1、Hypopituitarism(腺垂体功能减退症腺垂体功能减退症)Endocrinology department,the 1st affiliated hospital,chongqing medical universityJian longSella turcica（蝶鞍）（蝶鞍）Bean-shapedWeight:5 g Thyroid gland Adrenal gland Ovary(甲状腺）甲状腺）（肾上腺）（卵巢）（肾上腺）（卵巢）TargetglandAnterior part （前叶）（前叶）(Adenohypophysis)(腺垂体腺垂体)Posterior part (
2、后叶后叶)(Neurohypophysis)(神经垂体）神经垂体）Pituitary stalk (垂体柄垂体柄)Hypothalamus （下丘脑）（下丘脑）1）Positive feedback2）Negative feedbackHypothalamus Pituitary gland Target glands（下丘脑）（下丘脑）（垂体）（垂体）Hypothalamus Pituitary gland Target glands（下丘脑）（下丘脑）（垂体）（垂体）Feedback(反馈反馈)HypothalamusPIF(prolactin inhibiting factor)GHRH
3、(GH releasing hormone)LHRH(LH releasing hormone)TRH(TSH releasing hormone)CRH(Corticotropic releasing hormone)Anterior pituitary glandPRL(Prolactin)（催乳素）GH（growth hormone）(生长激素)LH(luteinizing hormone)(黄体生成素)FSH(follicle stimulating hormone)（卵泡刺激素）TSH（thyroid stimulating hormone)（促甲状腺激素）ACTH(adrenal
4、cortex stimulating hormone)促肾上腺皮质激素)Target glandE2、E3(estrogen)T(testosterone)T3、T4CortisoneHormonesHypopituitarismDefinition:Hypopituitarism is a condition in which the pituitary gland does not produce one or more of its hormones or not enough of them.Etiology(病因学):Primary Secondary1、tumor 2、ischem
5、ic necrosis（坏死）3、surgery、trauma、radiotherapy（放疗）3、infection、infiltration（浸润）4、hereditary disease（遗传）5、autoimmune disease（自身免疫）1.Secondary:damage to hypothalamus or pituitary stalk2.Primary:damage to pituitarySecondaryPrimary SecondarySimmond disease:is one kind of hypopituitarism,which accures only
6、in adult.Sheehans syndrome:is one kind of hypopituitarism,in which the decreased productions of the anterior pituitary hormones are due to ischemic postpartum（产后）pituitary necrosis（坏死）or septicemia（败血症）after delivery.HypopituitarismSimmond diseaseSheehans syndrome primary disease uthe kind of defici
7、ent pituitary hormonesuthe degree of the deficiency uthe rate of disease progression1 kind2 kinds3 kindsall kindsFunction loss Symptoms and signs50%insidious（隐匿的）75%obvious（显著的）95%serious（严重的）prolactin(PRL)gonadotropin(LH、FSH)growth hormone(GH)thyrotropin(TSH)corticotropin(ACTH)PRL can not lactate(泌
8、乳）after delivery2、Gonadotropin deficiencyAmenorrhoea（闭经）、Infertility（不孕）Regression of secondary sexal characteristics3、Growth hormone(GH)deficiency In adult it is not obvious.Symptoms and signs of hypopituitarismSymptoms and signs of hypopituitarism4、TSH deficiency Intolerance of colddry skinpallor（
9、苍白）（苍白）Periorbital puffiness（浮肿）（浮肿）horseness of voice bradycardia（心动过缓）（心动过缓）weight gainconstipation（便秘）（便秘）loss of hairSymptoms and signs hypopituitarism5、fatigue(乏力）乏力）anorexia（厌食）（厌食）nausea、vomiting loss of hairpostural hypotensionhypoglycemia（低血糖）（低血糖）hypopigmentation（色素减少）（色素减少）Hypopituitarism
10、 Primary hypoadrenocorticism(原发性肾上腺皮质功能减退原发性肾上腺皮质功能减退)POMCdecreasedincreasedpigmenthypopigmentation hyperpigmentation They possess several kinds of hormone deficiency,or all kinds.Symptoms and signs in hypopituitarism are combined by each kind of symptoms and signs due to hormones deficiency.Investi
11、gation1、Measurement of hormones 2、Stimulating test Investigation1、Measurement of hormones level pituitary hormonestarget glands hormonesPRLGHGnRH(LH、FSH)E2、TTSHT3、T4ACTHCortisonehypopituitarism normal range 2、Stimulating test：1）assess pituitary function 2)assess target gland function1)Assessment of
12、the functions of pituitary GHRH or CRF or LHRH is injecting into humans body,then measure the level of pituitary hormones and target gland hormones.Hormone from hypothalamus Hormone from pituitary glandGHRHGH CRFACTHLHRHLH、FSHCan not be elevatedHormone from pituitary glandTarget gland hormonesACTHco
13、rtisoneTSHT3、T42)Assessment of the function of target glandsInsulin-hypoglycemia stimulating testinsulin injection to induce hypoglycemiacortisoneAdrenal gland3、others Hypoglycemia Hypotension Hyposalemia(低钠血症)Anemia（贫血）4、Imageological examination（影像学检测）（影像学检测）CT or MRI X-rayDiagnosis1)history of da
14、mage to pituitary gland or hypothalamus2)symptoms and signs related to hormone deficiency3)evidency of anterior pituitary hormone deficiencyTreatmentHormone replacementAll life replacement1、Adrenal hormone replacement must be first Hydrocortisone 20mg 8AM 10mg 4PM Cortisone 5mg 8AM 2.5mg 4PM Fludroc
15、ortisone may be not required if necessary 0.1-0.2mg/d Goal:No symptoms and signs due to adrenal gland hormone deficiency.No symptoms and signs of due to adrenal gland hormone overdose.2、Thyroid hormone replacement L-T4 original dose 12.5-25ug/d maintenance dose 100-200ug/d 3、Sexal hormone Replacemen
16、t For people in reproductive age or anxiety for fertility Estrgen(雌激素)the first 25 days in each month Prosteron（孕激素）day 15 through 25 Goal:T3 T4 in normal rangePituitary crisisPituitary crisis occurred on the basis of pituitary dysfunction in various stress reactions.Treatment of pituitary crisis 1.Supplement of glucose First 50%glucose,40 to 60 ml,rescue hypoglycemia.10%glucose to maintain input2.Corticosteroids applications Hydrocortisone 200 of 300 mg decreasing the amount gradully to oral.3.Thyroid hormone replacement4.remove incentives(去除诱因)5.supportive treatment
