endocrine and metabolic disorders
Generalized Hypopituitarism
Symptoms and Signs of Generalized Hypopituitarism
Symptoms and signs relate to the underlying disorder and to the specific pituitary hormones that are deficient or absent. Onset is usually insidious and may not be recognized by the patient; occasionally, onset is sudden or dramatic. deficiency (causing ArginineVasopressin Deficiency (Central Diabetes Insipidus) ) is rare in primary pituitary disorders but is common with lesions of the pituitary stalk and hypothalamus. Function of all target glands decreases when all hormones are deficient (panhypopituitarism). Lack of luteinizing hormone (LH) and follicle-stimulating hormone (FSH) in children leads to Delayed Puberty . Premenopausal women develop amenorrhea, reduced libido, regression of secondary sexual characteristics, and infertility. Men develop erectile dysfunction, testicular atrophy, reduced libido, regression of secondary sexual characteristics, and decreased spermatogenesis with consequent infertility. GH deficiency may contribute to decreased energy, abnormal body composition, and dyslipidemia but is usually asymptomatic and clinically undetectable in adults. Effects of Growth Hormone Deficiency in Children are discussed elsewhere. TSH deficiency leads to Hypothyroidism , with such symptoms as facial puffiness, hoarse voice, bradycardia, and cold intolerance. ACTH deficiency results in Secondary Adrenal Insufficiency with attendant fatigue, hypotension, and intolerance to stress and infection. ACTH deficiency does not result in the hyperpigmentation characteristic of primary adrenal failure. ACTH deficiency does not result in hyponatremia or hyperkalemia as occurs in Hypothalamic lesions, which can result in hypopituitarism, can also disturb the centers that control appetite, causing a syndrome resembling anorexia nervosa, or sometimes hyperphagia with massive obesity. Sheehan syndrome,which affects postpartum women, is pituitary necrosis due to hypovolemia and shock occurring in the immediate peripartum period. Lactation does not start after childbirth, and the patient may complain of fatigue and loss of pubic and axillary hair. Pituitary apoplexyis a symptom complex caused by hemorrhagic infarction of either a normal pituitary gland or, more commonly, a pituitary tumor. Acute symptoms include severe headache, stiff neck, fever, visual field defects, and oculomotor palsies. The resulting edema may compress the hypothalamus, resulting in somnolence or coma. Varying degrees of hypopituitarism may develop suddenly, and the patient may present with vascular collapse because of deficient ACTH and cortisol. The cerebrospinal fluid often contains blood, and MRI documents hemorrhage. 