarism | The Pituitary Foundation

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When I was between five and six, I attended balletclasses. One day the ballet teacher was observing myarm positions and could not understand why my rightarm did not look the correct shape in certain positions.

The ballet teacher decided to ask my mum if I had anyproblems with it i.e. had I broken it at any time? My mumwas not aware of any problems and had not noticed it.

My mum and dad took me to our local GP, who afterlooking at my arm, decided to refer me to a bonespecialist at the Royal National Orthopaedic Hospital inLondon. I remember thinking it was fun, as I got to goon a train, a few x-rays were taken and afterwards Iwas diagnosed with Ollier disease (discondroplasia ofthe bone) this was managed by a yearly appointment tocheck things had not changed.

At around age of 11 to 12, they found that I also had itin my left ankle. We were told if they did not correct thetwisted ankle it would cause problems when I got olderwith walking.I went into hospital when I was 13 years old. This was ahard thing to deal with but luckily the hospital I went intoStanmore RNOH, Edgware was brilliant. My mum wasable to stay with me as there were parents housing onsite but it was hard on my sisters as my mum was awayfrom home a lot.

I was in hospital for nearly four months, as I caught amajor infection in the wound following surgery. It tookhold quickly. The plaster cast that they put on in theatresuddenly turned yellow; they took me into the treatmentroom, my dad came in and when they took the plaster offthey undone the stitches and the wound spilled infectioneverywhere; I remember my dad saying he could seethe bone beneath – it was bad!

I was put on IV antibiotics, but my veins kept collapsingwhich was very painful, and it would always happen lateat night. I had a fantastic friend; she sat with me everytime they needed to change the needle and she wassuch a wonderful person; she had gone through herown trauma by losing her leg due to cancer, but shewas such a strong person.

The nurses, doctors and domestic staff made my timein there enjoyable I made some good friends who I wishI had stayed in touch with but I was young and thoughtit did not matter.About a year or so after that surgery, I was back inhospital having my leg lengthened as the first surgeryhad left me with a 2 inch limp, so that I would notdevelop a back problem; they made the decision to lengthenit.

I went into surgery and had an external fixate attachedto my right tibia. I stayed in hospital for 3 months.Again, it was made fun but this time I was studying formy GCSEs so I had to do a lot more schooling, but itpassed the time as we had a giggle. We had some roughtimes too, but because most of the kids in there werenot poorly and as it was corrective surgery, we were allable bodied, so we would all take our wheelchairs downto the hospital shop; some would be on crutches, but wewere allowed our own space.

I saw a lot in my time in that hospital but it made methe person I am, because when you witness somebodyelses pain and it is greater than your own, you realisethat there is always someone worse off than yourself.I came home with the fixator still attached and went backto school; they were very supportive and my friendsthere were great, but I got a lot of attention as kids hadnot seen this device before, so they were curious butnever cruel.I lengthened it millimetre by millimetre, so it took alongtime, but once it was done I had no limp and things wereback to normal.

Once all that was finished with I then got on with myschooling; passed my GCSEs and left school. I thenmet my husband; I was age 16 and he lived in Harlow,Essex and I commuted to Harlow every weekend;during the week I worked in a bakery and went to nightcollege to learn cake decorating.

My consultant decided to lengthen my ulna bone as it wasshort. So once again I was in Stanmore hospital havinga fixator attached to my arm; once the lengthening wascomplete I had an op to take bone from my hip, as newbone had not grown between the gap; this was painfulas the removal of bone from the hip has to be chiselled.

Then, in early 1999 I was at work and my face suddenlystarted to tingle and went very red and numb in thespace of a couple of hours. I stayed at work and thoughtit was just an infection of some sort but as the daywent on I decided to go to my GP where by he gaveme antibiotics and said it could be the trigeminal nerve,I took them but the problem continued over the nextcouple of weeks and I was back and forward to my GP.When I was pregnant with my son (1997) I had to havea grommet fitted in my ear as it blocked up.

As the GP doc could not think what could be causingthe numbness, he sent me back to Dr OMalley at MiltonKeynes hospital; I went for the appointment and thedoctor decided to order an MRI scan. I had the scanand then went back to see Dr OMalley; I took my dadwith me and we were stunned by what we were beingshown – a tumour growing from the base of my skull thesize of an orange. It had grown up and into the opticnerve and damaged the nerves surrounding the rightside of my face; that is why I had numbness, rednessand a few painful headaches.

I was then referred from there to Oxford hospital where Isaw a Dr Kerr; they did not want to do a biopsy but theybrought in a specialist on tumours connected to Ollierdisease – a Dr Cadu Hudson. I was diagnosed witha chondrosarcoma, which is the rare form of maffuccisyndrome; these two diseases run side by side but itsrare to have both.

They talked us through the steps of how they weregoing to go about sorting the problem as the tumourwas very close to the carotid artery, so it was going tobe difficult to remove.The doctors thought it had been growing for about tenyears; as they are slow growing tumours they did not wantto rush in.

I had a Robbie Williams concert to go to in the September,Neil had brought me the tickets for Christmas; I loveRobbie and really wanted to go, so Dr Kerr said wewould hold off until after then as he knew the op wouldbe difficult – he implied I was to do and experience asmuch as I could. The only trouble was that the tumourwas not going to hold off, so in the May, I was rushed intoOxford hospital with a major headache. I was in over theweekend and Neil had gone home for the weekend asit was my mums 50th party and their 25th anniversary.It was hard for Neil and my family to celebrate it withoutme with them.

Over the weekend the headache got worse. ComeMonday morning, I had had a really bad night and theteam thought the tumour could have been bleeding!! Nopainkiller was working and I was given IV morphine. Iwas in so much pain in the morning, Dr Cadu Hudsonhad to come in as Dr Kerr was on holiday and theywanted to do surgery early that morning; Neil wascalled and he was on his way. They told me the risksthat were involved but I would not let them take medown to surgery until Neil arrived. My mum and dadwere not told how bad it was due to them being away,so I wanted him there to help me make some important decisions. I was so scared and confused; the consultantwas phoning Neil to find out how far away he was as itwas getting harder to hold off.

