Pituitary dysfunction

Introduction The pituitary gland is the most important endocrine gland in the human body, divided into two parts: the anterior lobe and the posterior lobe. It secretes a variety of hormones, such as growth hormone, thyroid stimulating hormone, adrenocorticotropic hormone, gonadotropin, oxytocin, prolactin, black cell stimulating hormone, etc., and also stores antidiuretic hormone secreted by the hypothalamus. These hormones play an important role in metabolism, growth, development and reproduction. The cause of pituitary dysfunction is called the primary pituitary dysfunction in the pituitary, and the secondary pituitary dysfunction in the hypothalamus.

Cause

The following types of diseases that cause dysfunction of pituitary hormone secretion:

1. Hyperfunction of the anterior pituitary:

1 hormone secreting pituitary adenoma. At present, it is inconclusive whether the pituitary adenoma is caused by hypothalamic hormone secretion dysfunction or pituitary spontaneous tumor.

2 pituitary hyperplasia. Ectopic tumors that secrete hormones released from the hypothalamus can cause diffuse and/or nodular hyperplasia of the pituitary gland and secrete excessive pituitary hormones. Common ectopic tumors include bronchial adenoma, lung cancer, thymic cancer, and islet cell tumor.

2, anterior pituitary dysfunction:

1 pituitary ischemic infarction.

2 pituitary and hypothalamic tumors. Direct compression of the pituitary or indirect blockage of the pituitary portal blood flow caused by anterior pituitary dysfunction, common in adults with non-functional pituitary tumors and children with craniopharyngioma.

3 pituitary and hypothalamic dysplasia.

4 autoimmune diseases.

5 infection. Very little affecting the pituitary. Viral encephalitis can affect the production of pituitary hormones in the hypothalamus and the delivery to the pituitary. Pituitary abscesses, tuberculosis, and syphilis can directly destroy the pituitary gland.

6 granuloma infiltration. Non-infectious granuloma can infiltrate the hypothalamus and pituitary gland, such as histiocytosis in children and carcinoid in adults, often with diabetes insipidus and anterior pituitary dysfunction.

7 systemic diseases. Leukemia, lymphoma, xanthoma, sarcoidosis, hemochromatosis, etc. can infiltrate the hypothalamus and pituitary.

8 pituitary destruction.

an examination

Related inspection

CT examination of pituitary CT examination of arginine growth hormone glucose inhibition growth hormone test

The judgment of the secretion function of the anterior pituitary cells is mainly based on:

1 clinical manifestations of excessive or too little secretion of pituitary hormones and its caused by water, salt and substance metabolism disorders.

2 Determination of blood levels of hormones in the pituitary gland (thyroid, adrenal cortex, gonad) and dynamic function test.

3 Determination of blood levels of anterior pituitary hormone and dynamic function test.

4 imaging (X-ray, CT, magnetic resonance) positioning examination.

5 venous catheter blood sampling to determine the level of hormones. If the venous catheter is inserted into the lower vein to measure the ACTH level, assist in determining whether the ACTH microadenomas are located on the left or right side.

Differential diagnosis

Pituitary dysfunction needs to be identified as follows:

1. The pituitary itself is destroyed or stressed syndrome: the secretion of hormones in the pituitary is reduced, causing the corresponding target gland to decrease and shrink. When growth hormone (CH) secretion is reduced, children show growth and development disorders, short stature, decreased protein synthesis in adults, muscle atrophy, subcutaneous fat, and low fasting blood glucose. When gonadotropin (GnH) secretion is reduced, children have delayed or absent sexual development, adult patients have gonad atrophy, women have menstrual scarcity or amenorrhea, loss of libido or disappear, males have secondary sexual disability, impotence, decreased spermatogenesis Infertility. When thyrotropin (TSH) secretion is reduced, there are chills, apathy, lethargy, mental retardation, slow movement, dry hair loss, pale complexion, less sweat, mucous edema, bradycardia, constipation and other hypothyroidism. Decreased adrenocorticotropic hormone (ACTH) secretion is characterized by fatigue, weakness, dizziness, reduction, nausea, weight loss, light skin tone, low blood pressure, positional hypotension, poor stress and other adrenal insufficiency. Prolactin (PRL) secretion is reduced in the absence of milk secretion or secretion after delivery.

It is generally believed that symptoms of anterior pituitary tissue destruction occur more than 60%, more than 75% of symptoms are more obvious, and more than 95% of symptoms are severe. According to the degree of pituitary involvement, it can be divided into the anterior pituitary function and the partial anterior pituitary dysfunction (only selectively damage 1 or 2 pituitary hormones). Generally, GH and GnH are often involved first, and TSH and ACTH are involved. When the function of the pituitary is diminished, the body's ability to adapt to changes in the external environment is reduced. In case of stress, such as overwork, cold, hunger, vomiting, diarrhea, infection, surgery or taking sleeping pills, the anterior pituitary dysfunction crisis can be induced due to poor pituitary hormone reserve. , the performance is:

1 hypoglycemia coma. More than on an empty stomach or after fasting, it can be epileptic seizures and even coma.

2 shock, hyponatremia and dehydration.

3 high fever coma or low body temperature coma in cold.

4 sensitive to sedative drugs. Generally, the usual dose can cause prolonged drowsiness or coma. The anterior pituitary dysfunction is associated with a high mortality rate, which is an endocrine emergency and should be actively rescued.

2, anterior pituitary hyperfunction syndrome: GH secretion of excessive adult manifestations of acromegaly, children manifested as giant disease; PRL excessive secretion of men showed sexual dysfunction and infertility, female manifestations of amenorrhea and galactorrhea syndrome. The clinical manifestations of excessive secretion of ACTH are Cushing's syndrome and Nelson's syndrome. Excessive secretion of TSH is clinically characterized by hyperthyroidism. When GnH is secreted too much, children have precocious puberty. In adults, FSH secretion is increased, LH secretion is normal or decreased, and women have multiple ovarian cysts. Men have pituitary nonfunctioning large adenomas and male sexual function is reduced.

3, the surrounding pituitary tissue compression syndrome: the following symptoms can occur:

1 headache.

2 vision loss, visual field defect, optic atrophy. It is caused by the expansion of the lesion to the optic nerve and the optic chiasm.

3 hypothalamic group. The upward expansion of the lesion affects the function of the hypothalamus. The patient has lethargy, irregular refractory fever, polyphagia or anorexia, obesity or weight loss, diabetes insipidus, and sexual dysfunction.

4 cavernous sinus syndrome. The lesion develops to the outside and compresses and invades the cavernous sinus involving the first and the cranial nerves, and the ocular dyskinesia and the ocular ocular dysfunction occur. When the lesion affects the first nerve, there may be symptoms such as trigeminal neuralgia or facial numbness.

5 cerebrospinal fluid rhinorrhea. The lesion is eroded by the saddle bottom.

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