bubble_chart Overview

Hypopituitarism, also known as Simmonds' disease, refers to a syndrome caused by the inability of the anterior pituitary gland to secrete sufficient hormones to meet the body's basal, physiological, or stress-related needs. **Causes:** 1. **Ischemic necrosis of the anterior pituitary** – Postpartum pituitary necrosis is referred to as Sheehan syndrome. Diabetic microangiopathy can also lead to pituitary ischemic infarction. 2. **Pituitary and hypothalamic tumors** 3. **Pituitary infiltrative diseases** – Such as leukemia and sarcoidosis. 4. **Autoimmune hypophysitis** 5. **Other causes** – Radiation therapy and chemotherapy; pituitary resection; infectious diseases such as pituitary abscess, subcutaneous nodules, encephalitis, or basal meningitis; empty sella syndrome (rare). 6. **Idiopathic** – Often manifests as a single hormone deficiency.

bubble_chart Diagnosis

1. Medical History and Symptoms:

Postpartum lactation reduction or absence; hypogonadism, decreased menstruation or amenorrhea, decreased libido, hair loss, atrophy of reproductive organs and breasts; testicular atrophy in males, impotence, atrophy of external genitalia and prostate; hypothyroidism, apathy, cold intolerance, sluggishness, bradycardia, thinning of eyebrows and hair, etc.; adrenal cortical insufficiency, weakness, fatigue, anorexia, hypotension, skin hypopigmentation, hypoglycemia, hyponatremia, etc. GH deficiency, short stature.

2. Auxiliary Examinations:

1. Endocrine function tests:

Show simultaneous reduction of pituitary tropic hormones and corresponding target gland hormones. (1) Decreased levels of target gland hormones and their metabolites in blood (T3, T4, FT3, FT4, TSH, ACTH, P, T, E2, FSH, LH); (2) After continuous stimulation with pituitary tropic hormones (TSH, CTH, LH) for several days, target gland hormones gradually increase, showing a delayed response, which can differentiate it from primary target gland hypofunction. (3) No response to TRH, CRH, or LHRH stimulation tests.

2. Sella turcica X-ray:

Enlargement of the sella turcica may indicate hypothalamic or pituitary tumors. Microadenomas may not enlarge the sella but can cause localized destruction; CT or MRI can aid in further diagnosis.

3. Differential Diagnosis:

Should be distinguished from nervous anorexia and target gland hypofunction. Long-term primary hypothyroidism can also cause TSH cell hyperplasia and pituitary enlargement, which should not be mistaken for hypopituitarism caused by pituitary tumors.

bubble_chart Treatment Measures

1. Hormone Replacement Therapy:

Supplement deficient target gland hormones to approximate normal secretion patterns.

1. Adrenocortical Hormones:

Cortisone or hydrocortisone 12.5–37.5 mg/day; or prednisone 5–7.5 mg, divided into two doses taken in the morning and afternoon, with 2/3 of the dose in the morning and 1/3 in the afternoon. During stress (e.g., infection, surgery, trauma, childbirth, etc.), the dosage should be temporarily increased by 2–3 times, and in severe cases, managed as a crisis. Most patients with hypopituitarism do not require mineralocorticoids.

2. Thyroid Hormones:

L-Thyroxine tablets, starting at 50 μg/day and gradually increasing to 100–200 μg/day. Thyroid tablets may also be taken orally. To prevent exacerbation of adrenocortical insufficiency, glucocorticoids should be used before or concurrently with thyroid hormone therapy.

3. Sex Hormones and Gonadotropins:

(1) Males: Testosterone propionate 25–50 mg, intramuscular injection, 1–2 times per week, or testosterone enanthate 200 mg, intramuscular injection, every 3–4 weeks. To promote spermatogenesis, HMG and HCG may be combined: the former is injected intramuscularly every other day at 1–2 ampules, for a course of over 3 months; the latter is injected intramuscularly 2–3 times per week at 1000 IU per dose.

(2) Females: For premenopausal women, artificial cycle therapy is used. Oral diethylstilbestrol 0.5–1 mg/day for 24 days, with progesterone 10 mg intramuscular injection added on days 21–25, leading to menstruation after withdrawal. Low-dose androgens may also be added, such as testosterone propionate 12.5 mg intramuscular injection 1–2 times per week.

2. Chinese Medicine Chinese Medicinals:

Mostly warming and tonifying kidney yang and qi-replenishing, blood-nourishing herbs, such as Right-Restoring Pill, Middle-Tonifying Qi-Replenishing Decoction, and Ten-Ingredient Major Tonifying Pill, to enhance the efficacy of hormone replacement therapy.

3. Etiological Treatment:

Pituitary tumors are treated with radiotherapy or surgical resection, while hypothalamic tumors require surgical intervention.