Hipopituitarismo
Summary
Definition
History and exam
Key diagnostic factors
- presença de fatores de risco
- história de lesão cerebral traumática
- cefaleias
- deficiência de crescimento ou baixa estatura
- infertilidade
- hipoglicemia
- amenorreia/oligomenorreia
- galactorreia
- puberdade tardia
- história familiar de deficiências hormonais hipofisárias
- hipotensão
- defeitos de campo visual
- oftalmoplegia
Other diagnostic factors
- eventos cardiovasculares
- intolerância ao frio
- ganho de peso
- disfunção erétil e redução da libido
- náuseas
- vômitos
- fadiga
- fraqueza
- tontura
- constipação
- pele ressecada
- relaxamento tardio dos reflexos
- desejo sexual hipoativo
- fogacho
- noctúria e poliúria
- atrofia da mama
- massas óssea e muscular reduzidas
- perda de pelos axilares e pubianos
Risk factors
- tumor hipofisário
- apoplexia hipofisária
- cirurgia na hipófise
- irradiação craniana
- lesão cerebral traumática
- predisposição genética
- distúrbios inflamatórios
- doença hipotalâmica
- hemorragia pós-parto grave (síndrome de Sheehan)
- síndrome da sela vazia
- meningite tuberculosa
- sífilis
Diagnostic investigations
1st investigations to order
- eletrólitos séricos
- osmolaridade sérica e urinária
- 08:00 cortisol e hormônio adrenocorticotrófico
- testes da função tireoidiana
- 08:00 testosterona, hormônio folículo-estimulante e hormônio luteinizante (LH) em homens
- estradiol, hormônio folículo-estimulante e hormônio luteinizante em mulheres
- prolactina
- fator de crescimento semelhante à insulina-1
- teste de estimulação com tetracosactídeo
Investigations to consider
- teste de tolerância à insulina
- teste de privação de água e resposta à desmopressina
- ressonância nuclear magnética (RNM) hipofisária
- tomografia computadorizada (TC) da hipófise
- teste de metirapona do eixo adrenal
Treatment algorithm
apoplexia hipofisária
hipopituitarismo
Contributors
Authors
Bridget Sinnott, MD
Professor of Medicine
Medical College of Georgia
Augusta
GA
Disclosures
BS declares that she has no competing interests.
Acknowledgements
Dr Bridget Sinnott would like to gratefully acknowledge Dr Vidhi Shah, the previous contributor to this topic.
Disclosures
VS declares that she has no competing interests.
Peer reviewers
Amir Hamrahian, MD
Associate Program Director
Department of Endocrinology, Diabetes and Metabolism
Cleveland Clinic
Cleveland
OH
Disclosures
AH declares that he has no competing interests.
Andrew James, BSc, MB BCh, MD, MRCP, FRCP
Consultant Endocrinologist
Newcastle Hospitals NHS Foundation Trust
Royal Victoria Infirmary
Newcastle
UK
Disclosures
AJ declares that he has no competing interests.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
References
Key articles
Fleseriu M, Christ-Crain M, Langlois F, et al. Hypopituitarism. Lancet. 2024 Jun 15;403(10444):2632-48. Abstract
Freda PU, Beckers AM, Katznelson L, et al. Pituitary incidentaloma: an endocrine society clinical practice guideline. J Clin Endocrinol Metab. 2011 Apr;96(4):894-904.Full text Abstract
Fleseriu M, Hashim IA, Karavitaki N, et al. Hormonal replacement in hypopituitarism in adults: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2016 Oct 13;101(11):3888-921.Full text Abstract
Bhasin S, Brito JP, Cunningham GR, et al. Testosterone therapy in men with hypogonadism: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2018 May 1;103(5):1715-44.Full text Abstract
Yuen KCJ, Biller BMK, Radovick S, et al. American Association of Clinical Endocrinologists and American College of Endocrinology guidelines for management of growth hormone deficiency in adults and patients transitioning from pediatric to adult care. Endocr Pract. 2019 Nov;25(11):1191-232.Full text Abstract
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
Differentials
- Doença de Addison
- Hipotireoidismo primário
- Choque (cardiogênico ou séptico)
More Differentials指南
- Testosterone therapy in men with hypogonadism
- ACR appropriateness criteria: neuroendocrine imaging
More 指南患者教育信息
Problemas de fertilidade: perguntas a fazer ao seu médico
Problemas de fertilidade: alguns motivos
更多 患者教育信息
登录或订阅即可浏览 BMJ Best Practice 临床实践完整内容
内容使用需遵循免责声明