Updated: 12/25/2015

General Hypopituitarism

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Topic
Presentation
  • Symptoms depend on specific hormone deficiency
    • ↓ FSH/LH
      • impotence (males), amenorrhea (females)
      • late-onset puberty (children)
    • ↓ GH
      • growth delay (children)
      • muscle wasting (adults)
      • hypoglycemia (adults) 
        • GH normally gluconeogenic
    • ↓ TSH
      • weakness
      • constipation
      • cold intolerance
Evaluation
  • FSH/LH
    • GnRH stimulation test
      • no change in FSH/LH release in hypopituitarism
      • see ↑ in cases of hypothalamic causes
  • GH
    • Arginine and sleep stimulation tests
      • no change in GH release in hypopituitarism
      • GH normally released at maximum rate at 5 AM
  • TSH
    • TRF stimulation
      • no change in TSH release in hypopituitarism
  • ACTH
    • metyrapone test
      • inhibitor of adrenal 11-hydroxylase
        • normally results in ↓ conversion of 11-deoxycortisol to cortisol
        • consequent ↑ in ACTH release and ↑ in 11-deoxycortisol proximal to the inhibited enzymes
      • in cases of hypopituitarism there is no ↑ in ACTH or 11-deoxycortisol
      • in adrenal disease there is an ↑ in ACTH but not 11-deoxycortisol
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Questions (1)

(M1.EC.14.6) A 16-year-old girl presents with fatigue and reports missing her period for the past several months though her prior menses were regular. She is short for her age. Her mother has been worried since her daughter started bumping into the furniture around the house. You perform a visual field in the office which reveals the following (Figure A). Vital signs are stable with the exception of blood pressure which is slightly lower than her baseline. The remainder of her physical examination is unremarkable. Regarding this patient, one would also expect to find: Tested Concept

QID: 104331
FIGURES:
1

Hyperkalemia

5%

(1/19)

2

Hyperpigmentation

32%

(6/19)

3

Salt wasting

21%

(4/19)

4

Elevated plasma cortisol level

11%

(2/19)

5

Hypoglycemia

32%

(6/19)

M 2 E

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