医学精品课件：02.2Hypopituitarism大课课件

Hypopituitarism(腺垂体功能减退症)Endocrinologydepartment,the1staffiliatedhospital,chongqingmedicaluniversityJianlongSellaturcica（蝶鞍）Bean-shapedWeight:5gThyroidglandAdrenalglandOvary

(甲状腺）（肾上腺）（卵巢）TargetglandAnteriorpart（前叶）

(Adenohypophysis)(腺垂体)Posteriorpart(后叶)(Neurohypophysis)(神经垂体）Pituitarystalk(垂体柄)Hypothalamus（下丘脑）1）Positivefeedback2）NegativefeedbackHypothalamusPituitaryglandTargetglands

（下丘脑）

（垂体）HypothalamusPituitaryglandTargetglands

（下丘脑）

（垂体）Feedback(反馈)HypothalamusPIF(prolactininhibitingfactor)GHRH(GHreleasinghormone)LHRH(LHreleasinghormone)TRH(TSHreleasinghormone)CRH(Corticotropicreleasinghormone)AnteriorpituitaryglandPRL

(Prolactin)（催乳素）GH（growthhormone）(生长激素)LH

(luteinizinghormone)(黄体生成素)FSH

(folliclestimulatinghormone)（卵泡刺激素）TSH（thyroidstimulatinghormone)（促甲状腺激素）ACTH

(adrenalcortexstimulatinghormone)促肾上腺皮质激素)TargetglandE2、E3(estrogen)T(testosterone)T3、T4CortisoneHormonesHypopituitarismDefinition:Hypopituitarismisaconditioninwhichthepituitaryglanddoesnotproduceoneormoreofitshormonesornotenoughofthem.Etiology(病因学):PrimarySecondary1、tumor2、ischemicnecrosis（坏死）3、surgery、trauma、radiotherapy（放疗）3、infection、infiltration（浸润）

4、hereditarydisease（遗传）5、autoimmunedisease（自身免疫）1.Secondary:damagetohypothalamusorpituitarystalk2.Primary:damagetopituitarySecondaryPrimarySecondarySimmonddisease:isonekindofhypopituitarism,whichaccures

onlyinadult.Sheehan’ssyndrome:isonekindofhypopituitarism,inwhichthedecreasedproductionsoftheanteriorpituitaryhormonesareduetoischemicpostpartum（产后）pituitarynecrosis（坏死）orsepticemia（败血症）afterdelivery.HypopituitarismSimmonddiseaseSheehan’ssyndromemanifestationofprimarydiseasemanifestationofhypopituitarism

Symptomsandsigns

aredependingonthekindofdeficientpituitaryhormonesthedegreeofthedeficiencytherateofdiseaseprogressionClinicalmanifestation1kind2kinds3kindsallkindsFunctionlossSymptomsandsigns50%insidious（隐匿的）>75%obvious（显著的）95%serious（严重的）Thepresentationisvariableandcomplex.Theclassiclosssequenceofpituitaryhormoneisinthefollowinginsheehan'syndrome:prolactin(PRL)gonadotropin(LH、FSH)growthhormone(GH)thyrotropin(TSH)corticotropin(ACTH)1、PRLdeficiency:

cannotlactate(泌乳）afterdelivery2、Gonadotropindeficiency

Amenorrhoea（闭经）、Infertility（不孕）Regressionofsecondarysexal

characteristics3、Growthhormone(GH)deficiency

Inadultitisnotobvious.SymptomsandsignsofhypopituitarismSymptomsandsignsofhypopituitarism4、TSHdeficiency

Intoleranceofcolddryskinpallor（苍白）Periorbital

puffiness（浮肿）

horsenessofvoicebradycardia（心动过缓）weightgainconstipation（便秘）lossofhairSymptomsandsigns

hypopituitarism5、ACTHdeficiencyfatigue(乏力）anorexia（厌食）nausea、vomitinglossofhairposturalhypotensionhypoglycemia（低血糖）hypopigmentation（色素减少）HypopituitarismPrimaryhypoadrenocorticism(原发性肾上腺皮质功能减退)POMCdecreasedincreasedpigmenthypopigmentationhyperpigmentationThePresentationisvariableandcomplex.Theypossessseveralkindsofhormonedeficiency,orallkinds.Symptomsandsignsinhypopituitarismarecombinedbyeachkindofsymptomsandsignsduetohormonesdeficiency.Investigation1、Measurementofhormones2、Stimulatingtest

Investigation1、MeasurementofhormoneslevelpituitaryhormonestargetglandshormonesPRLGHGnRH(LH、FSH)E2、TTSHT3、T4ACTHCortisonehypopituitarism

normalrange2、Stimulatingtest：

1）assesspituitaryfunction2)assesstargetglandfunction1)AssessmentofthefunctionsofpituitaryGHRHorCRForLHRHisinjectingintohuman’sbody,thenmeasurethelevelofpituitaryhormonesandtargetglandhormones.HormonefromhypothalamusHormonefrompituitaryglandGHRHGH

CRFACTHLHRHLH、FSHCannotbeelevatedHormonefrompituitaryglandTargetglandhormonesACTHcortisoneTSHT3、T42)AssessmentofthefunctionoftargetglandsInsulin-hypoglycemiastimulatingtestinsulininjectiontoinducehypoglycemiacortisoneAdrenalgland3、others

HypoglycemiaHypotensionHyposalemia(低钠血症)Anemia（贫血）4、Imageologicalexamination（影像学检测）CTorMRIX-rayDiagnosis1)historyofdamagetopituitaryglandorhypothalamus2)symptomsandsignsrelatedtohormonedeficiency3)evidencyofanteriorpituitaryhormonedeficiencyTreatmentHormonereplacementAlllifereplacement1、Adrenalhormonereplacement

mustbefirst

Hydrocortisone20mg8AM10mg4PMCortisone5mg8AM2.5mg4PM

Fludrocortisonemaybenotrequiredifnecessary0.1-0.2mg/d

Goal:

Nosymptomsandsignsduetoadrenalglandhormonedeficiency.

Nosymptomsandsignsofduetoadrenalglandhormoneoverdose.2、Thyroidhormonereplacement

L-T4originaldose12.5-25ug/dmaintenancedose100-200ug/d

3、SexalhormoneReplacement

Forpeopleinreproductiveageoran