OVERVIEW
Overview
Adult total hypopituitarism is a disease caused by the loss of hormone secretion from the pituitary gland, and is a common clinical endocrine disease. Its clinical manifestations are related to age of onset, gender, type of hormone involved and degree of impairment, and the pathologic nature of the primary disease.
Whether medical insurance
Yes
Department
Endocrinology, Neurology
Clinical symptoms
Fatigue, low blood pressure, confusion, fear of cold, weight gain, cleft lip or palate, color blindness, loss of sense of smell, male impotence, female amenorrhea, etc.
Harm
Insufficient secretion of any one or more of the hormones secreted by the pituitary gland will cause dysfunction of the corresponding target glands, seriously affecting their regulatory role in the body.
Tests
Gonadal function test, thyroid function test, adrenal cortex function test, pituitary hormone test, pituitary reserve function test, X-ray, CT, MRI, etc.
Diagnosis
Diagnosis is made on the basis of medical history and clinical manifestations, as well as adenopituitary hormone measurements and pituitary reserve function measurements.
Treatment principle
Etiologic treatment, hormone replacement therapy.
Curability
The treatment effect varies depending on the cause of the disease. Symptoms can be relieved after treatment. If the disease is effectively treated at an early stage, better recovery can be achieved.
Dietary advice
Eat high-calorie, high-protein, vitamin-rich, light and easy-to-digest foods.
Causes
Causes
Caused by traumatic brain injury, after surgical treatment or radiation therapy of the pituitary gland, or by non-secretory pituitary tumors, metastatic tumors, pituitary infarction, pituitary stroke, lymphocytic pituitary inflammation and other diseases.
Symptoms and Diagnosis
Typical symptoms
Most cases have an insidious onset and variable symptoms.1. Adrenocorticotropic hormone deficiency (ACTH) alone is clinically rare. It can lead to hypoadrenalism, fatigue, hypotension, hypoglycemia, and a lack of tolerance to stress (e.g., major surgery, trauma, infections, etc.).2 In premenopausal women, deficiency of gonadotropins (luteinizing hormone and follicle-stimulating hormone) can lead to amenorrhea, infertility, vaginal dryness, and deterioration of some of the female sexual characteristics.3 In gonadotropin-deficient males, impotence, atrophy of the testes, and a decrease in spermatogenesis may occur, resulting in Impotence, testicular atrophy, and decreased sperm production in gonadotropin-deficient men, leading to infertility and degeneration of male sexual characteristics. Gonadotropin deficiency is also seen in Kalman syndrome, which often presents with cleft lip or palate, color blindness, and loss of sense of smell.4. Thyroid stimulating hormone deficiency causes hypothyroidism, which is characterized by confusion, fear of cold, weight gain, constipation, and dry skin.
Diagnostic basis
History of traumatic brain injury, pituitary surgery or radiation therapy, non-secretory pituitary tumors, metastatic tumors, etc. 2. Fatigue, hypotension, blurred consciousness, fear of cold, weight gain, cleft lip or palate, color blindness, and loss of sense of smell, etc. 3. If the level of target gland hormones decreases and the level of pituitary thyroid stimulating hormones is normal or decreases, it can be diagnosed as hypopituitary hypopituitarism. 4. Hypopituitarism caused by lesions of hypothalamus and pituitary stalks. Hypopituitarism is often associated with mild to moderate elevation of serum prolactin levels and uremia.
Treatment
Treatment guidelines
Treatment of primary disease, target gland hormone replacement therapy.
Drug therapy
Target gland hormone replacement therapy for total hypopituitarism.1. Hypoadrenocorticotropic hypopituitarism should be corrected by firstly correcting the hypoadrenocorticism. Hydrocortisone or prednisone may be used.2 Thyrotropin deficiency is treated with levothyroxine sodium replacement to keep T4 in the middle or upper end of the normal range.3 Luteinizing hormone/follicle-stimulating hormone deficiency secondary to hypogonadotropic hypogonadism is treated with the goal of restoring fertility after sex hormone replacement.4 Hypothalamic-pituitary abnormalities in females may be treated with clomiphene to stimulate pituitary gonadotropin secretion and restore ovulation.5 Hypopituitary abnormalities in males may be treated with clomiphene to restore ovulation. In men, hypopituitarism can be treated with human chorionic gonadotropin alone to restore sex hormones and fertility.
Radiotherapy
If a large tumor spreads to the saddle, and complete resection of the tumor is not possible via the forehead or into the butterfly, ultrahigh-pressure radiotherapy can be used.
Surgical treatment
1. Transsphenoidal surgery can remove early detected microadenomas.2. Transsphenoidal surgery for hyperprolactinemia, although not poorly treated, still has the possibility of recurrence.3. Pituitary strokes, such as visual field disorders or sudden paralysis of the motor nerve, or drowsiness that progresses to unconsciousness due to hypothalamic compression, should be treated surgically immediately. Although high-dose corticosteroid medical treatment and general supportive therapy are effective in some cases, routine inlet pterygoid decompression should be performed immediately because it is a hemorrhagic tumor.
Prognosis
The prognosis varies depending on the etiology. Symptoms are mostly relieved with treatment. Better recovery can be achieved if the disease is effectively treated early.
Nursing care
Daily care
1. Indoor temperature and humidity should be appropriate, temperature 18 ~ 24 ℃, humidity 50% ~ 60%. 2. Pay attention to open windows and ventilation, keep warm to prevent infection. 3. Ensure sufficient sleep. 4. Appropriate activities, to the extent that there is no panic, discomfort. 5. Promptly channeling the patient’s anxiety, fear, depression, etc., caring, thoughtfulness, respect for the patient. 6. Patients with adrenal hyperalgesia should be washed with lukewarm water to keep the skin clean. 7. 7. Follow the doctor’s instructions to take medication correctly and observe the adverse drug reactions carefully. 8. Seek medical advice immediately when signs of pituitary crisis appear, such as infection, fever, trauma, diarrhea, vomiting, headache, etc.
Dietary management
Eat high-calorie, high-protein, vitamin-rich, light and easy-to-digest food, eat fresh vegetables and fruits as appropriate to ensure dietary fiber intake.