Hypopituitarism: Difference between revisions

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* Decreased secretion of one or more of 8 hormones normally produced by the pituitary gland at the base of the brain.  
* Decreased secretion of one or more of 8 hormones normally produced by the pituitary gland at the base of the brain.  
*If there is decreased secretion of one specific pituitary hormone, the condition is known as selective hypopituitarism.
*If there is decreased secretion of one specific pituitary hormone, the condition is known as selective hypopituitarism.
*Panhypopituitarism: If there is decreased secretion of most or all hormones
**Panhypopituitarism
**Autoimmune hypophysitis




=== Signs / Symptoms ===


* The most common problem is insufficiency of FSH and/or LH leading to sex abnormalities.
=== Autoimmune hypophysitis ===
* Growth hormone deficiency is more common in people with an underlying tumor than those with other causes.
 
* It can affect Anterior or posterior part of pituitary gland
** Lymphocytic Infundibuloneurohypophysitis (LINH): Posterior pituitary is affected resulting in [[Central diabetes insipidus]].
** Lymphocytic Adenohypophysitis (LAH): Anterior pituitary gland is involved.
** In some cases, pituitary inflammation leads to interruption of dopamine flow from the hypothalamus into pituitary causing [[Prolactin|Hyperprolactinaemia]] Surprisingly HPV and HHV-6 is seen in pituitary adenoma.
 
==== LINH ====
 
* Infundibulo-neuro-hypophysitis is a rare, acquired pituitary hormone deficiency, a type of primary hypophysitis
* It is characterized by an inflammation of the posterior pituitary and the stalk.
* The major clinical manifestation is [[Central diabetes insipidus|diabetes insipidus]] with polyuria and polydipsia.
* It has also Post-Node sign / Symptoms due to pressure effect of Pituitary adenoma including nausea, vomiting, visual disturbances / dizziness
* They may have fatigue, loss of libido, amenorrhea due to 
* Mass effects on adjacent structures (e.g. optic chiasm)
 
==== LAH ====
 
* LAH occurs when the anterior pituitary cells are affected by autoimmune (Lymphocytic) inflammation resulting in
** Adrenal insufficiency (ACTH producing cells are affected)
** Hypothyroidism (TSH producing cells are damaged)
** Hypogonadism (LH and/or FSH producing cells are involved).
* Causation: [[MTB, Mycobacterium tuberculosis|MTB]] ([[Tuberculosis Hypophysitis]])
 
==== [[Prolactin|Hyperprolactinaemia]] ====


* Hyperprolactinemia inhibits the secretion of GnRH / FSH and LH results in hypogonadism.
* Hyperprolactinemia may cause
** Galactorrhea
** [[Infertility remedies|Infertility]]
** Abnormal menstrual period
** [[Hypogonadism]]
** Erectile dysfunction
** Gynecomastia


=== Autoimmune hypophysitis ===
* 17% of [[PCOD, Poly Cystic Ovarian Disease|PCOS]] have Hyperprolactinaemia
*It can lead to deficiencies in one or more pituitary hormones, causing
**Central diabetes insipidus
**Central adrenal insufficiency
**Central hypothyroidism


* Therefore Autoimmune hypophysitis could be considered as secondary Hypogonadism / Hypothyroidism / Adrenal insufficiency


=== Types ===
==== Both anterior and posterior pituitary ====
LAH can thus be classified as:
Lymphocytic infundibular panhypophysitis


# Lymphocytic adenohypophysitis
=== Signs / Symptoms ===
# Posterior pituitary: LINH (Lymphocytic infundibular neurohypophysitis)
# Both LAH and LINH may also lead to symptoms of an intracranial mass such as headache or disturbance of vision


====1- LAH: Lymphocytic adenohypophysitis====
* The most common problem is insufficiency of FSH and/or LH leading to sex abnormalities.
* Growth hormone deficiency is more common in people with an underlying tumor than those with other causes.


* It is characterized by infiltration of the pituitary stalk with lymphocytes, as the name would suggest. Importantly, there is a paucity of plasma cells or granulomas, differentiating it from IgG4-related hypophysitis and granulomatous hypophysitis (e.g. due to neurosarcoidosis) respectively.
* Most common
* It mimics a pituitary adenoma
* It is closely related to other inflammatory conditions in the region, namely orbital pseudotumor and Tolosa-Hunt syndrome.
* It has endocrine hormone deficits (Hypopituitarism)
*TSH producing cell deficit results in secondary Hypothyroidism
*ACTH producing cell  [[Adrenal insufficiency]]
*LH and/or FSH producing cells deficit results in secondary [[Hypogonadism]]
*
*Interruption of dopamine flow from hypothalamus into pituitary, causing high levels of [[Prolactin]]
*Causation: [[MTB, Mycobacterium tuberculosis|MTB]] ([[Tuberculosis Hypophysitis]])