When Neil arrived, I then felt I could have the surgeryas I could relay things to him and say what I needed tosay to him and Ryan. I had the surgery; it went well butthe damage was already done to my eye, eye lid andface and I was in intensive care for three days – thesedays I dont remember. It took only ten days after that torecover and I went home to recover further.Once again, I had very good help and treatment atOxford from the nurses and doctors and I think theworld of Dr Cadu Hudson and Dr Kerr; they are veryclever people and special surgeons.I made it to the Robbie concert, three months aftersurgery and it was fantastic.I was kept a very close eye on at the clinic but theydecided a course of radiation would be needed to makesure that the tumour had stopped growing; but thething was, the radiation could not be done with normal radiation, I had to go to Paris for Proton and Photontherapy, at the IGR hospital Paris. The governmentwould pay for treatment but we had to fund the eightweek stay so family, friends, work friends and the localpaper helped find the money by fund raising, so I couldbe comfortable out there and that our son could belooked after while Neil was with me.

It was a hard time as we were away from our four yearold son, in a foreign country trying to communicate ourproblems when I did not speak French; Neil knew somebut only the kind of stuff for holiday visits, not hospitaltranslation. We had help from a lovely multilingual manin the hospital but it was very hard having radiation andnot being able to understand the instructions.Again the treatment and care we received was fantastic;we had two hospitals to visit- one that gave me theProton therapy at the IGR, and then we moved to thesecond hotel so I could have the second part of theradiation Photon therapy.

When I got back from Paris I was then referred to the endocrinology unit at the Churchill Radcliffe hospitalwhere I was kept a close eye on, as I was developingsymptoms of pituitary gland failure. They diagnosedhypopituitarism and I was gradually put on the relevanttablets for each part of pituitary shutdown.I am now on thyroxin, hydrocortisone, Premique HRTand growth hormone. I have a neck problem also due tothe radiation, so I am on pregabalin and ranitidine dueto the side effects of the pregabalin.Living with this pituitary problem is harder thandealing with the tumour itself and with my bonedisease put together, I am a different person. When Igot married to Neil six years ago, I was not well, butI weighed 10 stones 3lbs. Now I have no control overmy weight and I am 16 stones and 10lbs. You mightsay (and often I hear people say) But you are alive!!Yes I am, but its easy for them to say that as they are not inmy situation. It is a daily battle to remember to take mydrugs and to stay positive; deep depression, fatigue,keeping up with my son and not being able to get aboutdue to muscle fatigue. As I have low levels of growthhormone, this is being replaced slowly due to thepressure in my brain increasing the first time round.I am not a person to sit around and feel sorry for myself;I have continued to work with the help of my employerand friends, but have just been made redundant soam worried now if any employer will employ me. Mypositivity has come hugely from my husband Neil; hehas had to go through a lot of changes with me and stillhe is here supporting me.

I would like my story to be told as I feel I havebeen through a lot, but I still keep smiling, fundraising, working and generally staying positiveand as I said before There is always someonein more pain than you.If I can bring awareness and support, any research intoall of the diseases I have I will work to do that.

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Suzy’s story – hypopituitarism | The Pituitary Foundation

Hypopituitarism – Wikipedia

Hypopituitarism is the decreased (hypo) secretion of one or more of the eight hormones normally produced by the pituitary gland at the base of the brain.[1][2] If there is decreased secretion of most pituitary hormones, the term panhypopituitarism (pan meaning “all”) is used.[3]

The signs and symptoms of hypopituitarism vary, depending on which hormones are undersecreted and on the underlying cause of the abnormality. The diagnosis of hypopituitarism is made by blood tests, but often specific scans and other investigations are needed to find the underlying cause, such as tumors of the pituitary, and the ideal treatment. Most hormones controlled by the secretions of the pituitary can be replaced by tablets or injections. Hypopituitarism is a rare disease, but may be significantly underdiagnosed in people with previous traumatic brain injury.[1] The first description of the condition was made in 1914 by the German physician Dr Morris Simmonds.[4]

The hormones of the pituitary have different actions in the body, and the symptoms of hypopituitarism therefore depend on which hormone is deficient. The symptoms may be subtle and are often initially attributed to other causes.[1][5] In most of the cases, three or more hormones are deficient.[6] The most common problem is insufficiency of follicle-stimulating hormone (FSH) and/or luteinizing hormone (LH) leading to sex hormone abnormalities. Growth hormone deficiency is more common in people with an underlying tumor than those with other causes.[1][6]

Sometimes, there are additional symptoms that arise from the underlying cause; for instance, if the hypopituitarism is due to a growth hormone-producing tumor, there may be symptoms of acromegaly (enlargement of the hands and feet, coarse facial features), and if the tumor extends to the optic nerve or optic chiasm, there may be visual field defects. Headaches may also accompany pituitary tumors,[1] as well as pituitary apoplexy (infarction or haemorrhage of a pituitary tumor) and lymphocytic hypophysitis (autoimmune inflammation of the pituitary).[7] Apoplexy, in addition to sudden headaches and rapidly worsening visual loss, may also be associated with double vision that results from compression of the nerves in the adjacent cavernous sinus that control the eye muscles.[8]

Pituitary failure results in many changes in the skin, hair and nails as a result of the absence of pituitary hormone action on these sites.[9]

Deficiency of all anterior pituitary hormones is more common than individual hormone deficiency.

