HYPOPITUITARISM

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 Case scenario:

                         We present a 15-year-old boy, the second of a set of twins, who presented with short stature and delayed puberty. A subtle difference in stature was noticed on review of their childhood pictures by 2 years of age through the disparity in stature became obvious to the parents at 6 years of age and it became embarrassing at 15 years of age when parents decided to seek medical attention. He was a product of term gestation with a birth weight of 3.2kg; there was no history suggestive of birth trauma. A developmental milestone in the first two years of life was essentially normal like his unaffected twin brother. At presentation both height and weight were below 3rd percentile for age, he had a low blood pressure of 80/50mmHg, infantile male external genitalia with the testicular volume of 2ml, bone age of 7 years, very low serum testosterone, growth hormone, adrenocorticotropic hormone, thyroxine, follicle-stimulating hormone, luteinizing hormone, Cortisol and high thyroid-stimulating hormone. He achieved remarkable improvement in physical activity, height, weight, and hormonal profile within the first 7 months of hormone replacement therapy but could not sustain therapy because of financial constraints.

Introduction:

                    Hypopituitarism is a rare disorder in which the pituitary gland fails to produce one hormone or more hormones, or doesn't produce enough hormones.

Epidemiology:

                    On a global basis, the incidence is estimated to be 4.2 cases per 100,000 per year, and the prevalence is approximately 45.5 cases every 100,000 cases per year.

Causes: 

  1. A tumor compressing the parathyroid gland.
  2. Head injuries
  3. Radiation treatment to the head or neck
  4. Lack of blood flow to the pituitary gland or bleeding into the brain or pituitary gland.
  5. Certain medications, such as narcotics, high-dose corticosteroids, or certain cancer drugs called checkpoint inhibitors
  6. Inflammation of the pituitary gland is caused by an abnormal immune system response.
  7. Infections of the brain such as meningitis, or infections that can spread to the brain, such as tuberculosis and syphilis.
  8.  Severe loss of blood during childbirth may cause damage to the frontal part of the pituitary gland.    

 Symptoms:

            The symptoms of the pituitary gland are mainly related to the secretions of the pituitary gland and in the following are written the symptoms that will develop if the hormone is deficient.

Growth Hormone deficiency:

  1. Fatigue
  2. Muscle Weakness
  3. Changes in body fat consumption
  4. Lack of ambition
  5. Social isolation

Gonadotropin Deficency: 

                                         Women may have symptoms like
  1. Hot Flashes
  2. Irregular or no periods
  3. Loss of pubic hair
  4. An inability to produce milk while breastfeeding
Men may have symptoms like
  1. Erectile dysfunction
  2. Decreased facial or body hair
  3. Mood Changes

Thyroid-stimulating hormone deficiency:

  1. Fatigue
  2. Weight Gain
  3. Dry Skin
  4. Constipation
  5. Sensitivity to cold or difficulty staying warm

Adrenocorticotrophic hormone deficiency: 

  1. Severe Fatigue
  2. Low blood pressure
  3. Frequent and prolonged infections
  4. Nausea, Vomiting, or abdominal pain
  5. Confusion

Anti-diuretic hormone deficiency:

  1. Excessive urination
  2. Extreme Thirst
  3. Electrolyte imbalances

Complications: 

  1. Adrenal crisis 
  2. Osteoporosis
  3. Electrolyte abnormalities
  4. Diabetes Mellitus

Diagnosis:

                The diagnosis for hypopituitarism is made by measuring basal hormone levels in the morning fasting status or performing stimulation tests if necessary.

Management:

  1. Corticosteroids
  2. Levothyroxine
  3. Sex Hormones
  4. Growth hormone
  5. Fertility hormone

References and citations:

  1. Case Scenario was taken from the NCBI website; The URL is https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7757318/
  2. The Introduction was taken by the endocrine society; Their URL is https://www.endocrine.org/patient-engagement/endocrine-library/hypopituitarism#:~:text=Hypopituitarism%20(also%20called%20pituitary%20insufficiency,or%20even%20over%20several%20years.
  3.  The Epidemiology is from an article from the News medical life sciences written by Yolanda Smith, B.Pharm; The URL to the article is https://www.news-medical.net/health/Hypopituitarism-Epidemiology.aspx#:~:text=Hypopituitarism%20is%20considered%20to%20be,cases%20per%20100%20000%20people.
  4. The Causes and symptoms are from mayo clinic; The URL of the website is https://www.mayoclinic.org/diseases-conditions/hypopituitarism/symptoms-causes/syc-20351645
  5. The Complications are from wikidoc; The URL of this website is https://www.wikidoc.org/index.php/Hypopituitarism_natural_history,_complications_and_prognosis#:~:text=Complications%20of%20hypopituitarism%20include%20adrenal,replacement%20therapy%20is%20given%20adequately. 
  6. The Diagnosis is from NCBI; The URL of this website is https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4722397/#:~:text=The%20diagnosis%20of%20hypopituitarism%20is,sensitive%20and%20reliable%20immunoassay%20techniques. 
  7. The Management is from Mayoclinic; The URL is https://www.mayoclinic.org/diseases-conditions/hypopituitarism/diagnosis-treatment/drc-20351648
                                                                                                                                                                                                        
                                                                                        
                                                   

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