Acerca de

HYPOPITUITARISM
Overview
 

Hypopituitarism is a rare disorder in which your pituitary gland fails to produce one or more hormones, or doesn't produce enough hormones.

The pituitary gland is a kidney-bean-sized gland situated at the base of your brain. It is part of your body's endocrine system, which consists of all the glands that produce and regulate hormones. Despite its small size, the pituitary gland creates and releases a number of hormones that act on nearly every part of your body.

Hypopituitarism is when you have a short supply (deficiency) of one or more of the pituitary hormones. These hormone deficiencies can affect any number of your body's routine functions, such as growth, blood pressure or reproduction. Symptoms typically vary, based on which hormone or hormones you are missing.

If you have hypopituitarism, you'll likely need to take medication for the rest of your life. Medication helps replace the missing hormones, which helps control your symptoms.

 

Symptoms


The signs and symptoms of hypopituitarism usually develop gradually and get worse over time. They are sometimes subtle and may be overlooked for months or even years. But for some people, signs and symptoms develop suddenly.

Signs and symptoms of hypopituitarism vary from person to person, depending on which pituitary hormones are affected and to what degree. In people who have more than one pituitary hormone deficiency, the second deficiency may increase or, in some cases, hide the symptoms of the first deficiency.

 

Growth hormone (GH) deficiency


In children, GH deficiency may cause growth problems and short stature. Most adults who have GH deficiency don't have any symptoms, but for some adults, it can cause:

  • Fatigue

  • Muscle weakness

  • Changes in body fat composition

  • Lack of ambition

  • Social isolation

 
Luteinizing hormone (LH) and follicle-stimulating hormone (FSH) deficiency


The deficiency of these hormones called gonadotropins, affect the reproductive system. In women, the deficiency decreases egg and estrogen production from the ovaries. In men, the deficiency decreases sperm and testosterone production from the testicles. Women and men may experience a lower sex drive, infertility or fatigue. In children and adolescents, delayed puberty is usually the only symptom.

 

Women may also have symptoms such as:

  • Hot flashes

  • Irregular or no periods

  • Loss of pubic hair

  • An inability to produce milk for breast-feeding

 

Men may also have symptoms such as:

  • Erectile dysfunction

  • Decreased facial or body hair

  • Mood changes

 
Thyroid-stimulating hormone (TSH) deficiency


This hormone controls the thyroid gland. A TSH deficiency leads to low levels of thyroid hormones (hypothyroidism). This causes symptoms such as:

 

  • Fatigue

  • Weight gain

  • Dry skin

  • Constipation

  • Sensitivity to cold or difficulty staying warm


Adrenocorticotropic hormone (ACTH) deficiency


This hormone helps your adrenal glands work properly and helps your body react to stress. Symptoms of ACTH deficiency include:

  • Severe fatigue

  • Low blood pressure, which may lead to fainting

  • Frequent and prolonged infections

  • Nausea, vomiting or abdominal pain

  • Confusion

 

Anti-diuretic hormone (ADH) deficiency


This hormone, which is also called vasopressin, helps your body balance its fluid levels. An ADH deficiency can cause a disorder called diabetes insipidus, which can cause:

  • Excessive urination

  • Extreme thirst

  • Electrolyte imbalances

 

Prolactin deficiency

  • Prolactin is the hormone that tells the body when to start making breast milk. Low levels of prolactin can cause women to have problems making milk for breastfeeding.

 

When to see a doctor


See your doctor if you develop any of the signs and symptoms associated with hypopituitarism.

Contact your doctor immediately if signs or symptoms of hypopituitarism develop suddenly or are associated with a severe headache, visual disturbances, confusion or a drop in blood pressure. These could be signs and symptoms of sudden destruction of the pituitary gland tissue (pituitary apoplexy), often caused by bleeding into the pituitary gland. Pituitary apoplexy is a medical emergency and requires prompt medical attention.


Causes


Hypopituitarism has a number of causes. In many cases, hypopituitarism is caused by a tumor of the pituitary gland. As a pituitary tumor increases in size, it can compress and damage pituitary tissue, interfering with hormone production. A tumor can also compress the optic nerves, causing visual disturbances.

In addition to tumors, certain diseases or events that cause damage to the pituitary gland may also trigger hypopituitarism.

