OVERVIEW
Overview of hypopituitarism
Anterior pituitary hypopituitarism is a syndrome caused by insufficient secretion of hormones from the anterior pituitary gland due to necrosis and atrophy, tumors, inflammation, and injury.
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Department
Endocrinology
Clinical symptoms
Decreased libido, amenorrhea, breast atrophy, absence of breast milk, impotence, chills, fatigue, loss of appetite, nausea and vomiting, weight loss, headache, pallor, decreased response, and apathy.
Harmful effects
It can lead to abnormal functioning of endocrine, reproductive and digestive systems, affecting fertility, spirituality, etc. It can also cause visual impairment and so on.
Complications
Blindness, partial blindness, schizophrenia, hypoglycemia, etc.
Examination
Adrenocorticotropic hormone test, sex hormone test, pituitary hormone test, thyroid hormone test, hypothalamus releasing hormone excitation test, X-ray film, CT, MRI, etc.
Diagnosis
Diagnosis is made on the basis of medical history, clinical manifestations such as decreased libido, combined with endocrine function measurements and imaging tests.
Treatment principle
Give target hormone replacement therapy and surgery if necessary.
Curable
Symptoms can be improved with treatment.
Dietary recommendations
Give high-calorie, high-protein, high-vitamin diet.
Etiology
Epidemiology
Most commonly seen in women between 20 and 40 years of age.
Etiology
Caused by necrotic atrophy of the anterior pituitary gland, tumors, inflammation and injury.
Symptoms and Diagnosis
Typical symptoms
Insufficient secretion of gonadotropin and lactotropin: women with postpartum pituitary necrosis have no milk secretion, breasts are not distended, libido is reduced, and in severe cases, amenorrhea and genital atrophy are present. In males, there is degeneration of secondary sexual characteristics, impotence, cessation of sperm development, and shrinkage of external genitalia and prostate. Insufficient secretion of thyrotropin: fear of cold, memory loss, expression of indifference, slow reaction, drowsiness, dry and rough skin, hair loss; in severe cases, mucous edema, constipation, bradycardia, and sometimes psychosis, hallucinations, delusions, rigidity, schizophrenia or mania. Insufficient secretion of adrenocorticotropic hormone: weakness, fatigue, anorexia, nausea, weight loss, slow heart rate, lowered blood pressure, susceptibility to hypoglycemia, susceptibility to infection. Pituitary tumor and parapituitary tumor: headache, hemianopsia, blindness, increased intracranial pressure, etc.
Diagnostic basis
1. history of obstructed labor, labor hemorrhage shock, medical injury, trauma, tumor, etc. and the above clinical manifestations. 2. laboratory examination reveals low level and dysfunction of target gland hormones; pituitary hormone decreases, and adrenocorticotropic hormone excitatory test shows a delayed response. 3. imaging examinations such as X-ray film and CT can reveal lesions in the hypothalamus and pteronyssinus.
Treatment
Treatment guidelines
Relieve symptoms by target gland hormone replacement therapy; for lesions caused by tumor, surgical resection should be performed.
Drug therapy
Hormone replacement therapy, supplementing hormones of corresponding endocrine glands.1. Adrenocorticotropic hormone: hydrocortisone, cortisone, prednisone and other glucocorticosteroids can be chosen, which are usually started before or at least at the same time with thyroid hormone replacement therapy.2. Thyroid hormone: levothyroxine or dry thyroxine tablets can be chosen.3. Sex hormone (1) estrogen and progesterone can be used in women in their reproductive years for artificial cycle (2) Men can use androgen replacement therapy to improve libido. (2) Men can use androgen replacement therapy to maintain secondary sexual characteristics and libido.
Surgery
Hypopituitarism caused by pituitary tumors and parapituitary tumors can be treated with surgery, and malignant cases can be supplemented with radiation therapy.
Prognosis
Early and aggressive treatment can improve the prognosis, but most of them need lifelong medication; those caused by malignant tumors have poor prognosis.
Nursing care
Daily care
Take sufficient rest, live a regular life, ensure sufficient sleep, and avoid exertion. Keep the living environment quiet and clean, with appropriate temperature and humidity, and pay attention to keep warm. Do a good job of psychological care, avoid emotional excitement, and actively cooperate with the treatment. For patients with obvious swelling, skin care should be strengthened to prevent abrasions. Follow the doctor’s instructions, take medication on time, review regularly, and consult the doctor when discomfort occurs.
Dietary management
Give high-calorie, high-protein, high-vitamin diet; avoid tobacco, alcohol, strong tea, coffee and other stimulating foods.
Other attention
Any weak patient with excessive bleeding in difficult labor or no milk after delivery should be followed up for early detection of the disease and timely treatment.