Hypopituitarism Classification and external resources
ICD-10	E23.0, E89.3
ICD-9	253.7
DiseasesDB	6522
eMedicine	emerg/277  med/1137 ped/1130
MeSH	D007018

Hypopituitarism is a medical term describing the deficiency (hypo) of one or more hormones of the pituitary gland. The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify Diseases The International Statistical Classification of Diseases and Related Health Problems 10th Revision ( ICD -10) is a coding of diseases and signs symptoms abnormal findings E00-E35 - Endocrine diseases (E00-E07 Thyroid gland / Thyroid hormone ( Congenital iodine-deficiency syndrome ( E00-E35 - Endocrine diseases (E00-E07 Thyroid gland / Thyroid hormone ( Congenital iodine-deficiency syndrome ( The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify Diseases The following is a list of codes for International Statistical Classification of Diseases and Related Health Problems. The Diseases Database is a free Website that provides information about the relationships between medical conditions Symptoms, and Medications. eMedicine is an online clinical medical knowledge base that was founded in 1996 by Scott Plantz and Richard Lavely two medical doctors Medical Subject Headings ( MeSH) is a huge Controlled vocabulary (or metadata system for the purpose of indexing journal articles and books Hormones (from Greek ὁρμή - "impetus" are chemicals released by cells that affect cells in other parts of the body The pituitary gland, or hypophysis, is an Endocrine gland about the size of a Pea. The hypothalamus regulates pituitary secretion by the production of releasing hormones and posterior pituitary hormones and hence its dysfunction can also lead to hypopituitarism. The hypothalamus links the Nervous system to the Endocrine system via the Pituitary gland (hypophysis The posterior pituitary (or neurohypophysis) comprises the Posterior lobe of the Pituitary gland and is part of the Endocrine system.

In endocrinology, deficiency of one or multiple hormones of the anterior pituitary is generally referred to as hypopituitarism, while deficiency of the posterior lobe generally only leads to central diabetes insipidus. Endocrinology (from Greek grc ἔνδον endon, "within" grc κρῑνω krīnō, "to separate" and grc -λογία The anterior pituitary (also called the adenohypophysis, from Greek adeno, "gland" hypo, "under" physis, "growth" Diabetes insipidus ( DI) is a condition characterized by excretion of large amounts of severely diluted Urine, which cannot be reduced when fluid intake Diabetes insipidus ( DI) is a condition characterized by excretion of large amounts of severely diluted Urine, which cannot be reduced when fluid intake The deficiency of all anterior pituitary hormones is termed panhypopituitarism. The anterior pituitary (also called the adenohypophysis, from Greek adeno, "gland" hypo, "under" physis, "growth"

Contents 1 Physiology 2 Multiple hormone deficiencies 3 Causes 4 Diagnosis 5 Replacement therapy 6 See also 7 External links

Physiology

The hormones of the anterior pituitary include 2 proteins, 3 glycoproteins and a polypeptide:

1. prolactin (PRL) - stimulates milk production in the breast
2. growth hormone (GH) - growth and glucose homeostasis
3. luteinizing hormone (LH) - menstrual cycle and reproduction
4. follicle stimulating hormone (FSH) - same
5. thyroid stimulating hormone (TSH) - stimulates thyroxine production in the thyroid
6. adrenocorticotropic hormone (ACTH) - stimulates glucocorticoid production in the adrenal gland