Deficiency of luteinizing hormone (LH) and follicle-stimulating hormone (FSH), together referred to as the gonadotropins, leads to different symptoms in men and women. Women experience oligo- or amenorrhea (infrequent/light or absent menstrual periods respectively) and infertility. Men lose facial, scrotal and trunk hair, as well as suffering decreased muscle mass and anemia. Both sexes may experience a decrease in libido and loss of sexual function, and have an increased risk of osteoporosis (bone fragility). Lack of LH/FSH in children is associated with delayed puberty.[1][5]

Growth hormone (GH) deficiency leads to a decrease in muscle mass, central obesity (increase in body fat around the waist) and impaired attention and memory. Children experience growth retardation and short stature.[1][5]

Adrenocorticotropic hormone (ACTH) deficiency leads to adrenal insufficiency, a lack of production of glucocorticoids such as cortisol by the adrenal gland. If the problem is chronic, symptoms consist of fatigue, weight loss, failure to thrive (in children), delayed puberty (in adolescents), hypoglycemia (low blood sugar levels), anemia and hyponatremia (low sodium levels). If the onset is abrupt, collapse, shock and vomiting may occur.[1][5] ACTH deficiency is highly similar to primary Addison’s disease, which is cortisol deficiency as the result of direct damage to the adrenal glands; the latter form, however, often leads to hyperpigmentation of the skin, which does not occur in ACTH deficiency.[10]

Thyroid-stimulating hormone (TSH) deficiency leads to hypothyroidism (lack of production of thyroxine (T4) and triiodothyronine (T3) in the thyroid). Typical symptoms are tiredness, intolerance to cold, constipation, weight gain, hair loss and slowed thinking, as well as a slowed heart rate and low blood pressure. In children, hypothyroidism leads to delayed growth and in extreme inborn forms to a syndrome called cretinism.[1][5]

Prolactin (PRL) plays a role in breastfeeding, and inability to breastfeed may point at abnormally low prolactin levels.[7]

Antidiuretic hormone (ADH) deficiency leads to the syndrome of diabetes insipidus (unrelated to diabetes mellitus): inability to concentrate the urine, leading to polyuria (production of large amounts of clear urine) that is low in solutes, dehydration andin compensationextreme thirst and constant need to drink (polydipsia), as well as hypernatremia (high sodium levels in the blood).[11] ADH deficiency may be masked if there is ACTH deficiency, with symptoms only appearing when cortisol has been replaced.[7]

Oxytocin (OXT) deficiency generally causes few symptoms, as it is only required at the time of childbirth and breastfeeding.[1]

Kallmann syndrome causes deficiency of the gonadotropins only. Bardet-Biedl syndrome and Prader-Willi syndrome have been associated with pituitary hormone deficiencies.

The pituitary gland is located at the base of the brain, and intimately connected with the hypothalamus. It consists of two lobes: the posterior pituitary, which consists of nervous tissue branching out of the hypothalamus, and the anterior pituitary, which consists of hormone-producing epithelium. The posterior pituitary secretes antidiuretic hormone, which regulates osmolarity of the blood, and oxytocin, which causes contractions of the uterus in childbirth and participates in breastfeeding.[12]

The pituitary develops in the third week of embryogenesis from interactions between the diencephalon part of the brain and the nasal cavity. The brain cells secrete FGF-8, Wnt5a and BMP-4, and the oral cavity BMP-2. Together, these cellular signals stimulate a group of cells from the oral cavity to form Rathke’s pouch, which becomes independent of the nasal cavity and develops into the anterior pituitary; this process includes the suppression of production of a protein called Sonic hedgehog by the cells of Rathke’s pouch.[14] The cells then differentiate further into the various hormone-producing cells of the pituitary. This requires particular transcription factors that induce the expression of particular genes. Some of these transcription factors have been found to be deficient in some forms of rare combined pituitary hormone deficiencies (CPHD) in childhood. These are HESX1, PROP1, POU1F1, LHX3, LHX4, TBX19, SOX2 and SOX3. Each transcription factor acts in particular groups of cells. Therefore, various genetic mutations are associated with specific hormone deficiencies.[14][15] For instance, POU1F1 (also known as Pit-1) mutations cause specific deficiencies in growth hormone, prolactin and TSH.[12][14][15] In addition to the pituitary, some of the transcription factors are also required for the development of other organs; some of these mutations are therefore also associated with specific birth defects.[14][15]

Most of the hormones in the anterior pituitary are each part of an axis that is regulated by the hypothalamus. The hypothalamus secretes a number of releasing hormones, often according to a circadian rhythm, into blood vessels that supply the anterior pituitary; most of these are stimulatory (thyrotropin-releasing hormone, corticotropin-releasing hormone, gonadotropin-releasing hormone and growth hormone-releasing hormone), apart from dopamine, which suppresses prolactin production.[16] In response to the releasing hormone rate, the anterior pituitary produces its hormones (TSH, ACTH, LH, FSH, GH) which in turn stimulate effector hormone glands in the body, while prolactin (PRL) acts directly on the breast gland. Once the effector glands produce sufficient hormones (thyroxine, cortisol, estradiol or testosterone and IGF-1), both the hypothalamus and the pituitary cells sense their abundance and reduce their secretion of stimulating hormones. The hormones of the posterior pituitary are produced in the hypothalamus and are carried by nerve endings to the posterior lobe; their feedback system is therefore located in the hypothalamus, but damage to the nerve endings would still lead to a deficiency in hormone release.[1]

Unless the pituitary damage is being caused by a tumor that overproduces a particular hormone, it is the lack of pituitary hormones that leads to the symptoms described above, and an excess of a particular hormone would indicate the presence of a tumor. The exception to this rule is prolactin: if a tumor compresses the pituitary stalk, a decreased blood supply means that the lactotrope cells, which produce prolactin, are not receiving dopamine and therefore produce excess prolactin. Hence, mild elevations in prolactin are attributed to stalk compression. Very high prolactin levels, though, point more strongly towards a prolactinoma (prolactin-secreting tumor).[5][17]

The diagnosis of hypopituitarism is made on blood tests. Two types of blood tests are used to confirm the presence of a hormone deficiency: basal levels, where blood samples are takenusually in the morningwithout any form of stimulation, and dynamic tests, where blood tests are taken after the injection of a stimulating substance. Measurement of ACTH and growth hormone usually requires dynamic testing, whereas the other hormones (LH/FSH, prolactin, TSH) can typically be tested with basal levels. There is no adequate direct test for ADH levels, but ADH deficiency can be confirmed indirectly; oxytocin levels are not routinely measured.[1]

