Violations that occur after the removal of the pituitary gland
Endocrinology / / August 12, 2017
most demonstrative implications loss function of the anterior pituitary occur after surgical removal of the pituitary gland, produced with the purpose of treatment for some diseases.There is now a significant number of observations of such patients.
Despite the fact that this pathology yet rarely occurs, may be analyzed by the main manifestations of the syndrome associated with loss of function of the anterior pituitary hypothalamic centers without damage, and the basic principles of treatment of these patients.
most significant breach, a danger to the life of the patient after removal of the pituitary gland, is to reduce the function of the adrenal cortex.adrenal insufficiency may occur within 36 hours after surgery, but sometimes develops gradually over 3-4 weeks.Secondary gipokortitsizm after removal of the pituitary gland has some peculiarities compared to gipokortitsizm in connection with a primary lesion of the adrenal glands.Glikokortikoidnaya falls mainly a function of the adrenal glands, whil
patients after removal of the pituitary gland appears anorexia, nausea and vomiting, severe weakness, weakness, drowsiness;hyperthermia may occur.Blood pressure is reduced, there is orthostatic hypotension, and circulatory collapse may occur.Salt exchange is not significantly impaired.Patients receiving replacement therapy with cortisone, respond normally to limit sodium in the diet decrease in sodium excretion in the urine.
development of hypotension in patients after hypophysectomy at preferential loss of secretion of glucocorticoid, and with relatively preserved aldosterone production, apparently due to the fact that falls permissive glucocorticoid action needed for the manifestation of hypertensive effects.
pigmentation in patients with deficiency of the adrenal cortex by the removal of the pituitary is absent due to the fact that they have not the allocation is increased.However, in these patients, and there is no characteristic pallor peculiar to patients with panhypopituitarism.
patients after removal of the pituitary gland naturally decreases the function of sexual glands.Women stop menstruating, and after a few weeks of developing deep atrophic changes of genitals and mammary glands.Men in 4-6 weeks after the surgery there is atrophy of the testes and the external genitalia, impotence occurs.Sexual feeling disappears in both sexes.Stops growing and the hair falls out in the axillary and pubic areas.Hair is made thinner.
lowering thyroid function comes less naturally and more slowly than the decrease of the function of the adrenal cortex and gonads.The majority of patients with hypothyroidism develops after 1-6 months after the removal of the pituitary gland.The first signs of developing hypothyroidism are dry skin and weight gain.Later appear chilliness, constipation, lethargy, confusion, skin thickening.A significant increase in cholesterol levels in patients with secondary hypothyroidism due to the removal of the pituitary gland, in contrast to patients with primary hypothyroidism due to thyroid lesion is usually not observed.
addition, in some patients after removal of the pituitary and no clinical laboratory signs of hypothyroidism during the 6-24 months follow-up after the operation.Some of these patients had hyperfunctioning adenoma of the thyroid gland, in some cases, the thyroid gland was normal.In the case of incomplete removal of the pituitary gland is observed only a transient lowering of thyroid function.
If removing the pituitary gland produced within the sella below his diaphragm and the hypothalamus remains intact, resistant diabetes insipidus does not develop.Such patients due to the decrease glucocorticoid secretion by the adrenal cortex have a reduced tolerance to water stress, like Addison's disease patients.If diabetes insipidus developed in connection with damage proximal neurohypophysis and hypothalamus, urine output is relatively small in the absence of replacement therapy with cortisone and significantly increased after the introduction of cortisone.
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Carbohydrate metabolism after removal of pituitary changes little.There is only a small reduction in fasting blood sugar, hypoglycemic deepening phase after the carbohydrate load;little sensitivity to insulin increases.Diabetic patients after removal of pituitary greatly reduced need for insulin.This is not due to loss adrenocorticotropic pituitary function, as increased insulin sensitivity is maintained in patients receiving treatment with cortisone, but with the cessation of anterior pituitary secretion of growth hormone.
Introduction diabetics with removal of the pituitary growth hormone has a significant diabetogenic action.
ability to heal wounds and fractures in patients with pituitary posleudaleniya saved.Changes in the metabolism of calcium and phosphorus are absent.Body weight does not change significantly, although there is a certain tendency to weight gain.