===== Associations =====
Autoimmune conditions such as


=== Related disease ===
* [[Hashimoto thyroiditis|Autoimmune thyroiditis]]: HCV, MMP, EBV, MTB
* [[Hashimoto thyroiditis|Autoimmune thyroiditis]]: HCV, MMP, EBV, MTB
* [[Pernicious anemia]]: EBV, HCV
* [[Pernicious anemia]]: EBV, HCV
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==== 2- LINH : Lymphocytic Infundibuloneurohypophysitis====
=== Hyphophysitis & thyroiditis ===
* Rare
* occurs when the [[posterior pituitary]] is affected resulting in diabetes insipidus.
* Common symptoms include nausea, vomiting, fatigue, loss of libido, amenorrhea, and dizziness.
* Mass effects on adjacent structures (e.g. optic chiasm)
 
==== 3- Both anterior and posterior pituitary ====
Lymphocytic infundibular panhypophysitis
 


====Antibodies====
* 80% of patients with pituitary antibodies also have antibodies to thyroid gland or its hormones.
80% of patients with pituitary antibodies also have antibodies to thyroid gland or its hormones. Likewise, 20% of autoimmune thyroid patients also have pituitary antibodies. It follows that a subset of thyroid patients may have a disease related to autoimmune hypophysitis. Recent research has focused on a defect at the CTLA-4 gene which, coupled with other factors, may result in autoimmunity primarily focusing on certain endocrine glands including the pituitary and thyroid.
* Likewise, 20% of autoimmune thyroid patients also have pituitary antibodies.
* It follows that a subset of thyroid patients may have a disease related to autoimmune hypophysitis

Latest revision as of 00:06, 7 April 2023

Clinic

  • Decreased secretion of one or more of 8 hormones normally produced by the pituitary gland at the base of the brain.
  • If there is decreased secretion of one specific pituitary hormone, the condition is known as selective hypopituitarism.
    • Panhypopituitarism
    • Autoimmune hypophysitis


Autoimmune hypophysitis

  • It can affect Anterior or posterior part of pituitary gland
    • Lymphocytic Infundibuloneurohypophysitis (LINH): Posterior pituitary is affected resulting in Central diabetes insipidus.
    • Lymphocytic Adenohypophysitis (LAH): Anterior pituitary gland is involved.
    • In some cases, pituitary inflammation leads to interruption of dopamine flow from the hypothalamus into pituitary causing Hyperprolactinaemia Surprisingly HPV and HHV-6 is seen in pituitary adenoma.

LINH

  • Infundibulo-neuro-hypophysitis is a rare, acquired pituitary hormone deficiency, a type of primary hypophysitis
  • It is characterized by an inflammation of the posterior pituitary and the stalk.
  • The major clinical manifestation is diabetes insipidus with polyuria and polydipsia.
  • It has also Post-Node sign / Symptoms due to pressure effect of Pituitary adenoma including nausea, vomiting, visual disturbances / dizziness
  • They may have fatigue, loss of libido, amenorrhea due to
  • Mass effects on adjacent structures (e.g. optic chiasm)

LAH

  • LAH occurs when the anterior pituitary cells are affected by autoimmune (Lymphocytic) inflammation resulting in
    • Adrenal insufficiency (ACTH producing cells are affected)
    • Hypothyroidism (TSH producing cells are damaged)
    • Hypogonadism (LH and/or FSH producing cells are involved).
  • Causation: MTB (Tuberculosis Hypophysitis)

Hyperprolactinaemia

  • Hyperprolactinemia inhibits the secretion of GnRH / FSH and LH results in hypogonadism.
  • Hyperprolactinemia may cause
  • 17% of PCOS have Hyperprolactinaemia


Both anterior and posterior pituitary

Lymphocytic infundibular panhypophysitis

Signs / Symptoms

  • The most common problem is insufficiency of FSH and/or LH leading to sex abnormalities.
  • Growth hormone deficiency is more common in people with an underlying tumor than those with other causes.



Related disease


Hyphophysitis & thyroiditis

  • 80% of patients with pituitary antibodies also have antibodies to thyroid gland or its hormones.
  • Likewise, 20% of autoimmune thyroid patients also have pituitary antibodies.
  • It follows that a subset of thyroid patients may have a disease related to autoimmune hypophysitis
  1. ↑ CASE REPORT article Front. Endocrinol., 07 October 2020 Sec. Pituitary Endocrinology
  2. ↑ Joussen AM, Sommer C, Flechtenmacher C, Voelcker HE. Lymphocytic Hypophysitis Associated With Dacryoadenitis: An Autoimmunologically Mediated Syndrome. Arch Ophthalmol. 1999;117(7):959–962. doi:10.1001/archopht.117.7.959
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