essay - hypopituitarism.docx

8/12/2019 Essay - Hypopituitarism.docx

1/8

COLEGIO MASCULINO ESPRITU SANTO

BIOLOGY

TOPIC:

HYPOPITUITARISM

STUDENTS NAME:VCTOR ALCVAR

TEACHER:

MR. RICARDO PESNTEZ

20132014


2/8

What is Hypopituitarism?

At my practices at Luis Vernaza Hospital on vacations, strange diseases were of my

interests, and one of those rare cases and the most interesting for me was an old womanhaving hypopituitarism that could only be detected until any other disease could explain

what she had.

I want to be a doctor and I know sometimes strange cases will appear and I would like to

be familiarized with some of them, since that I learnt more of some organ systems

involving this disease called Hypopituitarism.

To understand what hypopituitarism is its important to know the most important organ

involved in this conditions, which is the pituitary gland. Pituitary gland is an endocrine

gland located at the base of the brain, resting at the silla turcica. It has 2 lobes, which

are the anterior and posterior lobe, and each of them produces different hormones.

These hormones are the reason by which this gland is considered the most important

gland after the hypothalamus. The anterior lobe produces and delivers hormones having

some of them different purposes depending on the sex of the individual.

In males the Follicle Stimulating Hormone, known as FSH stimulates the production of

sperm in testes; the Luteinizing Hormone or abbreviated LH stimulates the secretion of

testosterone. In females the FSH stimulates the follicle to grow and to produce estrogen,

the LH is necessary for the ovulation, the growth of the corpum luteum, and the secretion

of estrogen and progesterone.

The next hormones affect both men and women and are produced by the anterior lobe

too are the Thyroid Stimulating hormone or TSH that acts stimulating the thyroid gland to

produce thyroxin, the Prolactin or PRL that stimulates the production of milk at the

mammary glands, but not alone because its necessary the stimulation of estrogen,

growth hormone and others to cause mammary glands to develop and work; thats why


3/8

men dont produce milk, the Growth Hormone or GH that helps the production and

secretion of Insuline Like Growth Factor that stimulates cells to grow and multiply,

diminish the degradation of proteins, amino acids, glucose and helps the metabolism of

fats, The adrenocorticotropic hormone, abbreviated ACTH that stimulates Suprarenal

cortex to produce cortisol, aldosterone and testosterone and the Melanocyte Stimulating

Hormone or MSH that is known that produce the pigment of the skin called melanin, also

its being discussed if it affects cerebral activity.

The posterior lobe cant synthetize hormones, but it delivers these hormones which are

the Antidiuretic Hormone, referred as ADH that stimulates kidneys to reabsorb water to

blood, promotes the inhibition of sweat and the contraction of arterioles to increase blood

pressure and the Oxytocin hormone that in women stimulates the contractions during

labor and the expulsion of milk and in males facilitates the ejaculation process. It has also

been proved that oxytocin helps develop parental care sense, sexual desire and sexual

pleasure.

Because of all of these hormones produced by the pituitary gland, if this gland is not

working properly the quantity of the production of the hormones decreases or increases

causing effects on the body. If all the pituitarys hormones production is increasing then

the clinical condition is called pan-hypopituitarism and the decrease in the quantity of a

hormone production, sometimes even some hormones are completely suppressed, its

called hypopituitarism.

Normally when pituitary hormone production is getting lower, organs that receive these

hormones by negative feedback produce hormones to stimulate pituitary gland to

increase its production, but in hypopituitarism there is little or no response by the pituitary

gland.


4/8

This may be caused by the events like pituitary tumors or adenomas, most of the times

they are noncancerous and 20% of the people in the world present those benign tumors

and most of the times patients wont know in their entire life they had tumors in their head

because there are no symptoms. One of the treatments for those tumors, the cranial

radiotherapy, may cause hypopituitarism too.

Another situation that can lead to hypopituitarism is a traumatic brain injury, caused by an

accident, in those cases there can be many damages, including damage in the tissue of

the pituitary gland called Pituitary Apoplexy, a subarachnoid hemorrhage and aneurisms

that may affect the brain too.

Diseases such as meningitis, caused by bacterial or viral infections of the meninges, or

sarcoidosis, which is an autoimmune disease caused by an inflammation of an organ by

granulomas, and Hemochromatosis, which is an excess of iron absorbed by organs, may

affect and damage pituitary gland too and cause hypopituitarism.

Hypothalamus disorders, caused by anorexia, bulimia or eating disorders, and the

Sheehan syndrome that is a post-partum condition caused by too much blood lost are

typical diseases that make women present hypopituitarism a bit more than men.

Non common complications for diseases like Tuberculosis or Syphilis may affect the

pituitary gland. Surprisingly at least 50% of the cases reported are been alleged to not

showing a cause of the disease.

