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Essentials of Diagnosis
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Adrenocorticotropic hormone (ACTH) deficiency: low adrenal secretion of cortisol and epinephrine; normal aldosterone secretion
Growth hormone (GH) deficiency: in children, causes short stature; in adults, causes asthenia, obesity, and increased cardiovascular risk
Prolactin deficiency: postpartum lactation failure
Thyroid-stimulating hormone (TSH) deficiency: causes secondary hypothyroidism
Luteinizing hormone (LH) and follicle-stimulating hormone (FSH) deficiency: cause hypogonadism and infertility in men and women
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General Considerations
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Hypopituitarism with mass lesions
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Nonfunctioning pituitary neuroendocrine tumors are more likely than functioning pituitary adenomas to grow large enough to cause anterior hypopituitarism; they rarely cause diabetes insipidus
Other mass lesions include
Vascular lesions include
Pituitary tumor apoplexy
Acute Sheehan syndrome
Cavernous sinus aneurysm
Subarachnoid hemorrhage
Inflammatory/infiltrative lesions include
Infectious lesions can be bacterial, fungal, or parasitic
Pituitary metastases
Often present with
Usually from breast cancer (45%), particularly when HER2 positive
Lung cancer accounts for about 21% of pituitary metastases that typically present either before or within 1 year of the primary cancer
Lymphocytic hypophysitis
An autoimmune disorder affecting the pituitary gland
Characterized by infiltration of the infundibulum and pituitary by lymphocytes, macrophages, and plasma cells
Spontaneous lymphocytic hypophysitis is more common in women (71%) and most frequently presents during pregnancy or postpartum
The condition is often associated with other autoimmune conditions, such as systemic lupus erythematosus (SLE) or autoimmune (Hashimoto) thyroiditis
Immune checkpoint inhibitor hypophysitis
Can be caused by several immunity-enhancing drugs, particularly the
Symptoms develop a median of 9 weeks after beginning ipilimumab and a median of 26 weeks after commencing an anti-PD-1 agent
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Hypopituitarism without mass lesions
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