Generally, the finding of a combination of a low pituitary hormone together with a low hormone from the effector gland is indicative of hypopituitarism.[12] Occasionally, the pituitary hormone may be normal but the effector gland hormone decreased; in this case, the pituitary is not responding appropriately to effector hormone changes, and the combination of findings is still suggestive of hypopituitarism.[5]

Levels of LH/FSH may be suppressed by a raised prolactin level, and are therefore not interpretable unless prolactin is low or normal. In men, the combination of low LH and FSH in combination with a low testosterone confirms LH/FSH deficiency; a high testosterone would indicate a source elsewhere in the body (such as a testosterone-secreting tumor). In women, the diagnosis of LH/FSH deficiency depends on whether the woman has been through the menopause. Before the menopause, abnormal menstrual periods together with low estradiol and LH/FSH levels confirm a pituitary problem; after the menopause (when LH/FSH levels are normally elevated and the ovaries produce less estradiol), inappropriately low LH/FSH alone is sufficient.[1] Stimulation tests with GnRH are possible, but their use is not encouraged.[5][7]

For TSH, basal measurements are usually sufficient, as well as measurements of thyroxine to ensure that the pituitary is not simply suppressing TSH production in response to hyperthyroidism (an overactive thyroid gland). A stimulation test with thyrotropin-releasing hormone (TRH) is not regarded as useful.[7] Prolactin can be measured by basal level, and is required for the interpretation of LH and FSH results in addition to the confirmation of hypopituitarism or diagnosis of a prolactin-secreting tumor.[1]

Growth hormone deficiency is almost certain if all other pituitary tests are also abnormal, and insulin-like growth factor 1 (IGF-1) levels are decreased. If this is not the case, IGF-1 levels are poorly predictive of the presence of GH deficiency; stimulation testing with the insulin tolerance test is then required. This is performed by administering insulin to lower the blood sugar to a level below 2.2mmol/l. Once this occurs, growth hormone levels are measured. If they are low despite the stimulatory effect of the low blood sugars, growth hormone deficiency is confirmed. The test is not without risks, especially in those prone to seizures or are known to have heart disease, and causes the unpleasant symptoms of hypoglycemia.[1][5] Alternative tests (such as the growth hormone releasing hormone stimulation test) are less useful, although a stimulation test with arginine may be used for diagnosis, especially in situations where an insulin tolerance test is thought to be too dangerous.[18] If GH deficiency is suspected, and all other pituitary hormones are normal, two different stimulation tests are needed for confirmation.[7]

If morning cortisol levels are over 500nmol/l, ACTH deficiency is unlikely, whereas a level less than 100 is indicative. Levels between 100-500 require a stimulation test.[5] This, too, is done with the insulin tolerance test. A cortisol level above 500 after achieving a low blood sugar rules out ACTH deficiency, while lower levels confirm the diagnosis. A similar stimulation test using corticotropin-releasing hormone (CRH) is not sensitive enough for the purposes of the investigation. If the insulin tolerance test yields an abnormal result, a further test measuring the response of the adrenal glands to synthetic ACTH (the ACTH stimulation test) can be performed to confirm the diagnosis.[19] Stimulation testing with metyrapone is an alternative.[19] Some suggest that an ACTH stimulation test is sufficient as first-line investigation, and that an insulin tolerance test is only needed if the ACTH test is equivocal.[5][7] The insulin tolerance test is discouraged in children.[5] None of the tests for ACTH deficiency are perfect, and further tests after a period of time may be needed if initial results are not conclusive.[1]

Symptoms of diabetes insipidus should prompt a formal fluid deprivation test to assess the body’s response to dehydration, which normally causes concentration of the urine and increasing osmolarity of the blood. If these parameters are unchanged, desmopressin (an ADH analogue) is administered. If the urine then becomes concentrated and the blood osmolarity falls, there is a lack of ADH due to lack of pituitary function (“cranial diabetes insipidus”). In contrast, there is no change if the kidneys are unresponsive to ADH due to a different problem (“nephrogenic diabetes insipidus”).[1]

If one of these tests shows a deficiency of hormones produced by the pituitary, magnetic resonance imaging (MRI) scan of the pituitary is the first step in identifying an underlying cause. MRI may show various tumors and may assist in delineating other causes. Tumors smaller than 1cm are referred to as microadenomas, and larger lesions are called macroadenomas.[1]Computed tomography with radiocontrast may be used if MRI is not available.[7] Formal visual field testing by perimetry is recommended, as this would show evidence of optic nerve compression by a tumor.[7]

Other tests that may assist in the diagnosis of hypopituitarism, especially if no tumor is found on the MRI scan, are ferritin (elevated in hemochromatosis), angiotensin converting enzyme (ACE) levels (often elevated in sarcoidosis), and human chorionic gonadotropin (often elevated in tumor of germ cell origin). If a genetic cause is suspected, genetic testing may be performed.[7]

Treatment of hypopituitarism is threefold: removing the underlying cause, treating the hormone deficiencies, and addressing any other repercussions that arise from the hormone deficiencies.[1]

Pituitary tumors require treatment when they are causing specific symptoms, such as headaches, visual field defects or excessive hormone secretion. Transsphenoidal surgery (removal of the tumor by an operation through the nose and the sphenoidal sinuses) may, apart from addressing symptoms related to the tumor, also improve pituitary function, although the gland is sometimes damaged further as a result of the surgery. When the tumor is removed by craniotomy (opening the skull), recovery is less likelybut sometimes this is the only suitable way to approach the tumor.[1][17] After surgery, it may take some time for hormone levels to change significantly. Retesting the pituitary hormone levels is therefore performed 2 to 3 months later.[5]

Prolactinomas may respond to dopamine agonist treatmentmedication that mimics the action of dopamine on the lactrotrope cells, usually bromocriptine or cabergoline. This approach may improve pituitary hormone secretion in more than half the cases, and make supplementary treatment unnecessary.[1][5][17][20]

Other specific underlying causes are treated as normally. For example, hemochromatosis is treated by venesection, the regular removal of a fixed amount of blood. Eventually, this decreases the iron levels in the body and improves the function of the organs in which iron has accumulated.[21]