 

Examples include:

  • Head injuries

  • Brain surgery

  • Radiation treatment to the head or neck

  • Lack of blood flow to the brain or pituitary gland (stroke) or bleeding (haemorrhage) into the brain or pituitary gland

  • Certain medications, such as narcotics, high-dose corticosteroids or certain cancer drugs called checkpoint inhibitors

  • Inflammation of the pituitary gland caused by an abnormal immune system response (hypophysitis)

  • Infections of the brain, such as meningitis, or infections that can spread to the brain, such as tuberculosis or syphilis

  • Infiltrative diseases, which affect multiple parts of the body, including sarcoidosis, an inflammatory disease occurring in various organs; Langerhans cell histiocytosis, in which abnormal cells cause scarring in numerous parts of the body; and hemochromatosis, which causes excess iron deposits in the liver and other tissues

  • Severe loss of blood during childbirth, which may cause damage to the front part of the pituitary gland (Sheehan's syndrome or postpartum pituitary necrosis)

  • In some cases, hypopituitarism is caused by a genetic mutation (inherited). These mutations affect the pituitary gland's ability to produce one or more of its hormones, often starting at birth or in early childhood.

  • Tumors or diseases of the hypothalamus, a portion of the brain situated just above the pituitary, also can cause hypopituitarism. The hypothalamus produces hormones of its own that directly affect the activity of the pituitary gland.

  • In some cases, the cause of hypopituitarism is unknown.

By Mayo Clinic Staff

READ MORE AT:

https://www.mayoclinic.org/diseases-conditions/hypopituitarism/symptoms-causes/syc-20351645#:~:text=Hypopituitarism%20is%20a%20rare%20disorder,the%20base%20of%20your%20brain

Overview

 

Diabetes insipidus is an uncommon disorder that causes an imbalance of fluids in the body. This imbalance leads you to produce large amounts of urine. It also makes you very thirsty even if you have something to drink.

While the terms "diabetes insipidus" and "diabetes mellitus" sound similar, they're not related. Diabetes mellitus — which involves high blood sugar levels and can occur as type 1 or type 2 — is common and often referred to simply as diabetes.

There's no cure for diabetes insipidus. But treatments can relieve your thirst and decrease your urine output and prevent dehydration.

Symptoms

 

Signs and symptoms of diabetes insipidus include:

  • Being extremely thirsty

  • Producing large amounts of pale urine

  • Frequently needing to get up to urinate during the night

  • Preferring cold drinks

 

If your condition is serious and you drink a lot of fluids, you can produce as much as 20 quarts (about 19 litres) of urine a day. A healthy adult typically urinates an average of 1 to 2 quarts (about 1 to 2 litres) a day.

 

An infant or young child with diabetes insipidus may have the following signs and symptoms:

  • Heavy, wet diapers

  • Bed-wetting

  • Trouble sleeping

  • Fever

  • Vomiting

  • Constipation

  • Delayed growth

  • Weight loss

 

When to see a doctor

 

See your doctor immediately if you notice excessive urination and extreme thirst.

Causes

 

Diabetes insipidus occurs when your body can't properly balance the body's fluid levels.

Your kidneys filter the fluid portion of your blood to remove waste products. The majority of the fluid is returned to the bloodstream while the waste and a smaller amount of fluid make up urine. Urine is excreted from your body after being temporarily stored in your bladder.

A hormone called anti-diuretic hormone (ADH), or vasopressin, is needed for the fluid that's filtered by the kidneys to go back into the bloodstream. ADH is made in a part of the brain called the hypothalamus and stored in the pituitary gland, a small gland found in the base of the brain. Conditions that cause a deficiency of ADH or block the effect of ADH result in the production of excess urine.

If you have diabetes insipidus, your body can't properly balance fluid levels.

 

The cause depends on the type of diabetes insipidus you have. Types include:

  • Central diabetes insipidus.
    • Damage to the pituitary gland or hypothalamus from surgery, a tumour, head injury or illness can cause central diabetes insipidus by affecting the usual production, storage and release of ADH. An inherited genetic disease also can cause this condition.

  • Nephrogenic diabetes insipidus.
    • Nephrogenic diabetes insipidus occurs when there's a defect in the structures in your kidneys that makes your kidneys unable to properly respond to ADH. The defect may be due to an inherited (genetic) disorder or a chronic kidney disorder. Certain drugs, such as lithium or antiviral medications such as foscarnet (Foscavir), also can cause nephrogenic diabetes insipidus.