These hormones are secreted in individually characteristic pulsatile patterns, often with distinct circadian rhythm, rather than at steady rates throughout 24 hours. Proteins are large Organic compounds made of Amino acids arranged in a linear chain and joined together by Peptide bonds between the Carboxyl Not to be confused with Peptidoglycan. Glycoproteins are proteins that contain Oligosaccharide chains ( Glycans) covalently attached Prolactin ( PRL) or Luteotropic hormone ( LTH) is a Peptide hormone primarily associated with Lactation. Milk is an opaque white liquid produced by the Mammary glands of female Mammals (including Monotremes. The breast is the upper Ventral region of an animal’s Torso, particularly that of Mammals including Human beings. Growth hormone ( GH) is a Peptide hormone that stimulates growth and cell reproduction in humans and other animals Glucose (Glc a Monosaccharide (or simple Sugar) also known as grape sugar, is an important Carbohydrate in Biology. Luteinizing hormone ( LH, also known as lutropin) is a Hormone produced by the Anterior pituitary gland. The menstrual cycle is a recurring cycle of physiologic changes that occurs in reproductive-age Females Overt menstruation (where there is blood flow from the Follicle-stimulating hormone ( FSH) is a Hormone synthesized and secreted by Gonadotropes in the Anterior pituitary gland. Thyroid-stimulating hormone (also known as TSH or thyrotropin) is a Peptide hormone synthesized and secreted by Thyrotrope cells in the Thyroxine, or 353'5'-tetra­iodothyronine (often abbreviated as T4) a form of Thyroid hormones is the major Hormone secreted by the The thyroid is one of the largest Endocrine glands in the body Adrenocorticotropic hormone ( ACTH or corticotropin) is a Polypeptide Hormone produced and secreted by the Pituitary gland Glucocorticoids (GC are a class of Steroid hormones characterised by an ability to bind with the glucocorticoid receptor ( GR) and trigger similar effects In Mammals the adrenal glands (also known as suprarenal glands) are the triangle-shaped Endocrine glands that sit on top of the Kidneys their

The posterior pituitary is the site of release of the nonapeptide hormones antidiuretic hormone (ADH) and oxytocin, the former regulating plasma osmolarity and the latter regulating uterine contractions during childbirth as well milk ejection from the breasts. Arginine vasopressin ( AVP) also known as vasopressin, argipressin or antidiuretic hormone ( ADH) is a Hormone found in Oxytocin ( IPA: /ˌɔksɪˈtoʊsɪn/ (Greek "quick birth" is a Mammalian Hormone that also acts as a Neurotransmitter in the Osmolarity is a measure of the osmoles of solute per Liter of solution while the osmolality is a measure of the osmoles of Solute per Kilogram The uterus (from the Latin word for womb) is the major Female reproductive organ of most Mammals including Humans One end the In Medicine ( Obstetrics) a contraction is a forceful and painful motion of the Uterus as part of the process of Childbirth. Childbirth (also called labour, birth, partus or parturition) is the culmination of a Human Pregnancy or

Multiple hormone deficiencies

Deficiency of a single pituitary hormone occurs less commonly than deficiency of more than one hormone. Sometimes referred to as progressive pituitary hormone deficiency or partial hypopituitarism, there is usually a predictable order of hormone loss.

Generally, growth hormone is lost first, then luteinizing hormone deficiency follows. The loss of follicle-stimulating hormone, thyroid stimulating hormone, adrenocorticotopic hormones and prolactin typically follow much later. The progressive loss of pituitary hormone secretion is usually a slow process, which can occur over a period of months or years. Hypopituitarism does occasionally start suddenly with rapid onset of symptoms

Most people with hypopituitarism lack growth hormone as well as one or more others. As for the posterior pituitary, antidiuretic hormone deficiency is the main problem, while oxytocin deficiency rarely causes clinically significant problems.

Causes

Hypopituitarism and panhypopituitarism can be congenital or acquired. A partial list of causes and forms:

• Congenital hypopituitarism
  • Hypoplasia of the pituitary
    • Isolated idiopathic congenital hypopituitarism
    • Associated with other congenital syndromes and birth defects
      • Septo-optic dysplasia
      • Holoprosencephaly
      • Chromosome 22 deletion syndrome
      • Rapaport syndrome
  • Single gene defect forms of anterior pituitary hormone deficiency
• Acquired hypopituitarism (Simmonds' disease)
  • trauma (e. In Medicine and Psychology, the term syndrome refers to the association of several clinically recognizable features signs (observed by a physician A congenital disorder is a disease or disorder that is present at birth Septo-optic dysplasia (SOD also known as de Morsier syndrome is a congenital malformation Syndrome manifested by hypoplasia (underdevelopment Holoprosencephaly is a type of Cephalic disorder. This is a disorder characterized by the failure of the Prosencephalon (the Forebrain of the Embryo 22q112 deletion syndrome, also known as Velocardiofacial Syndrome DiGeorge Syndrome conotruncal anomaly face syndrome Congenital Thymic Aplasia and Strong Syndrome is a disorder caused Treatment of physical trauma is described here and in First aid. g. , skull base fracture)
  • surgery (e. Surgery (from the χειρουργική cheirourgikē, via chirurgiae meaning "hand work" is a medical specialty that uses operative manual and instrumental g. , removal of pituitary neoplasm)
  • tumor - secretory and non-secretory (20%) pituitary or hypothalamic neoplasms, cause hypopituitarism by compressing the remaining tissue
  • inflammation (e. See also Cancer A tumor or tumour is the name for a swelling or lesion formed by an abnormal growth of cells (termed neoplastic Pituitary adenomas are Tumors that occur in the Pituitary gland, and account for about 10% of intracranial neoplasms. Inflammation ( Latin, inflamatio, to set on fire is the complex biological response of vascular tissues to harmful stimuli such as Pathogens g. sarcoidosis or autoimmune hypophysitis)
  • radiation (e. Sarcoidosis, also called sarcoid (from the Greek sarx, meaning "flesh" or Besnier-Boeck disease, is an immune system disorder characterized Autoimmune Hypophysitis is defined as below normal production of one or more hormones by the Pituitary gland due to Autoimmunity. Radiation, as in Physics, is Energy in the form of waves or moving Subatomic particles emitted by an atom or other body as it changes from a higher energy g. , after cranial irradiation for childhood leukemia)
  • shock
    • (Sheehan's syndrome occurring after heavy postpartum hemorrhage in childbirth and the resulting pituitarynecrosis)
  • hemochromatosis
• other diseases. Leukemia or leukaemia (Greek leukos λευκός, "white" aima αίμα, "blood" is a Cancer of the Blood Sheehan syndrome, also known as postpartum hypopituitarism or postpartum pituitary necrosis, is Hypopituitarism (decreased functioning of the Pituitary Obstetrical hemorrhage refers to heavy bleeding during Pregnancy, labor, or the Puerperium. Childbirth (also called labour, birth, partus or parturition) is the culmination of a Human Pregnancy or Necrosis (in Greek Νεκρός = "dead" is the name given to unnatural Death of cells and living tissue. Haemochromatosis, also spelled hemochromatosis (see spelling differences) also called siderophilia

Diagnosis

Hypopituitarism may come to medical attention by symptoms or features of pituitary hormone deficiency (e. g. , poor growth, hypoglycemia, micropenis, delayed puberty, polyuria, impaired libido, fatigue, and many others), or because the physician has diagnosed one of the many disorders and conditions associated with hypopituitarism listed above and tests for it. Hypoglycemia or hypoglycaemia is the medical term for a pathologic state produced by a lower than normal level of Glucose ( sugar) in the blood Micropenis is a medical term that describes an unusually small Penis. Puberty is described as delayed when a boy or girl has passed the usual age of onset of Puberty with no physical or hormonal signs that it is beginning In Medicine, polyuria is a condition characterized by the passage of large volumes of urine (at least 2 Sexual dysfunction or sexual malfunction (see also Sexual function) is difficulty during any stage of the Sexual act (which includes desire, A provocative test (triple bolus test) measures the secretory response of the pituitary to a stimulus (other hormones, drugs, exercise, etc. A triple bolus test or a dynamic pituitary function test is a medical diagnostic procedure used to assess a patient's Pituitary function ) by measuring serum levels of the hormone involved.

Replacement therapy

Hypopituitarism and panhypopituitarism are treated by replacement of appropriate hormones. Since most of the anterior pituitary hormones are proteins or glycoproteins released in pulsatile patterns, whose functions are to induce secretion of smaller molecule hormones (thyroid hormones and steroids), it is simpler and less expensive for most purposes to simply replace the target gland hormones. Proteins are large Organic compounds made of Amino acids arranged in a linear chain and joined together by Peptide bonds between the Carboxyl Not to be confused with Peptidoglycan. Glycoproteins are proteins that contain Oligosaccharide chains ( Glycans) covalently attached The thyroid is one of the largest Endocrine glands in the body A steroid is a Terpenoid Lipid characterized by a Carbon skeleton with four fused rings generally arranged in a 6-6-6-5 fashion There are a few exceptions, such as fertility induction.

