HYPOPITUITARISM

Etiology
1. Congenital hypothalamic
  Deficiencies of GnRH,TRH,GHRH,CRF.
2. Acquired hypothalamic
  Craniopharyngioma,sarcoidosis,TB,radiotherapy,tumours.
3. Pituitary
  P.adenoma,post partum necrosis,hemorrhage,autoimmune surgery,radiotherapy.

C/f
-GH Deficiency:early to occur bt no significant symptoms in adults.
-LH Defi. leads to loss of libido,impotence in males and oligo or amenorrhoea in females.there may b gynecomartia.axillary n pubic hairs become sparse.
-ACTH defi. Leads to cortisol def. resulting in symptoms and signs of adrenal insufficiency with skin pallor due to lack of melanin.
-TSH def.leads to symptoms and signs of secondary hypothyroidism.
-PRL def. Failure of lactation.
-ultimately the patient goes into coma.

Lab investigations
-low free thyroxine with low or normal TSH.
-low early morning cortisol wid low ACTH.
-low testosterone without elevation of gonadotropins.

Management
-ACTH deficiency is treated with cortisol 20mg in the morning and 10mg in the evening or prednisolone 5mg in the morning and 2.5mg in the evening.doses should be at least doubled during acute illnesses and administered without delay by intra muscular or iv injections in patients who are vomiting.
-TSH def is treated wid thyroxine 0.1 to 0.15 mg daily.
-gonadotropin def. Is treated wid sex hormone replacement