Most pituitary hormones can be replaced indirectly by administering the products of the effector glands: hydrocortisone (cortisol) for adrenal insufficiency, levothyroxine for hypothyroidism, testosterone for male hypogonadism, and estradiol for female hypogonadism (usually with a progestogen to inhibit unwanted effects on the uterus). Growth hormone is available in synthetic form, but needs to be administered parenterally (by injection). Antidiuretic hormone can be replaced by desmopressin (DDAVP) tablets or nose spray. Generally, the lowest dose of the replacement medication is used to restore wellbeing and correct the deranged results, as excessive doses would cause side-effects or complications.[1][5][7] Those requiring hydrocortisone are usually instructed to increase their dose in physically stressful events such as injury, hospitalization and dental work as these are times when the normal supplementary dose may be inadequate, putting the patient at risk of adrenal crisis.[5][12]

Long-term follow up by specialists in endocrinology is generally needed for people with known hypopituitarism. Apart from ensuring the right treatment is being used and at the right doses, this also provides an opportunity to deal with new symptoms and to address complications of treatment.[5][7]

Difficult situations arise in deficiencies of the hypothalamus-pituitary-gonadal axis in people (both men and women) who experience infertility; infertility in hypopituitarism may be treated with subcutaneous infusions of FSH, human chorionic gonadotropinwhich mimics the action of LHand occasionally GnRH.[1][5][7]

Several hormone deficiencies associated with hypopituitarism may lead to secondary diseases. For instance, growth hormone deficiency is associated with obesity, raised cholesterol and the metabolic syndrome, and estradiol deficiency may lead to osteoporosis. While effective treatment of the underlying hormone deficiencies may improve these risks, it is often necessary to treat them directly.[5]

Several studies have shown that hypopituitarism is associated with an increased risk of cardiovascular disease and some also an increased risk of death of about 50% to 150% the normal population.[5][12] It has been difficult to establish which hormone deficiency is responsible for this risk, as almost all patients studied had growth hormone deficiency.[7] The studies also do not answer the question as to whether the hypopituitarism itself causes the increased mortality, or whether some of the risk is to be attributed to the treatments, some of which (such as sex hormone supplementation) have a recognized adverse effect on cardiovascular risk.[7]

The largest study to date followed over a thousand people for eight years; it showed an 87% increased risk of death compared to the normal population. Predictors of higher risk were: female sex, absence of treatment for sex hormone deficiency, younger age at the time of diagnosis, and a diagnosis of craniopharyngioma. Apart from cardiovascular disease, this study also showed an increased risk of death from lung disease.[7][22]

Quality of life may be significantly reduced, even in those people on optimum medical therapy. Many report both physical and psychological problems. It is likely that the commonly used replacement therapies still do not completely mimic the natural hormone levels in the body.[5] Health costs remain about double those of the normal population.[5]

Hypopituitarism is usually permanent. It requires lifelong treatment with one or more medicines.

There is only one study that has measured the prevalence (total number of cases in a population) and incidence (annual number of new cases) of hypopituitarism.[1] This study was conducted in Northern Spain and used hospital records in a well-defined population. The study showed that 45.5 people out of 100,000 had been diagnosed with hypopituitarism, with 4.2 new cases per year.[6] 61% were due to tumors of the pituitary gland, 9% due to other types of lesions, and 19% due to other causes; in 11% no cause could be identified.[1][6]

Recent studies have shown that people with a previous traumatic brain injury, spontaneous subarachnoid hemorrhage (a type of stroke) or radiation therapy involving the head have a higher risk of hypopituitarism.[23] After traumatic brain injury, as much as a quarter have persistent pituitary hormone deficiencies.[24] Many of these people may have subtle or non-specific symptoms that are not linked to pituitary problems but attributed to their previous condition. It is therefore possible that many cases of hypopituitarism remain undiagnosed, and that the annual incidence would rise to 31 per 100,000 annually if people from these risk groups were to be tested.[1]

The pituitary was known to the ancients, such as Galen, and various theories were proposed about its role in the body, but major clues as to the actual function of the gland were not advanced until the late 19th century, when acromegaly due to pituitary tumors was described.[25] The first known report of hypopituitarism was made by the German physician and pathologist Dr Morris Simmonds. He described the condition on autopsy in a 46-year-old woman who had suffered severe puerperal fever eleven years earlier, and subsequently suffered amenorrhea, weakness, signs of rapid aging and anemia. The pituitary gland was very small and there were few remnants of both the anterior and the posterior pituitary.[1][4] The eponym Simmonds’ syndrome is used infrequently for acquired hypopituitarism, especially when cachexia (general ill health and malnutrition) predominates.[26][27] Most of the classic causes of hypopituitarism were described in the 20th century; the early 21st century saw the recognition of how common hypopituitarism could be in previous head injury victims.[1]

Until the 1950s, the diagnosis of pituitary disease remained based on clinical features and visual field examination, sometimes aided by pneumoencephalography and X-ray tomography. Nevertheless, the field of pituitary surgery developed during this time. The major breakthrough in diagnosis came with the discovery of the radioimmunoassay by Rosalyn Yalow and Solomon Berson in the late 1950s.[28] This allowed the direct measurement of the hormones of the pituitary, which as a result of their low concentrations in blood had previously been hard to measure.[25] Stimulation tests were developed in the 1960s, and in 1973 the triple bolus test was introduced, a test that combined stimulation testing with insulin, GnRH and TRH.[29] Imaging of the pituitary, and therefore identification of tumors and other structural causes, improved radically with the introduction of computed tomography in the late 1970s and magnetic resonance imaging in the 1980s.[25]

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Hypopituitarism – Wikipedia

Hypopituitarism Hypopituitarism

Hypopituitarism Definition

Hypopituitarism is loss of function in an endocrine gland due to failure of the pituitary gland to secrete hormones which stimulate that glands function. The pituitary gland is located at the base of the brain. Patients diagnosed with hypopituitarism may be deficient in one single hormone, several hormones, or have complete pituitary failure.

