Sodium loss coma is a loss of sodium due to gastrointestinal disorders, surgery, and infection that can precipitate a crisis as in primary hyperaldosteronism. Peripheral circulatory collapse is particularly pronounced in this type of critical coma. It is important to note that increased sodium excretion may occur during the first few days of corticosteroid administration, probably because the glomerular filtration rate, which was low, is increased after treatment. It has been reported that less than 1 week after treatment with corticosteroids, patients enter a coma with a significant negative sodium balance. In addition, when thyroid preparations are applied alone, especially in excessive doses, the metabolic rate increases, the body’s need for adrenocorticotropic hormone increases, and the lack of adrenocorticotropic hormone becomes more severe; on the other hand, thyroid preparations have the effect of promoting solute excretion in hypothyroidism, thus causing water loss and sodium loss. Hypopituitarism is the result of damage to the pituitary gland, which leads to insufficient secretion of multiple or single pituitary hormones. It occurs in the postpartum period and is known as Sheehan’s syndrome. If the patient also has pituitary hormone deficiency, the condition is called panhypopituitarism. The etiology of the disease is complex and can be caused by various lesions of the hypothalamus, pituitary gland and adjacent tissues that involve the adenopituitary gland. The disease can be divided into two categories according to the location of the primary lesion: secondary hypopituitarism caused by hypothalamic pro-releasing hormone deficiency and primary hypopituitarism caused by the pituitary gland itself. The former is more common, while the latter includes simple GH deficiency, simple ACTH deficiency, simple LH/FSH deficiency and simple TSH deficiency, with simple GH deficiency being the most common. Multi-hormone deficiency hypopituitarism is also called combined pituitary hormone deficiency (CPHD), while single hormone deficiency hypopituitarism is also called isolated pituitary hormone deficiency. 1. Primary hypopituitarism (1) Congenital: Some congenital developmental malformations can cause pituitary hypoplasia, resulting in a variety of pituitary hormone deficiencies. These diseases are: anencephaly, holoprosence-phaly, de Morsier syndrome, Hall-Pallister syndrome and Reiger syndrome. The forebrain anomalies include cyclopia, cebocephaly, and orbital hypotelorism. de Morsier syndrome is also known as septo-optic dysplasia, in which the septum pellucidum is absent. de MorsieI syndrome is caused by inactivating mutations in the Hesx-1 gene. de Motsier syndrome patients have abnormal hypothalamic development, resulting in hypopituitarism, of which GH Hall-Pallister syndrome also has pituitary hypoplasia or even pituitary agenesis, and may be associated with hypothalamic hamartoblastoma. In addition to pituitary hypoplasia, Reiger syndrome has iris defects, glaucoma and abnormalities of the kidneys, gastrointestinal tract and umbilicus, which are caused by mutations in the Ptx-2 gene. In addition, cleft lip and cleft palate can be combined with GH deficiency. According to foreign data, about 4% of cleft lip and cleft palate patients have GH deficiency. Mutations in the transcription factors Pit-1 and Prop-1 can also cause pituitary hypoplasia, resulting in deficiencies of various pituitary hormones. In addition, mutations in some pituitary hormone genes can cause deficiencies of the corresponding hormones. For example, mutations in the GH-1 gene can cause GH deficiency. (2) Pituitary tumors: Pituitary tumors are by far the most common cause of this disease. Pituitary adenoma is the most common pituitary tumor. Various pituitary adenomas can cause hypopituitarism by compressing the normal pituitary tissue and pituitary stalk. Non-functioning adenomas are less likely to cause hypopituitarism because of their insidious onset of hormonal hypersecretion. Other pituitary tumors and tumors of adjacent pituitary tissues can also cause hypopituitarism, including craniopharyngioma, Rathke’s cyst, dermatomal cyst, ganglioneuroblastoma, paraganglioma, nasal glioma (esthesioneuroblastoma), sarcoma, lipoma, and hemangiopericytoma. hemangiopericytoma), embryonal cell tumor, etc. The symptoms of secondary hypogonadism due to gonadotropin deficiency are the first and most common, followed by secondary hypothyroidism due to TSH deficiency, and secondary hypoadrenocorticism due to ACTH deficiency, which is generally milder and less common; GH can also be reduced, but its manifestation lacks specificity in adults and is often overlooked. (3) Pituitary stroke: Pituitary stroke refers to ischemic necrosis or hemorrhage of pituitary tissue. Pituitary tumors and postpartum hemorrhage are the most common causes of pituitary stroke. Atherosclerosis, especially in combination with diabetes mellitus, also predisposes to pituitary stroke. The secretion function of the pituitary gland is reduced after a stroke, which causes the disease. (4) Infection: Bacterial (pituitary tuberculosis, pituitary abscess, etc.), fungal, viral (encephalitis, epidemic hemorrhagic fever, etc.) and spirochete (syphilis, etc.) infections can cause hypopituitarism. (5) Infiltrative lesions: Some infiltrative lesions such as hemochromatosis, nodular disease, Wegener’s granulomatosis, etc. can involve the pituitary gland and cause hypopituitarism. Lymphocytic pituitaryitis is also an infiltrative lesion. (6) Pituitary trauma: Pituitary trauma can damage pituitary tissue and cause hypoplasia. (7) Pituitary surgery: Excessive removal of pituitary tissue during pituitary surgery or excessive surgical damage to the pituitary gland can cause hypopituitarism. (8) Radiation injury: If the pituitary tumor is treated with radiation at a high dose, it is very likely to cause hypopituitarism, and its incidence increases with time. Radiation therapy for other intracranial or extracranial tumors can also produce hypopituitarism. (9) Other diseases: Empty saddle syndrome, internal carotid aneurysm, cavernous sinus thrombosis, etc. can also cause hypopituitarism. (10) Idiopathic: The cause of idiopathic hypopituitarism is not known. MRI shows that the pituitary gland and pituitary stalk are small. 2, secondary hypopituitarism Hypothalamus or other parts of the lesion caused by hypothalamus pituitary-releasing hormone secretion is insufficient or can not effectively act on the pituitary gland can also produce adenopituitary insufficiency, is the secondary hypopituitarism. (1) Pituitary stalk lesion: Pituitary stalk can be damaged by pituitary trauma or surgery; pituitary stalk can be compressed by tumors in the pituitary and its adjacent parts, both of which can cause dysfunction of the pituitary portal system, making hypothalamic pituitary releasing hormone ineffective in acting on the pituitary gland, thus causing hypopituitarism. (2) Hypothalamic and adjacent lesions: Various lesions of hypothalamus such as tumor, infection, infiltrative lesions, radiation injury, trauma, surgery, etc. can cause hypopituitary-releasing hormone secretion of hypothalamus to be insufficient, resulting in hypopituitarism. Kallmann syndrome is also essentially a hypothalamic hypopituitarism. The causative gene for this disorder has been cloned and is located in the Xp22,3 region of the X chromosome, and its coding product is a neuronal migration protein. The deletion or mutation of this gene can lead to impaired migration of GnRH neurons, resulting in insufficient LH/FSH secretion. (3) Functional: Malnutrition, excessive exercise and anorexia nervosa can cause hypothalamic dysfunction, resulting in insufficient GnRH secretion in the hypothalamus and thus LH/FSH deficiency. Mental stress can cause hypothalamic dysfunction and GHRH suppression in children, thus causing GH secretion deficiency. Various critical illnesses can reduce hypothalamic TRH production, with a consequent decrease in pituitary TSH secretion. Long-term use of glucocorticosteroids may depress hypothalamic CRH and decrease ACTH secretion.