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How are the different hormonal treatments monitored? Monitoring central adrenal insufficiency and central hypothyroidism is not as clear-cut as monitoring their primary counterparts. • ACTH deficiency: Because there is no reliable marker to determine exact glucocorticoid requirements, dose adjustments depend on clinical status, comorbid conditions, and the patient’s sense of well-being. • TSH deficiency: Serum TSH levels cannot be …

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How is pituitary insufficiency treated? The goal of therapy is to replace hormone deficits as close to the physiologic pattern as possible. • ACTH deficiency: Hydrocortisone 15 to 20 mg per day, in two or three divided doses, or prednisone 5 mg per day, is commonly used to replace cortisol. Patients using divided doses of hydrocortisone should …

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Functional causes of pituitary insufficiency It is important to exclude functional hypopituitarism when patients present with an isolated pituitary deficit. Patients receiving high doses of oral glucocorticoids for > 6 weeks or those having frequent articular or epidural glucocorticoid injections or using high doses of potent inhaled glucocorticoids have suppressed plasma ACTH levels and may …

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Empty sella turcica occurs as a result of intrasellar herniation of the suprasellar subarachnoid space with compression of the pituitary gland producing, in many cases, a remodeling of the sella; this results from a combination of an incomplete diaphragm sella and increased cerebrospinal fluid pressure. It is classified as primary or secondary. Primary empty sella …

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Types of hypophysitis Hypophysitis is a general term used to describe chronic inflammation of the pituitary gland and can be classified according to the anatomic location of the pituitary involvement, the cause, and the histopathologic appearance. On the basis of clinical, radiologic, and pathologic findings, the condition is classified as adenohypophysitis, infundibuloneurohypophysitis, and panhypophysitis. Depending on …

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Sheehan’s syndrome is a form of hypopituitarism that occurs in women after delivering a baby, as a result of infarction within the adenohypophysis caused by massive uterine hemorrhage and hypovolemia. Typically, these women are unable to lactate for their newborn and have persistent amenorrhea and symptoms of hypocortisolemia and hypothyroidism. Pituitary MRI imaging shows an …

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How soon after radiation therapy should pituitary insufficiency be expected? Any radiation fields that include the hypothalamic–pituitary area can cause neuroendocrine dysfunction. Irradiation for sellar and parasellar tumors, primary brain tumors, nasopharyngeal carcinoma, acute lymphoid leukemia, and tumors of the skull base have been shown to compromise hypothalamic/pituitary function. Depending on the radiation dose and …

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