The pituitary is a pea-sized gland located at the base of the brain, and surrounded by bone. The hypothalamus, another endocrine organ in the brain, controls the function of the pituitary gland by providing hormonal orders. In turn, the pituitary gland regulates the many hormones that control various functions and organs within the body. The posterior pituitary acts as a sort of storage area for the hypothalamus and passes on hormones that control function of the muscles and kidneys. The anterior pituitary produces its own hormones which help to regulate several endocrine functions.

In hypopituitarism, something interferes with the production and release of these hormones, thus affecting the function of the target gland. Commonly affected hormones may include:

Gonadotropin deficiency involves two distinct hormones affecting the reproductive system. Luteinizing hormone (LH) stimulates the testes in men and the ovaries in women. This deficiency can affect fertility in men and women and menstruation in women. Follicle-stimulating hormone (FSH) has similar effects to LH.

Also known as corticotropin, adrenocorticotopic hormone (ACTH) stimulates the adrenal gland to produce a hormone similar to cortisone, called cortisol. The loss of this hormone can lead to serious problems.

Growth hormone (GH) regulates the bodys growth. Patients who lose supply of this hormone before physical maturity will suffer impaired growth. Loss of the hormone can also affect adults.

Deficiency of a single pituitary hormone occurs less commonly than deficiency of more than one hormone. Sometimes referred to as progressive pituitary hormone deficiency or partial hypopituitarism, there is usually a predictable order of hormone loss. Generally, growth hormone is lost first, then luteinizing hormone deficiency follows. The loss of follicle-stimulating hormone, thyroid stimulating hormone and adrenocorticotopic hormones follow much later. The progressive loss of pituitary hormone secretion is usually a slow process, which can occur over a period of months or years. Hypopituitarism does occasionally start suddenly with rapid onset of symptoms.

This condition represents the loss of all hormones released by the anterior pituitary gland. Panhypopituitarism is also known as complete pituitary failure.

There are three major mechanisms which lead to the development of hypopituitarism. The first involves decreased release of hypothalamic hormones that stimulate pituitary function. The cause of decreased hypothalamic function may be congenital or acquired through interference such as tumors, inflammation, infection, mass lesions or interruption of blood supply. A second category of causes is any event or mass which interrupts the delivery of hormones from the hypothalamus. These may include particular tumors and aneurysms. Damage to the pituitary stalk from injury or surgery can also lead to hypopituitarism.

Hypopituitarism is a partial or complete insufficiency of pituitary hormone secretion that may derive from pituitary or hypothalamic disease. The onset can

Read more: Pediatric Hypopituitarism: Background, Etiology, Epidemiology

Symptoms of Hypopituitarism

The list of signs and symptoms mentioned in various sources for Hypopituitarism includes the 21 symptoms listed below:

Research symptoms & diagnosis of Hypopituitarism:

Review the available symptom checkers for these symptoms of Hypopituitarism:

Review the available Assessment Questionnaires for the symptoms of Hypopituitarism:

Read information about complications of Hypopituitarism.

Do I have Hypopituitarism?

Home medical tests related to Hypopituitarism:

The list of other diseases or medical conditions that may be on the differential diagnosis list of alternative diagnoses for Hypopituitarism includes:

See the full list of 12

More information about symptoms of Hypopituitarism and related conditions:

Click on any of the symptoms below to see a full list of other causes including diseases, medical conditions, toxins, drug interactions, or drug side effect causes of that symptom.

When considering symptoms of Hypopituitarism, it is also important to consider Hypopituitarism as a possible cause of other medical conditions. The Disease Database lists the following medical conditions that Hypopituitarism may cause:

For a more detailed analysis of Hypopituitarism as a symptom, including causes, drug side effect causes, and drug interaction causes, please see our Symptom Center information for Hypopituitarism.

These general reference articles may be of interest in relation to medical signs and symptoms of disease in general:

Full list of premium articles on symptoms and diagnosis

The symptom information on this page attempts to provide a list of some possible signs and symptoms of Hypopituitarism. This signs and symptoms information for Hypopituitarism has been gathered from various sources, may not be fully accurate, and may not be the full list of Hypopituitarism signs or Hypopituitarism symptoms. Furthermore, signs and symptoms of Hypopituitarism may vary on an individual basis for each patient. Only your doctor can provide adequate diagnosis of any signs or symptoms and whether they are indeed Hypopituitarism symptoms.

Continue reading here: Symptoms of Hypopituitarism RightDiagnosis.com

by Ian M. Chapman, MBBS, PhD

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* THIS IS THE CONSUMER VERSION *

Hypopituitarism is an underactive pituitary gland that results in deficiency of one or more pituitary hormones.

Hypopituitarism can be caused by several factors, including certain inflammatory disorders, a tumor of the pituitary gland, or an insufficient blood supply to the pituitary gland.

Symptoms depend on what hormone is deficient and may include short height, infertility, intolerance to cold, fatigue, and an inability to produce breast milk.

The diagnosis is based on measuring the blood levels of hormones produced by the pituitary gland and on imaging tests done on the pituitary gland.

Treatment focuses on replacing deficient hormones with synthetic ones but sometimes includes surgical removal or irradiation of any pituitary tumors.

Hypopituitarism, an uncommon disorder, can be caused by a number of factors, including a pituitary tumor or an insufficient blood supply to the pituitary gland.

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The rest is here: Hypopituitarism Hormonal and Metabolic Disorders Merck

Hypopituitarism What is hypopituitarism?

Hypopituitarism, also called an underactive pituitary gland, is a condition that affects the anterior lobe of the pituitary glandusually resulting in a partial or complete loss of functioning of that lobe. The resulting symptoms depend on which hormones are no longer being produced by the gland. Because the pituitary gland affects the other endocrine organs, effects of hypopituitarism may be gradual or sudden and dramatic.

