Panhypopituitarism
Chloe de Crecy
Etiology
- Originates from hypothalamus vs anterior pituitary. Time course: acute vs insidious.
- Hypothalamic: mass (benign vs malignant), radiation, infiltrative dz (sarcoid), infections (TB), TBI, stroke
- Pituitary: mass (adenoma, cysts), surgery, radiation, infiltrative dz (hypophysitis, hemochromatosis), infection, infarction, apoplexy, genetic mutations, empty sella
Evaluation
- Not all hormones are always affected. Secretion of GH and gonadotropins more likely affected than ACTH and TSH.
- Consult Endocrine
| HPA Axis | Symptoms | Testing | Replacement |
|---|---|---|---|
|
CRH – ACTH – Cortisol (Adrenals) | Fatigue, weight loss, hypoglycemia |
AM cortisol (low) ACTH (low or inappropriately normal) Cosyntropin Stim test |
Hydrocortisone (~15-25mg total daily) Prednisone 5 mg daily |
|
TRH – TSH – T4/T3 (Thyroid) | Fatigue, cold intolerance, constipation, bradycardia, skin changes, anemia, delayed reflexes | TSH, T4, T3 (all low) | Levothyroxine |
|
GnRH – LH/FSH - Estrogen, androgens (Gonads) | Hypogonadism F: anovulation, hot flashes, vaginal atrophy, decreased bone density M: decreased energy/libido, low energy, decreased muscle mass, decreased spermatogenesis, decreased bone density |
F w/ amenorrhea: LH, FSH, estradiol,
medroxyprogesterone challenge (withdrawal bleeding) M: LH, FSH, total testosterone; add free testosterone on subsequent labs |
F: estradiol (+ progestin if uterus) M: Testosterone (injection, gel, oral) or hCG if trying to conceive |
| GHRH – Growth hormone – liver, fat |
Children: short stature Adults: decrease in lean body mass, decrease in bone density, dyslipidemia | IGF-1 (low) | Recombinant growth hormone |
| Dopamine (inhibitor) – Prolactin – mammary glands |