Insufficiency of the anterior pituitary gland : clinical picture
Endocrinology / / May 19, 2016
Clinical manifestations of the most common forms of hypopituitarism - Sheehan is illness - are diverse and vary according to the severity and speed of development of the disease.
In severe and rapidly developing formapomrachenie consciousness, stupor.In the future, patients with postpartum hypopituitarism rarely complain of headaches.
With slow disease development there are complaints of patients less certain.Often the first signs of the disease in these patients are symptoms of disorders of the pituitary gonadotrophic function, sometimes for several years preceded by other disorders.Women complain of menstrual disorders - rare and scanty menstruation or complete cessation of the disappearance of sexual feelings.Gradually joined complaints related to the failure of the thyroid gland, - increasing sluggishness, lethargy, sensitivity to cold, constipation.Weakness and anorexia are made especially prominent in the development of adrenal insufficiency.At the same time there may be seizures, associated wit
This sequence of complaints in patients with slow disease progression is not mandatory.In some patients the complaint from the outset may be associated with a decrease in the function of the thyroid gland or the adrenal cortex, or reflect a gradual reduction in thyrotrophic simultaneous production of gonadotrophic and adrenokortikotrop-term pituitary functions.
simultaneous damage to the pituitary gland and the hypothalamus causes in some patients the symptoms of diabetes insipidus - allocation of large amounts of urine with a low specific weight and thirst.Diabetes insipidus can be transient or persistent.With diencephalic pathology may be associated with some vegetative disorders that are observed in some patients - vasomotor lability, breach of thermoregulation.
Changes in the mental sphere manifest the growing mental apathy, indifference to the environment.The total lack of appetite are periodically replaced by acute attacks of hunger.Against the background of this chronic condition and Staehelin Kind (1956) observed in patients with postpartum hypopituitarism in the later stages of the disease schizo-frenopodobnye condition with acute agitation, hallucinations, delusional experiences.
An objective study is often noteworthy characteristic "alabaster" pale skin, does not correspond to the degree of anemia;often the skin has a yellowish tint.Due to a decrease in thyroid function are usually dry skin, atrofich Nye, often - pasty.However, if there is a significant decrease thyroid function, usually expressed myxedema no skin changes characteristic of primary hypothyroidism.Hair thinning, become dry and brittle, sometimes baldness.Disappears vegetation on the pubic and axillary areas.Brittle nails.Often kariez teeth and hair loss.
Fatness patients often lowered.In patients with postpartum hypopituitarism, in which the pathological process is localized mainly in the anterior pituitary, is only partly capturing hypo-thalamic region, weight loss is usually mild or absent, and the decline of the power does not reach the degree of cachexia.With widespread damage to the hypothalamus, some patients develop sudden weight loss - Cachexia.
Pulse rare.Blood pressure is reduced;orthostatic hypotension observed.
often subnormal body temperature.Only a few patients have low-grade fever, which can be delivered in connection with a violation of thermoregulation due to hypothalamic damage.
Goes Down resistance to infections.
Gastric secretion and exocrine pancreas decrease, causing dyspepsia, vomiting, constipation, rarely - diarrhea.
Lowering gonadal function leads to atrophy of the breast in women, internal and external genitalia.
In the absence of adequate replacement therapy in patients with anterior pituitary insufficiency may develop gipopituitarnaya coma, accompanied by hypothermia, and bradycardia, and being able to cause the death of patients.
With a significant decrease in the height of ECG peaks thyroid function is reduced, and ECG takes the form typical of hypothyroidism.
patients postpartum hypopituitarism sometimes reveals calcification in sella.
often develops normochromic anemia.Sometimes there is a leukopenia to 3400-3700 1 mm.kv.with a decrease in neutrophil count to 26-27%.Reducing the number of neutrophils, apparently due to the insufficiency of the adrenal cortex, as indicated in the treatment of glucocorticoid normalization of white blood cell count and leukocyte formula.
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In the absence of diabetes insipidus fluid intake and urine output decreases.Sometimes there is a slight albuminuria.In the presence of diabetes insipidus in patients not receiving the treatment of glucocorticoid or ACTH, polyuria and decreased urine specific gravity usually moderate.When treating or cortisol analogs symptoms of diabetes insipidus are enhanced, apparently due to increased glomerular filtration.
fasting blood sugar decreased.There is increased sensitivity to insulin.Sugar curve after load often flattened.
blood cholesterol is usually moderately elevated.However, even in the presence of the thyroid gland, high cholesterol does not reach that largely marked deficiency, which is characteristic of patients with primary myxedema.
sodium and chlorine level in the blood is reduced, but the patients are to a certain extent retain the ability to detain him while limiting sodium in food.Sodium reduction largely associated with impairment of cortisol, aldosterone than failure.
data on the level of potassium in the blood change contradictory.
unchanged content of calcium and phosphorus in the blood.