Symptoms vary depending on what hormones are insufficiently produced by the pituitary gland. The following are common symptoms associated with reduced production of certain hormones:

Insufficient gonadotropins production (luteinizing hormone and follicle-stimulating hormone)

In premenopausal women, this leads to absent menstrual cycles, infertility, vaginal dryness, and loss of some female characteristics. In men, this deficiency leads to impotence, shriveling of testes, decreased sperm production, infertility, erectile dysfunction,and loss of some male characteristics.

Insufficient growth hormone production

This usually produces no symptoms in adults. However, it can cause loss of bone density and loss of muscle mass in adults. In children, this deficiency can lead to stunted growth and dwarfism.

Insufficient thyroid-stimulating hormone production

This usually leads to an underactive thyroid and may cause confusion, cold intolerance, weight gain, constipation, and dry skin.

Insufficientadrenocorticotropin hormone production

This rare deficiency leads to an underactive adrenal gland, resulting in low blood pressure, a low blood sugar level, fatigue, and a low tolerance for stress.

Insufficient prolactin production

This rare deficiency may cause an inability to produce breast milk after childbirth in some women.

The symptoms of hypopituitarism may resemble other conditions or medical problems. Always consult yourdoctor for a diagnosis.

Causes of hypopituitarism can directly affect the pituitary gland, or indirectly affect the glandthrough changes inthe hypothalamus.

Causes of primary hypopituitarism (directly affecting pituitary gland)

Causes of secondary hypopituitarism (affecting the hypothalamus)

Pituitary tumors

Inadequate blood supply to pituitary gland (stroke)

Infections and/or inflammatory diseases

Sarcoidosis. A rare inflammation of the lymph nodes and other tissues throughout the body

Amyloidosis.A rare disease which causes the buildup of amyloid, a protein and starch, in tissues and organs

Radiation therapy

Surgical removal of pituitary tissue

Autoimmune diseases

Head trauma

Genetic diseases

Tumors of the hypothalamus

Inflammatory disease or a disease that spreads, such as cancer

Head injuries

Surgical damage to thehypothalamusand/or blood vessels or nerves leading to it

Symptoms of several underactive glands may help adoctor diagnose hypopituitarism. In addition to a complete medical history and medical examination, diagnostic procedures for hypopituitarism may include:

Computed tomography (CT or CAT scan).A noninvasive diagnostic procedure that uses a combination of X-rays and computer technology to produce horizontal, or axial, images of the body to detect any abnormalities that may not show up on an ordinary X-ray.

Magnetic resonance imaging (MRI).A noninvasive procedure that produces two-dimensional views of an internal organ or structure.

Blood and urine tests.These tests will measure various hormone levels.

Treatment of hypopituitarism depends on its cause. The goal of treatment is to restore the pituitary gland to normal function when possible, or to replace or substitute for inadequate hormones when necessary.

Treatment may include replacement hormone therapy, surgical tumor removal, and/or radiation therapy.

View post: Hypopituitarism Massachusetts General Hospital, Boston, MA

There are notable differences between the terms hypopituitarism and panhypopituitarism. Hypopituitarism is a rare condition that refers to a decrease of function of two or more hormones produced by the pituitary gland. When all pituitary hormone production is deficient or decreased, the term Panhypopituitarism is used. Both Hypopituitarism and Panhypopituitarism are very complicated. They involved many endocrine functions and hormones.

The Introduction will help you understand the differences withspecific details.

Introduction Panhypopituitarism

MAGIC is made up of parents of affected children. If youwould like to talk withsomeone-

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Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Job Classification

In most duration tables, five job classifications are displayed. These job classifications are based on the amount of physical effort required to perform the work. The classifications correspond to the Strength Factor classifications described in the United States Department of Labors Dictionary of Occupational Titles. The following definitions are quoted directly from that publication.

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Hypopituitarism Hypopituitarism

Hypopituitary: Pituitary Gland Disorder Causes & Treatments

Hypopituitary Overview

Hypopituitarism is a condition in which the pituitary gland (a small gland at the base of the brain) does not produce one or more of its hormones or else not enough of them. This condition may occur because of disease in the pituitary or hypothalamus (a part of the brain that contains hormones that control the pituitary gland). When there is low or no production of all the pituitary hormones, the condition is called panhypopituitarism. This condition may affect either children or adults.

The pituitary gland sends signals to other glands, for example the thyroid gland, to produce hormones, such as thyroid hormone. The hormones produced by the pituitary gland and other glands have a significant impact on bodily functions, such as growth, reproduction, blood pressure, and metabolism. When one or more of these hormones is not produced properly, the bodys normal functions can be affected. Some of the problems with hormones, such as with cortisol or thyroid hormone, may require prompt treatment. Others may not be life threatening.

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The pituitary gland produces several hormones. Some important hormones include:

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

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 such as meningitis, or various other conditions. In some cases, the cause is unknown.

Some people may have no symptoms or a gradual onset of symptoms. In other people, the symptoms may be sudden and dramatic. The symptoms depend on the cause, how fast they come on, and the hormone that is involved.

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

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.

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

Drugs used to treat hypopituitarism replace the deficient hormone.

If a tumor is involved, surgery may be performed, depending on its type and location.

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

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

Visit the Pituitary Network Association web site.

hypopituitarism, panhypopituitarism, pituitary gland, hypothalamus, pituitary insufficiency, underactive pituitary gland, thyroid hormone deficiency, growth hormone deficiency, FSH, follicle-stimulating hormone, LH, luteinizing hormone, adrenocorticotropin hormone, ACTH, prolactin, ADH, antidiuretic hormone, low hormones

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Hypopituitary: Pituitary Gland Disorder Causes & Treatments

Panhypopituitarism: Background, Pathophysiology, Epidemiology

Migliaretti G, Aimaretti G, Borraccino A, et al. Incidence and prevalence rate estimation of GH treatment exposure in Piedmont pediatric population in the years 2002-2004: Data from the GH Registry. J Endocrinol Invest. 2006 May. 29(5):438-42. [Medline].

Hanna CE, Krainz PL, Skeels MR, Miyahira RS, Sesser DE, LaFranchi SH. Detection of congenital hypopituitary hypothyroidism: ten-year experience in the Northwest Regional Screening Program. J Pediatr. 1986 Dec. 109(6):959-64. [Medline].

