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
HPS 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 |
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 |
F w/ amennorhea: LH, FSH, estradiol, medroxyprogesterone challenge (withdrawal bleeding) M: LH |
F: estradiol (+ progestin if uterus) M: Testosterone (injection, gel, patch) or hCG if trying to conceive/p> |
| 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 | inhibited lactation | Not done | Not done |