A rare case documented by American Association of Clinical Endocrinologists 2013

Scientific & Clinical Congress showed a 37 year old man who after 15 of excessive use of

marijuana has developed hypopituitarism. It appears that the Tetrahydrocannabinol

abbreviated THC present in marijuana, can suppress multiple hypothalamic-pituitary-

gonadal axis pathways affecting organs systems.


5/8

The incidence of this disease in the world is about 4 cases per 100.000 per year. The

principal reported causes for hypopituitarism are a brain trauma from a car or motorcycle

accident and tumors. This disease also doesnt have an specific group of people.

Symptoms can vary depending on the amount and which hormones are missing, the

organs they affect and the severity of this disorder, nevertheless the typical symptoms

are: Abdominal pain, decreased appetite and failure to produce milk.

Fatigue, accompanied with headache and weakness may appear too. Infertility and loss

of armpit and pubic hair in women and men, including facial hair may occur in some

cases. Some patients may include low blood pressure, vision and weight and diabetes

insipidus, caused by large excretion amounts of urine and an almost unstoppable thirst.

For an accurate detection of hypopituitarism the exams of many of the hormones involved

in the pituitary glands production have to be taken.

Pituitary Magnetic Resonance Imaging or MRI and a Cranial Computed Tomography or

CT scan must be done to detect any tumor, granuloma, hemorrhage, Inflammation and

any other abnormal situation at the brain or specifically at the hypothalamus and pituitary

gland.

ACTH stimulation Test measures cortisol levels, glucagon stimulation test and insulin

induced hypoglycemia test can help to diagnose a lack of ACTH too. TSH and Thyroxin

Test helps to indicate is there is a low level in TSH.

LH an FSH and Testosterone level Test are helpful to know if low LH and FSH could

indicate hypogonadism, and high levels of them can show a different kind of

hypogonadism. In men a low level of testosterone with FSH an LH level normal or low

indicates hypopituitarism.

GH exam consist on provocating a secret ion of GH because giving a serum cant help

when GH in an adult is produced in little amount. Prolactin stimulation test is normal.


6/8

Water deprivation Test and ADH stimulation Test consist of measuring water intake, if

urine levels remain and osmolality keeps going high a diabetes insipidus diagnosis is

accepted, to affirm this a ADH simulation test will help to determine if its c ompletely a

diabetes insipidus and showing the presence of hypopituitarism or if its a nephrogenic

diabetes insipidus which involves renal damage or disorder.

Treating the conditions causing the hypopituitarism, like extracting the benign tumor, or

fighting a disease of the hypothalamus affecting the pituitary gland may lead to a total or

partial recovery of the glands functions. In those cases in which there is not a total

recovery or when is unknown the damage of the pituitary gland and so it cant be

repaired, then the way to help recover the bodys normal function is by hormonal therapy

what consist in giving the amount of any of the pituitary hormones to be at the normal

levels. These hormones are given in many ways, orally, of by injections, or absorbed by

skin.

The dosages may vary depending on the progression of the disease, the person

receiving the treatment and external factors such as another disease, even a simple flu,

affecting the patient. Thats why endocrinologist have to take care of the patients

dosages at the first 3 weeks until the optimal dosages are established, this can be known

with regular blood test to confirm the body is working properly with these hormones, and

every then 6 months, but the regular blood tests have to be taken and posterior

observations may be needed for any other disease appearing as said before.

Benefits from the hormonal treatment are that there is no other way to treat

hypopituitarism apart from the surgery to eliminate granulomas, tumors or hemorrhages

and the treatment can give the person the sensation of a normal life while at

consequences of the treatment are that the amount of hormonal substitutes is not the

proper dosage and may damage an organ. This can explain in part why it has been


7/8

showed that the life expectancy of a person with permanent hypopituitarism is diminished

a little with heart diseases and bone tissue damages, but it is still unknown a concrete

reason.

Drugs like the prednisone are used to replace hormones that arent present when the

ACTH is at low levels. Levothyroxines like levoxyl may be used for treating a thyroid

hormone deficiency. Sex hormones are used in different ways, a mix of testosterone and

estrogen for men and for women the mix is of progesterone and estrogen and

gonadotropins that may replace LH and FSH are used to recover fertility but in the case

of men the fertility may be recovered after 4 months because the life a single sperm can

be of about 71 days.

Growth hormones like somatropin help children to grow and for adults for the other

metabolic functions but not to grow, itsimportant to mention that a mix of sex hormones

and growth hormones are used when the dwarfism produced by hypopituitarism may lead

to a deficiency in the sexual reproductive maturity as well.

A basic recommendation for a patient with this condition is having an ID that show the

person has the disease in case of a complication or an accident that will affect hormonal

quantity.

The knowledge of the body leads to the knowledge of how treating diseases, through

hypopituitarism theres an open door to the endocrine system, which has to work perfect

during all our lives and I think that better the understanding of this system of the body will

lead to a better life condition treatments, or to the understanding of the rest of the human

body and the understanding of diseases and how to combat them and eradicate them.


8/8

essay - hypopituitarism.docx

Documents