Matthai SM, Smith CS. Pituitary hypoplasia associated with a single central maxillary incisor. J Pediatr Endocrinol Metab. 1996 Sep-Oct. 9(5):543-4. [Medline].

Willnow S, Kiess W, Butenandt O, et al. Endocrine disorders in septo-optic dysplasia (De Morsier syndrome)–evaluation and follow up of 18 patients. Eur J Pediatr. 1996 Mar. 155(3):179-84. [Medline].

Burgner DP, Kinmond S, Wallace AM, et al. Male pseudohermaphroditism secondary to panhypopituitarism. Arch Dis Child. 1996 Aug. 75(2):153-5. [Medline].

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Panhypopituitarism: Background, Pathophysiology, Epidemiology

Symptoms of Hypopituitarism – RightDiagnosis.com

Symptoms of Hypopituitarism

The list of signs and symptoms mentioned in various sources for Hypopituitarism includes the 21 symptoms listed below:

Research symptoms & diagnosis of Hypopituitarism:

Review the available symptom checkers for these symptoms of Hypopituitarism:

Review the available Assessment Questionnaires for the symptoms of Hypopituitarism:

Read information about complications of Hypopituitarism.

Do I have Hypopituitarism?

Home medical tests related to Hypopituitarism:

The list of other diseases or medical conditions that may be on the differential diagnosis list of alternative diagnoses for Hypopituitarism includes:

See the full list of 12

More information about symptoms of Hypopituitarism and related conditions:

Click on any of the symptoms below to see a full list of other causes including diseases, medical conditions, toxins, drug interactions, or drug side effect causes of that symptom.

When considering symptoms of Hypopituitarism, it is also important to consider Hypopituitarism as a possible cause of other medical conditions. The Disease Database lists the following medical conditions that Hypopituitarism may cause:

For a more detailed analysis of Hypopituitarism as a symptom, including causes, drug side effect causes, and drug interaction causes, please see our Symptom Center information for Hypopituitarism.

These general reference articles may be of interest in relation to medical signs and symptoms of disease in general:

Full list of premium articles on symptoms and diagnosis

The symptom information on this page attempts to provide a list of some possible signs and symptoms of Hypopituitarism. This signs and symptoms information for Hypopituitarism has been gathered from various sources, may not be fully accurate, and may not be the full list of Hypopituitarism signs or Hypopituitarism symptoms. Furthermore, signs and symptoms of Hypopituitarism may vary on an individual basis for each patient. Only your doctor can provide adequate diagnosis of any signs or symptoms and whether they are indeed Hypopituitarism symptoms.

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Symptoms of Hypopituitarism – RightDiagnosis.com

Hypopituitarism.

Hypopituitarism is the partial or complete insufficiency of anterior pituitary hormone secretion and may result from pituitary or hypothalamic disease. The reported incidence (12-42 new cases per million per year) and prevalence (300-455 per million) is probably underestimated if its occurrence after brain injuries (30-70% of cases) is considered. Clinical manifestations depend on the extent of hormone deficiency and may be non specific, such as fatigue, hypotension, cold intolerance, or more indicative such as growth retardation or impotence and infertility in GH and gonadotropin deficiency, respectively.A number of inflammatory, granulomatous or neoplastic diseases as well as traumatic or radiation injuries involving the hypothalamic-pituitary region can lead to hypopituitarism. Several genetic defects are possible causes of syndromic and non syndromic isolated/multiple pituitary hormone deficiencies. Unexplained gonadal dysfunctions, developmental craniofacial abnormalities, newly discovered empty sella and previous pregnancy-associated hemorrhage or blood pressure changes may be associated with defective anterior pituitary function.The diagnosis of hypopituitarism relies on the measurement of basal and stimulated secretion of anterior pituitary hormones and of the hormones secreted by pituitary target glands. MR imaging of the hypothalamo-pituitary region may provide essential information. Genetic testing, when indicated, may be diagnostic.Secondary hypothyroidism is a rare disease. The biochemical diagnosis is suggested by low serum FT4 levels and inappropriately normal or low basal TSH levels that do not rise normally after TRH. L-thyroxine is the treatment of choice. Before starting replacement therapy, concomitant corticotropin deficiency should be excluded in order to avoid acute adrenal insufficiency. Prolactin deficiency is also very rare and generally occurs after global failure of pituitary function. Prolactin deficiency prevents lactation. Hypogonadotropic hypogonadism in males is characterized by low testosterone with low or normal LH and FSH serum concentrations and impaired spermatogenesis. Hyperprolactinemia as well as low sex hormone binding globulin concentrations enter the differential diagnosis. Irregular menses and amenorrhea with low serum estradiol concentration (

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Hypopituitarism.

Hypopituitarism – Hormonal and Metabolic Disorders – Merck …

By Ian M. Chapman, MBBS, PhD

NOTE: This is the Consumer Version. CONSUMERS: Click here for the Professional Version

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Hypopituitarism is an underactive pituitary gland that results in deficiency of one or more pituitary hormones.

Hypopituitarism can be caused by several factors, including certain inflammatory disorders, a tumor of the pituitary gland, or an insufficient blood supply to the pituitary gland.

Symptoms depend on what hormone is deficient and may include short height, infertility, intolerance to cold, fatigue, and an inability to produce breast milk.

The diagnosis is based on measuring the blood levels of hormones produced by the pituitary gland and on imaging tests done on the pituitary gland.

Treatment focuses on replacing deficient hormones with synthetic ones but sometimes includes surgical removal or irradiation of any pituitary tumors.

Hypopituitarism, an uncommon disorder, can be caused by a number of factors, including a pituitary tumor or an insufficient blood supply to the pituitary gland.

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NOTE: This is the Consumer Version. CONSUMERS: Click here for the Professional Version

NOTE: This is the Consumer Version. DOCTORS: Click here for the Professional Version

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Hypopituitarism – Hormonal and Metabolic Disorders – Merck …

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