FAILURE DUE TO FRONT pituitary disease processes in the pituitary gland or diencephalic area ( DIENTSEFALO -pituitary cachexia - DISEASE Simmonds ; postpartum hypo- PITUITARIZM - DISEASE Sheehan )
Endocrinology / / August 12, 2017
deficiency of the anterior pituitary may result from its destruction by a pathological process (tumor, trauma, infection, poor circulation), vascular disorders of the hypothalamus and pituitary connections, as well as damage to the hypothalamic centers that regulate the activity of the pituitary.
pathogenesis.In some cases, the pathological process, damaging the pituitary gland in some extent and has a damaging effect on the hypothalamus.Depending on the nature and localization process, the prevalence of hypothalamic pituitary disorders or diseases, this group can be divided into separate pathological forms.They combine the fact that in these diseases is reduced or terminated development of all or some tropic pituitary hormones.
In 1914 Simmonds described the violations related to the destruction of the anterior pituitary and manifested, among other symptoms, rapid depletion - cachexia.It is believed that this rare form of the disease - dientsefalo-pituitary cachexia - associated mainly with damage to
With the destruction of the anterior pituitary tumor intrasellyarnoy diencephalic violations mostly absent and the clinical picture may correspond to that seen with surgical removal of the pituitary gland.
If there suprasellar tumor or infection (syphilis, tuberculosis, malaria and so on. P.), Traumatic injury dientsefalo-pituitary region diencephalic violations can get over the symptoms associated with a decrease in the production of hormones of the anterior pituitary.
In 1939, Sheehan has allocated a special form of the disease - lack of anterior pituitary gland that occurs as a result of necrosis of his circulatory disorders during childbirth accompanied by hemorrhage and shock.Observations show that in patients with postpartum hypopituitarism - Sheehan's disease - symptoms associated with a decrease in the production of hormones of the anterior pituitary, often associated with violations, depending on the damage to the hypothalamic centers, - diabetes insipidus, sleep disturbance, appetite, different vegetative and neuropsychological disorders.This gives rise to a large proportion of cases the disease is not considered as a purely pituitary damage, but as dientsefalo-pituitary pathology.
Sheehan's disease appears to be the most common form of failure of the anterior pituitary.
In pregnant women, the pituitary gland is particularly sensitive to disturbances of circulation.Perhaps this is due to the fact that during pregnancy there comes a significant increase in anterior pituitary with a relative deficiency of its blood supply.It is suggested that hypertrophic pituitary gland compresses the blood vessels that supply it with blood.However, to explain the increased sensitivity to disturbance field dientsefalogipofizarnoy circulation during pregnancy only hypertrophy of the pituitary gland can not.Sheehan and Stenfild necrosis was observed in the anterior pituitary pregnant women equally often in the presence of a very large pituitaries and at their relatively small size.Studies have shown that the primary vascular disorder is a spasm of the arteries that supply blood to anterior pituitary and leg.Arterial spasm, apparently associated with severe circulatory disorder common in bleeding during childbirth.In this case violated the portal circulation and direct arterial blood supply of the anterior pituitary gland, but saved the blood supply to the legs.If the spasm lasts less than an hour, the parenchyma of the anterior pituitary undergoes only reversible damage.With more prolonged spasm of the anterior pituitary tissue necrotic, and when the blood flows into the damaged blood vessels, thrombosis.The volume of the anterior pituitary necrosis depends on the strength and duration of spasm.In half of the defeat captures 97- 99% iron, but pars tuberalis and a small part of the pars interlobaris usually stored.
predisposing factors to the development of postpartum hypopituitarism, apparently, are the multiple pregnancies and repeated pregnancy, coming in for a short time.We describe the cases of postpartum hypopituitarism after a normal delivery, which preceded the birth or abortion, accompanied by a large bleeding and shock.
Along with circulatory disorders due to massive bleeding during childbirth cause of postpartum hypopituitarism may be puerperal sepsis with septic embolism pituitary vessels.
circulatory disorders due to bleeding (gastric, nasal, immoderate donation) in rare cases may lead to the development of hypopituitarism and non-pregnant women and in men.
The main symptoms of the disease are associated with a decrease in the function of the endocrine glands, which are under the regulatory influence of the anterior pituitary.
At Sheehan's disease may occur uneven decline in the function of glands, the regulation of which is carried by the anterior pituitary;there are deleted form of the disease.
Thus, in 15-30% of patients with severe postpartum hypopituitarism are occasionally uterine bleeding, in some cases - the true menstruation.In the group of patients who have survived the signs of ovarian activity, destruction of the pituitary, thyroid degree of atrophy and adrenal were the same as in patients who had a persistent amenorrhea.The presence of occasional uterine bleeding is not evidence of a small amount of pituitary necrosis.Described patients with selective loss rut-dotropnoy thyrotrophic and pituitary function after pathological delivery when stored adrenocorticotropic function.
Smith and Howard describes the three patients with postpartum hypopituitarism, who had only a small reduction in thyroid function is normal or slightly increased secretion of gonadotropins.The menstrual cycle was preserved or broken.In these patients revealed different degrees of deficiency of production of adrenocorticotropic hormone.
In patients who have not completely disrupted the function of sexual glands, may become pregnant.During pregnancy, there is improvement of the patients, apparently in connection with the inclusion of hormonal function of the placenta.After birth, the phenomenon of pituitary insufficiency are amplified again.
seems unconvincing attempt to explain the uneven lowering of separating different tropic hormones of the anterior pituitary in patients with postpartum hypopituitarism that necrosis is selectively exposed to certain sections of the adenohypophysis, where the cells are concentrated, producing certain hormones.
flow postpartum hypopituitarism - fast its manifestation or slow gradual development, after a long "latency" period, as well as the prevalence of insufficiency of those or other peripheral endocrine glands do not depend on the number of preserved tissue adenohypophysis or the localization of necrosis in the pituitary gland.
probably "mosaic" symptoms experienced by some patients with Sheehan's syndrome is associated with selective damage to various nuclei of the hypothalamus that regulate the production of various anterior pituitary hormones.
- Pathological Anatomy at the failure of the anterior pituitary
- deficiency of the anterior pituitary.The clinical picture
- deficiency of the anterior pituitary.These hormonal studies
- deficiency of the anterior pituitary.The disease
- deficiency of the anterior pituitary.Diagnosis and differential diagnosis
- Treatment failure of the anterior pituitary
Isolated deficiency of secretion of various hormones of the anterior pituitary gland may occur as an independent pathological form, not only in patients with postpartumhypopituitarism.
Selective reduction of the production of gonadotropins leads to the development of hypogonadotropic hypogonadism.
Less common cases of isolated reducing production of adrenocorticotropic hormone.In these patients, there is clinical picture of chronic adrenal insufficiency, but there is no pigmentation.Some of them have a good therapeutic effect has ACTH.
selective reduction of certain pituitary hormones in these patients is the result of damage to the hypothalamus.