Panhypopituitarism is also known as Simmonds’ disease or Simmond ‘s syndrome. In the case of the disease, too little or no hormones are produced in the anterior pituitary gland.
What is Panhypopituitarism?
Panhypopituitarism is a disease of the anterior pituitary gland. The anterior pituitary represents the largest part of the pituitary gland. See gradinmath for What is Kasabach-Merritt Syndrome.
It produces the hormones ACTH (adrenocorticotropic hormone), TSH (thyroid stimulating hormone), MSH (melanocyte stimulating hormone), FSH (follicle stimulating hormone), LH (luteinizing hormone), prolactin and somatotropin.
All of these hormones are deficient or absent in panhypopituitarism. It is therefore a generalized insufficiency of the anterior pituitary gland. Panhypopituitarism can be acute or chronic.
Causes
The main cause of panhypopituitarism is a tumor of the pituitary gland. The disease takes a subacute or chronic course. Autoimmune processes can also impair the function of the pituitary gland. Rarely, panhypopituitarism arises from Sheehan’s syndrome. In Sheehan’s syndrome, the mother’s anterior pituitary gland fails to function due to a lack of blood supply after birth.
Acute insufficiencies of the anterior pituitary are also triggered by trauma. Only rarely is the entire pituitary stalk torn off in an accident. However, an impairment of the pituitary gland by an accident is quite common. Studies from the USA show that the pituitary gland function is disturbed in almost half of all patients with a moderate traumatic brain injury.
Symptoms, Ailments & Signs
Only when 80 percent of the pituitary gland has been destroyed do the first clinical symptoms appear. This is explained by the lack of hormones. As a result of the TSH deficiency, an underactive thyroid gland (hypothyroidism) develops. TSH causes the thyroid gland to produce the thyroid hormones T3 and T4. With a lack of T3 and T4, the affected patients suffer from reduced performance, listlessness, weakness, tiredness, constipation, hair loss and depression.
The hormone ACTH shows its effect on the adrenal cortex. Under the stimulation of ACTH, the adrenal cortex produces glucocorticoids, mineralocorticoids and steroids. If there is a lack of ACTH, too little cortisol is formed. The main symptom of this secondary adrenal insufficiency is weakness. Those affected also lose weight, vomit frequently and have low blood pressure.
Hyperpigmentation of the skin is also typical. However, if there is a simultaneous lack of MSH, the hyperpigmentation may be absent. Patients who produce too little melanocyte-stimulating hormone are very pale. The lack of follicle stimulating hormone and luteinizing hormone leads to hypofunction of the gonads.
In women, this is noticeable by the absence of menstrual bleeding . The affected women are temporarily infertile. After pregnancy, panhypopituitarism manifests itself with a lack of prolactin through agalactia. The medical term agalacte refers to the lack of milk production during breastfeeding. Agalactia usually occurs in connection with Sheehan’s syndrome.
In panhypopituitarism, too little or no growth hormone is produced. This leads to short stature in childhood. In adulthood, the deficiency manifests itself in the form of trunk obesity. In trunk obesity there is a tendency for increased fat storage on the trunk. Coronary heart disease (CHD) can also be the result of a lack of growth hormones.
The 7 A’s serve as a reminder for the symptoms of panhypopituitarism: no eyebrows, no armpit hair, agalactia and amenorrhea, apathy and adynamia and alabaster-colored pallor. Typical symptoms are also reduced blood pressure and reduced osmolality in the urine.
Diagnosis & course of disease
The clinical picture already provides the first indications of the disease. Previous events, such as trauma or childbirth, can reinforce the suspicion. After a detailed anamnesis, a basic hormone diagnosis or an endocrinological functional diagnosis is usually carried out on the patient. The individual pituitary subfunctions are tested.
Decreased pituitary hormones such as ACTH or FSH are groundbreaking in laboratory chemical diagnostics. The target hormones of these regulating hormones are also reduced. There are also too few thyroid or adrenal cortex hormones in the blood. A stimulation test can be carried out to determine whether the disorder originates in the anterior pituitary itself or in the superordinate hypothalamus. The hormone secretion of the pituitary gland is stimulated at different levels.
The most important test is the insulin hypoglycemia test. In this test, the patient is injected with insulin. This leads to a significant drop in blood sugar. Normally, due to a massive stress reaction, increased levels of ACTH, cortisol and somatotropin would be released. If there is no increase, there is pituitary or hypothalamic damage. To rule out the hypothalamus as a cause, further releasing hormone tests can be performed.
These tests include the CRH test, the GHRH test, and the TRH test. Since the cause of pituitary insufficiency is usually a tumor, imaging diagnostics must always be carried out if panhypopituitarism is suspected. As a rule, therefore, a magnetic resonance imaging is performed. Since pituitary tumors also endanger the optic nerves due to their spatial location, an ophthalmological diagnosis should also be carried out.
Complications
In most cases, panhypopituitarism leads to a hormone deficit, which can lead to various complications and symptoms. However, the further course depends heavily on this deficit, so that no general prediction can usually be made about it. However, those affected by panhypopituitarism also suffer from a malfunction of the thyroid gland.
