Interstitial-pituitary insufficiency

Interstitial - pituitary insufficiency
(Panhypopituitarism, diencephalic pituitary cachexia, Simmonds disease) is a disease characterized by loss or decrease in the function of the hypothalamic-pituitary system with secondary hypofunction of the peripheral endocrine glands.

Etiology. The defeat of the hypothalamic-pituitary system in infections (sepsis, encephalitis, tuberculosis), sarcoidosis, trauma, tumors or due to vascular disorders.

Pathogenesis. Falling or lowering of corticotropic, gonadotropic, thyreotropic functions of the pituitary causes hypofunction of the adrenal cortex, gonads, thyroid gland. The clinical picture depends on the degree of decrease in the triple functions of the pituitary gland.

Symptoms. Weakness, adynamy, apathy, lethargy, loss of appetite. Progressive weight loss, cachexia (with Simmonds disease). Symptoms of hypothyroidism of the thyroid gland, dryness, pallor of the skin, hair loss on the head, pubic region, in the armpits, brow drop, brittle bones, swelling of the face, chilliness, inhibition, drowsiness, constipation. Decreased activity of the adrenal cortex caused adynamia, hypotension, a tendency to hypoglycemia, dyspeptic disorders. The disorder of the gonadotropic function of the pituitary gland leads to amenorrhea, atrophy of the mammary glands in men, to impotence in men. Diencephalic pathology may manifest as a sleep disorder, polydipsia, bulimia.

With Sheehan's disease (interstitial-pituitary insufficiency, which developed as a result of massive blood loss and collapse during labor), non-simultaneous and uneven loss of tropic functions of the pituitary gland with hypofunction of a particular gland can be observed. Initial symptoms: weakness, dizziness, anorexia, agalactia, amenorrhea. Often the symptoms in the clinical picture are hypocorticism. Exhaustion, as with Simmonds disease, as a rule, is not observed. The diagnosis is based on anamnestic data, a clinic, a decrease in the content of 17-oxycorticosteroids in the blood and daily urine, low levels of TSH, and T3 T4 in plasma. When X-ray examination of the spine - often the phenomenon of osteoporosis.

Treatment. Substitution therapy with corticosteroids (cortisone 25-50 mg per day, prednisolone 5-10 mg / day). With low blood pressure, glucocorticosteroids are supplemented with an oil solution of deoxycorticosterone acetate in the form of an injection 5 mg 2-3 times a week or in tablets 1-3 times a day under the tongue 5-15 mg / day. Thyroid hormones (thyroid hormone, thyreocardium, thyrotoxicum, thyroxine), sex hormones depending on the sex of the patient (microfollin, progesterone, infecoundin, testosterone propionate, testanate, omnadren), anabolic steroids (retabolyl, methandrostenolone, silabolin), peritol, vitamins C, B1 , B6, B12. Diet with the introduction of a sufficient number of proteins, fats, vitamins.