Introduction to Hypopituitarism – Symptoms and Causes Essay

Hypopituitarism refers to deficiency of one or more hormones produced by the anterior pituitary or released from the posterior pituitary. Hypopituitarism is associated with excess mortality, a key risk factor being cortisol deficiency due to adrenocorticotropic hormone (ACTH) deficiency. Onset can be acute or insidious, and the most common cause in adulthood is a pituitary adenoma, or treatment with pituitary surgery or radiotherapy. Hypopituitarism is diagnosed based on baseline blood sampling for thyroid stimulating hormone, gonadotropin, and prolactin deficiencies, whereas for ACTH, growth hormone, and antidiuretic hormone deficiency dynamic stimulation tests are usually needed. Repeated pituitary function assessment at regular intervals is needed for diagnosis of the predictable but slowly evolving forms of hypopituitarism. Replacement treatment exists in the form of thyroxine, hydrocortisone, sex steroids, growth hormone, and desmopressin. If onset is acute, cortisol deficiency should be replaced first. Modifications in replacement treatment are needed during the transition from paediatric to adult endocrine care, and during pregnancy.Hypopituitarism Disease Process Essay.

Pros and cons to Causes, Symptoms, and Risks – Hypopituitarism‎ Essay

However, in patients with hypopituitarism, the pituitary gland or some of its component secretory cells are unable to respond adequately to a reduction in the target hormone levels. As a result, the action of the target glands continues to remain low. This eventually leads to a deficiency in the hormones produced by the target glands, and a reduction in their physiologic function. The end result is a failure of some body process. Unlike the assessment of the target glands, the function of the pituitary gland is usually assessed by the function of the target gland in combination with the concentration of the stimulating or tropic pituitary hormone. For example, the function of the pituitary gland in regulating thyroid function is assessed by the concentration of the secondary hormone, thyroxin, in the blood as well as that of the tropic hormone thyrotropin or thyroid stimulating hormone. Hypopituitarism is diagnosed based on baseline blood sampling for thyroid stimulating hormone, gonadotropin, and prolactin deficiencies, whereas for ACTH, growth hormone, and antidiuretic hormone deficiency dynamic stimulation tests are usually needed. Repeated pituitary function assessment at regular intervals is needed for diagnosis of the predictable but slowly evolving forms of hypopituitarism. Replacement treatment exists in the form of thyroxine, hydrocortisone, sex steroids, growth hormone, and desmopressin. If onset is acute, cortisol deficiency should be replaced first. Modifications in replacement treatment are needed during the transition from paediatric to adult endocrine care, and during pregnancy. Hypopituitarism Disease Process Essay. A low level of thyroxin with an inappropriately low or even normal thyrotropin level would, therefore, indicate pituitary disease and not thyroid disease. This is because the tropic hormone would be increased in response to the low thyroid hormone concentration in blood, by the normal pituitary.

Citations about Management of Hypopituitarism Essay

The underlying pathology, speed of onset and the severity of hypopituitarism have a significant impact on the clinical features (Aetiology, diagnosis, and management of hypopituitarism in adult life. Prabhakar VK, Shalet SM Postgrad Med J. 2006 Apr). In particular, if hypopituitarism is caused by a space-occupying lesion (tumor), then mass effects such as headache, visual impairment, and rarely, personality changes and hypothalamic syndrome may appear. The clinical expression of severe panhypopituitarism, which typically occurs immediately after hypopituitary patients discontinue hormone replacement or following the pituitary apoplexy or hypophysectomy, may be evident within several hours (diabetes insipidus) or a few days (adrenal insufficiency) (Diagnosis and treatment of hypopituitarism: an update. van Aken MO, Lamberts SW). In fact, in many cases, these patients are not diagnosed with hypopituitarism for a prolonged time ( Hormone replacement therapy in hypopituitarism. Smith JC Expert Opin Pharmacother. 2004 May). GH-secreting cells (somatotrophs) are particularly vulnerable to pressure, which is why GH deficiency occurs first and most frequently among all pituitary hormones, followed by deficiencies of gonadotropin (luteinizing hormone [LH] and follicle stimulating hormone [FSH]), TSH and ACTH (or ACTH and TSH), and prolactin (The severity of growth hormone deficiency in adults with pituitary disease is related to the degree of hypopituitarism. Toogood AA, Beardwell CG, Shalet SM Clin Endocrinol (Oxf). 1994 Oct). Smith JC Expert Opin Pharmacother. 2004 May). The clinical symptoms stemming from a lack of ACTH, TSH, and/or gonadotropins vary somewhat but are similar to those associated with target gland hormone deficiency. Hypopituitarism Disease Process Essay.

Conclusion to essay on Neonatal Hypopituitarism: Approaches to Diagnosis and Treatment

In a word, the management of congenital hypopituitarism is multidisciplinary and requires a lifelong follow-up. The management should not only focus on optimizing the hormone replacement but also to monitor carefully for the evolvement of potential hormonal deficiencies in the future. In syndromic forms of hypopituitarism, it is also vital to address the wider issues such as visual and neuro-developmental issues and offer appropriate genetic counselling. While replacing hormones in suspected combined pituitary hormone deficiency, it is important to assess the adequacy of cortisol secretion and replacing with hydrocortisone when the cortisol secretion is suboptimal before commencing on thyroxine. Hypopituitarism Disease Process Essay. As mentioned above, patients on cortisol replacement should be carefully monitored for symptoms of DI. Diagnosis of hypopituitarism requires active clinical suspicion on subtle symptoms the patient presents, with clinical background of probability. These patients are often visiting various specialists before diagnosis is made. It is treatable, and a patient with this condition should be able to perform normal activities as long as the appropriate hormonal therapy is used consistently and properly. Even after the proper regimen has been established, a patient with hypopituitarism requires lifelong medical follow-up.

ORDER A PLAGIARISM-FREE PAPER NOW

References

Aetiology, diagnosis, and management of hypopituitarism in adult life. Prabhakar VK, Shalet SM Postgrad Med J. 2006 Apr

Hormone replacement therapy in hypopituitarism. Smith JC Expert Opin Pharmacother. 2004 May

The severity of growth hormone deficiency in adults with pituitary disease is related to the degree of hypopituitarism.
Toogood AA, Beardwell CG, Shalet SM Clin Endocrinol (Oxf). 1994 Oct

Hormone replacement therapy in hypopituitarism. Smith JC Expert Opin Pharmacother. 2004 May. Hypopituitarism Disease Process Essay.

Colao A, Vitale G, Cappabianca P, Briganti F, Ciccarelli A, De Rosa M, et al. Outcome of cabergoline treatment in men with prolactinoma: effects of a 24-month treatment on prolactin levels, tumor mass, recovery of pituitary function, and semen analysis. J Clin Endocrinol Metab. 2004;89:1704–1711. [PubMed] [Google Scholar]

Johannsson G, Burman P, Wiren L, Engstrom BE, Nilsson AG, Ottosson M, et al. Low dose dehydroepiandrosterone affects behavior in hypopituitary androgen-deficient women: a placebo-controlled trial. J Clin Endocrinol Metab. 2002;87:2046–2052. [PubMed] [Google Scholar]

Bhasin S, Cunningham GR, Hayes FJ, Matsumoto AM, Snyder PJ, Swerdloff RS, et al. Testosterone therapy in men with androgen deficiency syndromes: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2010;95:2536–2559. Hypopituitarism Disease Process Essay.