Anterior hypopituitarism
Introduction
Introduction to anterior pituitary hypofunction The anterior pituitary dysfunction, also known as Simmonddisease, refers to a syndrome group that is secreted by the anterior pituitary gland and does not meet the needs of the human body, physiology, or stress. A series of clinical manifestations caused by insufficient secretion of anterior pituitary hormone caused by any cause are called anterior pituitary dysfunction. The disease is divided into primary and secondary types. The former is caused by pituitary secretory cell destruction. As a result, the latter is caused by hypothalamic lesions leading to the lack of stimulation of the pituitary gland, which is more common in the clinic. basic knowledge The proportion of illness: 0.003% Susceptible people: no specific people Mode of infection: non-infectious Complications: hypoglycemia
Cause
Causes of anterior pituitary hypofunction
1. Ischemic necrosis of the anterior pituitary is caused by postpartum pituitary necrosis, which is called Sheehan syndrome. Diabetic microangiopathy can also occur in pituitary ischemic infarction.
2. Pituitary and hypothalamic tumors.
3. Pituitary invasive disease leukemia, sarcoidosis and so on.
4. Autoimmune pituitary inflammation.
5. Other radiation therapy and chemotherapy; pituitary resection; pituitary abscess, tuberculosis, encephalitis, skull base meningitis and other infectious diseases; empty sella syndrome (rare).
6. Idiopathic is mostly a single hormone deficiency.
Prevention
Prevention of anterior pituitary hypofunction
Actively treat various primary diseases, remove predisposing factors, and prevent infection. For Xi'an syndrome, pay attention to prenatal examination, preparation for childbirth, and prevent the occurrence of postpartum hemorrhage, which can effectively reduce the occurrence of Xi'an syndrome.
Complication
Anterior pituitary hypofunction complication Complications
Patients often have hypoglycemia reactions, and at the same time, often with adrenal insufficiency, peripheral circulatory failure due to insufficient secretion of corticosteroids.
Symptom
Pituitary anterior hypofunction symptoms common symptoms coma cortisol deficiency postpartum pituitary necrosis blood pressure drop appetite loss cortical dysfunction dizziness chills hypoglycemia expression indifference
symptom:
1. There are primary causes of infection: such as postpartum hemorrhage, pituitary tumor, pituitary surgery or radiation therapy, craniocerebral trauma, infection or inflammation (tuberculosis, syphilis, meningoencephalitis), systemic disease (leukemia, lymphoma, cerebral artery) Hardening, malnutrition) and immune pituitary inflammation.
2. Gonadotropin and prolactin secretion deficiency group: postpartum no milk, amenorrhea, yin, sputum, eyebrows shedding, sparse (male beard scarce), loss of libido, disappearance, external genital atrophy, uterus, breast atrophy (male impotence , testicles, prostate atrophy).
3. Thyroid-stimulating hormone deficiency group: less gas lazy words, indifferent expression, mental decline, slow movement, loss of appetite, chills, less sweat, dry skin, facial swelling, yellow, and even mucous edema.
4. Adrenocortical hormone deficiency group: dizziness, weakness, nausea, vomiting, abdominal pain, diarrhea, weight loss, blood pressure drop, easy infection and syncope and even shock, coma.
5. Pituitary crisis; if there are various kinds of stress, infection, surgery, trauma, mental stimulation, digestive tract diseases, certain drugs (sedation, anesthetics and hypoglycemic drugs, etc.) can aggravate the primary disease and induce crisis occur.
Examine
Examination of anterior pituitary hypofunction
1. Endocrine function measurement:
It shows that the pituitary hormone and the corresponding target gland hormone are simultaneously reduced, (1) the target gland hormone and its metabolites are decreased in the blood (T3, T4, FT3, FT4, TSH, ACTH, P, T, E2, FSH, LH); 2) After several days of continuous excitatory use of pituitary hormone (TSH, CTH, LH), the target gland hormone gradually increased, showing a delayed response, which can be differentiated from primary target gland hypofunction, and (3) TRH, CRH, LHRH stimulation test did not respond.
2. Sella X-ray:
Sella enlargement can be seen in hypothalamic or pituitary tumors. The microadenomas have no enlargement but can have localized destruction. CT or MRI can help further diagnosis.
an examination:
1. Hypoglycemia, a low glucose tolerance curve, or a reactive hypoglycemia curve, which is abnormally sensitive to insulin.
2. Plasma anterior pituitary hormones such as growth hormone (GH), prolactin (PRL), thyroid stimulating hormone (TSH), adrenocorticotropic hormone (ACTH), follicle stimulating hormone (FSH), luteinizing hormone (LH) The levels were low, and the pituitary gland did not respond or responded slightly to the stimulation of the hypothalamic release hormone (such as TRH, LHRH stimulation test).
3. secondary gonads, thyroid, adrenal insufficiency, serum testosterone, estradiol, thyroid hormone, cortisol levels, but delayed response to the corresponding exogenous pituitary stimulating hormone (such as ACTH stimulation test) .
Diagnosis
Diagnosis and differentiation of anterior pituitary hypofunction
diagnosis
Diagnosis can be based on medical history, clinical symptoms, and laboratory tests.
Differential diagnosis
Should be associated with anorexia nervosa and target gland function, long-term primary hypothyroidism can also cause TSH cell proliferation and pituitary enlargement, do not mistaken pituitary tumor caused by pituitary hypofunction.
