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The pituitary and hypopituitarism 

The pituitary and hypopituitarism
The pituitary and hypopituitarism

Gary Butler

and Jeremy Kirk

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date: 13 June 2021

The pituitary is formed of two anatomically and embryologically distinct lobes:

anterior pituitary: which secretes growth hormone (GH), gonadotropins (luteinizing hormone (LH) and follicle-stimulating hormone (FSH)), adrenocorticotropic hormone (ACTH), thyroid-stimulating hormone (TSH), and prolactin

posterior pituitary: which secretes vasopressin and oxytocin.

Hypopituitarism is deficiency of one or more pituitary hormones. Some hormones, e.g. GH (LH/FSH), are more likely to present with isolated deficiencies, while others, e.g. TSH, ACTH, are more often found as part of multiple pituitary hormone deficiency (MPHD).

Deficiencies may be congenital (including genetic) or acquired; secondary to tumour, trauma, infiltration, infection, or irradiation.

GH deficiency:

diagnosed using a combination of clinical, radiological, and biochemical assessment (including GH stimulation testing)

treatment is with GH (including if necessary into adulthood).

LH/FSH deficiency:

If acquired, often one of the first anterior pituitary hormones to be lost.

Congenital forms:

present with cryptorchidism and/or micropenis in males

may occur in isolation, or in association with anosmia (Kallmann and CHARGE syndromes).

Treatment: sex steroid therapy to induce secondary sexual characteristics, and recombinant FSH/LH to induce fertility potential.

ACTH deficiency:

Unlike primary adrenal problems, hyperpigmentation does not occur.

Although mineralocorticoid production is preserved, hyponatraemia may still occur.

Treatment is with hydrocortisone.

TSH deficiency:

TSH may be low, normal, or raised (but inappropriate for free thyroxine level).

Treatment is with thyroxine.

Vasopressin deficiency:

produces cranial diabetes insipidus

treatment is with DDAVP (orally or nasally).

Prolactin and oxytocin deficiency rarely produce clinical problems.

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