• GH is replaced with growth hormone. Growth hormone ( GH) is a Peptide hormone that stimulates growth and cell reproduction in humans and other animals Growth hormone (GH is a protein Hormone secreted by the Pituitary gland which stimulates growth and cell reproduction
• TSH is replaced with thyroxine. Thyroxine, or 353'5'-tetra­iodothyronine (often abbreviated as T4) a form of Thyroid hormones is the major Hormone secreted by the
• ACTH is usually replaced with hydrocortisone but any glucocorticoid may be used. Cortisol is a Corticosteroid Hormone produced by the Adrenal gland (in the Zona fasciculata of the Adrenal cortex) Glucocorticoids (GC are a class of Steroid hormones characterised by an ability to bind with the glucocorticoid receptor ( GR) and trigger similar effects
• LH and FSH are most often replaced by supplying the appropriate sex steroids (e. Sex steroids, also known as gonadal steroids, are Steroid hormones that interact with Vertebrate Androgen or Estrogen receptors g. , testosterone or estrogen and progestin). Testosterone is a Steroid hormone from the Androgen group In mammals testosterone is primarily secreted in the testes of males and the Ovaries Estrogens (US otherwise oestrogens or œstrogens) are a group of Steroid compounds named for their importance in the Estrous cycle, A progestin is a synthetic progestagen that has progestinic effects similar to Progesterone. Virtually all people who need T or E2 replacement for hypopituitarism rarely have spontaneous, effective spermatogenesis or follicular maturation. Spermatogenesis is the process by which male Spermatogonia develop into mature Spermatozoa. Ovarian follicle is the basic unit of female reproductive biology and is composed of a roughly spherical aggregations of cells found in the Ovary. Both GnRH by subcutaneous pump and gonadotropins (Pergonal) by daily subcutaneous injections have been used effectively to induce fertility. Gonadotropin-releasing hormone ( GNRH) also known as Luteinizing-hormone releasing hormone ( LHRH) is a tropic Peptide Hormone Gonadotropins are Protein Hormones secreted by Gonadotrope cells of the Pituitary gland of Vertebrates Gonadotropin is sometimes Female infertility|Male infertility Infertility primarily refers to the biological inability of a Man or a Woman to contribute to conception.
• Prolactin is not usually replaced, as infant formula is readily available, simpler, and much cheaper. Infant formula is an artificial substitute for human Breast milk, designed for Infant consumption
• ADH is replaced most commonly with oral, nasal, and sometimes intravenous or subcutaneous desmopressin. Desmopressin (trade names DDAVP, Stimate, Minirin) is a Synthetic replacement for antidiuretic hormone, the Hormone that
• Oxytocin is most important during labor and delivery at the end of pregnancy, and can be replaced in that circumstance by synthetic oxytocin. Oxytocin ( IPA: /ˌɔksɪˈtoʊsɪn/ (Greek "quick birth" is a Mammalian Hormone that also acts as a Neurotransmitter in the Oxytocin ( IPA: /ˌɔksɪˈtoʊsɪn/ (Greek "quick birth" is a Mammalian Hormone that also acts as a Neurotransmitter in the
• It has recently been shown that there is a decreased risk of nonfatal stroke in both genders and of nonfatal cardiac events in GHD men due to the larger prescription of cardioprotective drugs and to 6 years of GH-replacement. The increased prevalence of T2DM in GHD women can be partly attributed to a higher body mass and to decreased physical activity. [1]

See also

• growth hormone deficiency
• pituitary gland
• Kallmann syndrome
• Empty sella syndrome
• Insulin tolerance test

External links

• All about Hypopituitarism

Growth Hormone Deficiency is the medical condition of inadequate production of Growth hormone (GH and it effects on children and adults The pituitary gland, or hypophysis, is an Endocrine gland about the size of a Pea. Kallmann syndrome is an example of Hypogonadism (decreased functioning of the sex hormone-producing glands caused by a deficiency of Gonadotropin-releasing hormone Empty sella syndrome (abbreviated ESS) is a disorder that involves the Sella turcica, a bony structure at the base of the brain that surrounds and protects the An insulin tolerance test ( ITT) is a medical diagnostic procedure during which Insulin is injected into a patient's vein to assess Pituitary function

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