This leads to tiredness and general exhaustion of those affected. Patients also often suffer from hair loss, depression and constipation. The quality of life of those affected is significantly reduced due to the illness. If this complaint is not treated, it can also lead to adrenal insufficiency, which can have a negative impact on the life expectancy of the person concerned.
Weight loss or low blood pressure can also occur as a result of panhypopituitarism and continue to limit the affected person’s everyday life. If the disease occurs in childhood, it leads to short stature or various heart diseases. As a rule, the treatment of the disease always depends on the cause. If there is a tumor, it must be removed. A general course cannot be predicted, since the tumor may have spread to other regions of the body.
When should you go to the doctor?
Changes in the hormonal balance indicate a health disorder. If they are constant or increasing in intensity, a doctor is needed. In the case of symptoms such as hair loss, changes in the complexion and disorders of the digestive tract, a doctor’s visit is necessary. If sexually mature women experience irregularities or no menstrual periods, it is recommended that the symptoms be clarified. If you are unable to have children despite all efforts, a check-up is advisable to clarify the fertility status.
A decreased libido or sexual dysfunction are signs of an irregularity in the organism that should be treated. Behavioral problems, mood swings and personality changes are warning signs that should be followed up. If withdrawal behavior or reduced participation in social life is evident, a check-up visit with a doctor or therapist is advisable. Changes in weight, repeated vomiting and nausea are also alarming signals.
Disorders of the growth process in children and adolescents, short stature, a pale appearance, as well as irregular heart rhythms should be presented to a doctor. Sluggishness, apathy, easily fatiguable and an increased need for sleep are considered signs of health impairment and should be examined by a doctor. Fat deposits, swelling or a general feeling of being unwell and sick should be examined by a doctor. Consultation of a doctor is recommended for people with reduced well-being.
Treatment & Therapy
The treatment of panhypopituitarism depends on the cause. If the disease is based on a tumour, the therapeutic approach depends on the size of the tumour, the type of tumor and the potential damage caused by the mass. A combination of surgical and drug measures is usually used.
Radiation therapy is also used. The limited pituitary function can often be restored in this way. If recovery is not possible, the missing hormones must be substituted.
Outlook & Forecast
Sudden hypofunction of the pituitary gland can lead to various functional disorders and degrees of severity. Depending on the cause and effect, it is a severe to very severe acute illness. The prospects for people suffering from an underactive pituitary gland (panhypopituitarism) can therefore only be judged by the causes of the underactive gland. A comprehensive diagnosis is absolutely necessary.
Some of the causes of an underactive pituitary gland can now be treated quite effectively. In this case, the prognosis is significantly more positive. The administration of missing hormones can often improve the quality of life of those affected. Their chances of survival increase up to a normal life expectancy. If the missing hormones cannot be administered, the expectation of survival with this disorder can still be ten to fifteen years.
The situation is different in patients who fall into a pituitary coma. The reason for this may lie in severe stress. Pituitary coma can be caused by untreated hypothyroidism or hypopituitary gland activity, or a stroke. It is a life threatening situation. This requires immediate emergency measures. The forecast depends on how quickly these measures are taken. In addition, the severity of the resulting sequelae or the age of those affected are also a criterion. Without prompt administration of glucocorticoids and thyroid hormones, many comatose patients die.
Prevention
Panhypopituitarism cannot be prevented.
Aftercare
In most cases, those affected with panhypopituitarism have only limited direct follow-up measures available. For this reason, early diagnosis of this disease is very important to avoid other complications or symptoms. Therefore, sufferers should ideally consult a doctor at the first signs and symptoms of panhypopituitarism.
Generally, self-healing cannot occur. Those affected are dependent on taking various medications that can alleviate these symptoms. The person concerned should pay attention to the prescribed dosage so that the symptoms can be alleviated. Regular check-ups and examinations by a doctor are also very important, so that there are no other complications or complaints that can reduce the quality of life of those affected.
It is not uncommon for those affected to depend on the help and support of friends and family due to panhypopituitarism, which can prevent the development of depression and other mental health problems. The further course of panhypopituitarism depends heavily on the time of diagnosis, so that it is usually not possible to make a general prediction.
You can do that yourself
Panhypopituitarism often triggers a hormone deficiency, so monitor the symptoms closely. In order to avoid or alleviate complications, affected persons should consult a doctor at an early stage. Signs such as tiredness and lethargy can be a sign of aggravation. Other complaints such as depression, hair loss and constipation reduce the quality of life. For this reason, it is essential to treat the disease medically.
By regularly taking the prescribed medication, the thyroid malfunction associated with the disease can be combated. If they experience particular behavioral or mood changes, patients should heed these warnings and be honest with their doctor. In this context, social behavior plays a role that should not be underestimated.
If necessary, treatment by a psychotherapist is advisable. If the psychological mood is balanced, it is much easier for the patient to deal better with the physical complaints and the special symptoms. Such therapy can therefore be very important even for children and adolescents. With repeated nausea, vomiting and sharp changes in body weight, patients should not hesitate for long, but make an appointment with a doctor soon. By acting quickly on such alarm signals, those affected can get their complaints under control quite well.