hypopituitarism (pituitary insufficiency) - a chronic dysfunction of the anterior pituitary (adenohypophysis, the pituitary gland).This part of the brain is composed of two parts: the front and rear.The cells of the anterior lobe produce 6 hormones: ACTH, or adrenocorticotropic hormone, growth hormone or growth hormone, prolactin, thyroid stimulating hormone or thyrotropin, follicle stimulating hormone or follitropin and luteinizing hormone or lutropin.When the reduction or complete loss of function of the adenohypophysis number of hormones produced by them in the blood rapidly decreased, resulting in impaired organ function: peripheral endocrine glands, which are controlled by them.In this article we consider the phenomenon of hypopituitarism, talk about its symptoms and treatment options. Content
Pituitary insufficiency may occur in different forms:
also highlights a condition called intermediate-pituitary insufficiency, and the lack of pituitary function is combined with other endocrine disorders, diabetes insipidus.
structure and function of the pituitary gland may be impaired under the influence of many factors.The main ones are listed below.
There is a hereditary form of hypopituitarism associated with the defective gene located on the X chromosome.In this case, the disease affects multiple members of a family, and it itself is classified as idiopathic hypopituitarism.
In adult patients with hypopituitarism, may be determined by the following clinical manifestations of the disease:
hypopituitarism Symptoms appear only when the normal functioning of cells is less than 10% of the original quantity.Typically, the disease develops slowly over many years, gradually progressing.The first signs of the disease are symptoms of deficiency of follicle (folitropina) and luteinizing (lutropin) anterior pituitary hormones.If hypopituitarism debuts at puberty, a child marked eunuchoid body proportions (short torso and long limbs), delayed sexual development.The women at the present state of reduced libido, disturbed menstrual cycle, the hair in the armpits and pubic hair fall out, breasts and genitals atrophy.Men have sharply reduced the potency and sex drive, facial hair, underarms, pubic hair fall out, testes atrophy.It is also one of the early symptoms of hypopituitarism is a violation of the sense of smell.
deficiency of pituitary growth hormone in children is manifested by a sharp slowdown in growth, and adults - an unexpected decline in blood glucose, the symptoms of hypoglycemia.
In the case of reducing the secretion of thyroid-stimulating hormone, children begin to fall behind in physical and mental development, and adults develop hypothyroidism, ie hypothyroidism with its characteristic features.
Decreased blood levels kortikotropnogo hormone or corticotropin, entails a reduction in the function of the adrenal cortex, the so-called gipokortitsizm.The symptoms of this condition are lack of pigmentation, pale skin, weight loss patient, pronounced weakness in the muscles, lower blood pressure (hypotension), slow down the heart rate (bradycardia), dyspeptic disorders (nausea, vomiting, and others).In addition, such patients are expressed symptoms of hypogonadism (cm. Above).
When tumors of the pituitary gland are marked changes in the fundus of the eye, loss of the outer (temporal) half of the left and right visual fields.
In the case of the pathology of the hypothalamus can be diagnosed symptoms of diabetes insipidus, eating disorders, sleep and thermoregulation.
hemorrhages occur in the pituitary tumor syndrome of acute hypopituitarism: suddenly arisen excruciating headache, visual loss, a sharp decline to almost 0 in blood pressure, loss of consciousness, meningeal symptoms.
For successful diagnosis doctor should pay close attention to the complaints of the patient, medical history data (when ill with a disease that began as progressed, the sequence of the onset of symptoms) and diseases (inflammatory disease of the brain injury of his massive blood loss).
patient necessarily be assigned diagnostic hormone tests - determination of basal levels of anterior pituitary hormones, and sex hormones, adrenal hormones and thyroid.It should be remembered that, in the case of determining the low basal level of hormones of peripheral endocrine glands (thyroid, sexual, adrenal glands), once the diagnosis of hypopituitarism is not presented as reasons for the decline of hormones in the blood may be different.To find out what caused this phenomenon, there should be incentives functional tests with special substances.
to visually assess the state of the sella (the area in which the pituitary gland is located), and close to him organs, the patient appoint instrumental research methods, such as radiography, computed or magnetic resonance imaging of the skull and sella.
Pathological changes in the fundus, visual field loss, defined in the survey as an ophthalmologist favor the diagnosis of hypopituitarism, and in some cases to help determine the cause of the disease.
First, we should differentiate hypopituitarism disease called anorexia nervosa.Common features of these pathologies are a poor appetite and loss of weight up to exhaustion (cachexia).But anorexia nervosa is characterized in many ways, such as the preservation of physical activity of the patient (or rather, the patient: women suffer this disorder are much more likely than men), and not altered secondary sex characteristics.Debuts anorexia, usually at a young age after a conscious effort to lose weight and the consequent desire to rebuff the meal.
idiopathic pituitary dwarfism also be distinguished from a number of diseases that provoke stunting.It is a congenital adrenal hyperplasia, congenital hypothyroidism, diabetes (syndrome Nobekur, Mauriac), early puberty, genetic arthropathy.Also, can hinder the growth of heavy somatic diseases.We should also be said about the so-called familial short stature: it is constitutional delay of growth observed simultaneously in several or even all members of one family.
There are a number of rare genetically determined pathologies, somewhat similar in the clinical course with hypopituitarism, and about them, too, it is important to remember the time of diagnosis:
In order to treat this disease are usually held hormone replacement therapy, it compensates for the deficiency in the bodyof a hormone.
Insufficient gonadotropins men compensated by the introduction of drugs Testenat, methyltestosterone, Testobromletsit, Andriol and others.The dose of the drug administered is dependent on the initial level of testosterone in the blood.
Women, unlike men, hormone therapy should be cycles of 25 days with estrogen, and the next 5 days - medroxyprogesterone.The method of choice is therapy with clomiphene.It is introduced, starting with the 5th day of the cycle for 5 consecutive days.If the effect of the therapy is absent 12 consecutive days administered Pergonal then stimulate ovulation administration of human chorionic gonadotropin.
In the case of failure to systematically administered TSH thyroid hormones.
When corticotropin deficiency prescribed glucocorticoids (cortisol, dexamethasone).
If hypopituitarism is caused by a tumor of the hypothalamus or pituitary gland, shown surgery or radiation therapy to the affected area.
In the case of pituitary hemorrhage in a patient in need of urgent medical assistance, to combat acute adrenal insufficiency.
If the disease is identified in the deep stage and promptly appoint a sufficient dose of the missing hormones, quality of life greatly improved, that is, the prognosis is favorable.