  • Gestational diabetes insipidus.
    • Gestational diabetes insipidus is rare. It occurs only during pregnancy when an enzyme made by the placenta destroys ADH in the mother.

  • Primary polydipsia.
    • Also known as dipsogenic diabetes insipidus, this condition can cause the production of large amounts of diluted urine from drinking excessive amounts of fluids. Primary polydipsia can be caused by damage to the thirst-regulating mechanism in the hypothalamus. The condition has also been linked to mental illness, such as schizophrenia.

 

Sometimes, there's no obvious cause of diabetes insipidus. However, in some people, the disorder may be the result of an autoimmune reaction that causes the immune system to damage the cells that make vasopressin.

Risk factors

 

Nephrogenic diabetes insipidus that's present at or shortly after birth usually has an inherited (genetic) cause that permanently changes the kidneys' ability to concentrate urine. Nephrogenic diabetes insipidus usually affects males, though women can pass the gene on to their children.

 
Complications
 
Dehydration

Diabetes insipidus may lead to dehydration. Dehydration can cause:

  • Dry mouth

  • Changes in skin elasticity

  • Thirst

  • Fatigue

 
Electrolyte imbalance

Diabetes insipidus can cause an imbalance in minerals in your blood, such as sodium and potassium (electrolytes), that maintains the fluid balance in your body. Symptoms of an electrolyte imbalance may include:

  • Weakness

  • Nausea

  • Vomiting

  • Loss of appetite

  • Muscle cramps

  • Confusion

 

By Mayo Clinic Staff

READ MORE AT:

https://www.mayoclinic.org/diseases-conditions/diabetes-insipidus/symptoms-causes/syc-20351269#:~:text=Diabetes%20insipidus%20(die%2Duh%2D,you%20have%20something%20to%20drink.

Celiac disease
 
Overview

Celiac disease, sometimes called celiac sprue or gluten-sensitive enteropathy, is an immune reaction to eating gluten, a protein found in wheat, barley and rye.

If you have celiac disease, eating gluten triggers an immune response in your small intestine. Over time, this reaction damages your small intestine's lining and prevents it from absorbing some nutrients (malabsorption). The intestinal damage often causes diarrhea, fatigue, weight loss, bloating and anemia, and can lead to serious complications.

In children, malabsorption can affect growth and development, besides causing the symptoms seen in adults.

There's no cure for celiac disease — but for most people, following a strict gluten-free diet can help manage symptoms and promote intestinal healing.

 
Symptoms

The signs and symptoms of celiac disease can vary greatly and differ in children and adults. Digestive signs and symptoms for adults include:

  • Diarrhea

  • Fatigue

  • Weight loss

  • Bloating and gas

  • Abdominal pain

  • Nausea and vomiting

  • Constipation

However, more than half the adults with celiac disease have signs and symptoms unrelated to the digestive system, including:

  • Anemia, usually from iron deficiency

  • Loss of bone density (osteoporosis) or softening of bone (osteomalacia)

  • Itchy, blistery skin rash (dermatitis herpetiformis)

  • Mouth ulcers

  • Headaches and fatigue

  • Nervous system injury, including numbness and tingling in the feet and hands, possible problems with balance, and cognitive impairment

  • Joint pain

  • Reduced functioning of the spleen (hyposplenism)

 
Children

Children with celiac disease are more likely than adults to have digestive problems, including:

  • Nausea and vomiting

  • Chronic diarrhea

  • Swollen belly

  • Constipation

  • Gas

  • Pale, foul-smelling stools

The inability to absorb nutrients might result in:

  • Failure to thrive for infants

  • Damage to tooth enamel

  • Weight loss

  • Anemia

  • Irritability

  • Short stature

  • Delayed puberty

  • Neurological symptoms, including attention-deficit/hyperactivity disorder (ADHD), learning disabilities, headaches, lack of muscle coordination and seizures

 
Dermatitis herpetiformis

Gluten intolerance can cause this itchy, blistering skin disease. The rash usually occurs on the elbows, knees, torso, scalp and buttocks. This condition is often associated with changes to the lining of the small intestine identical to those of celiac disease, but the skin condition might not cause digestive symptoms.

Doctors treat dermatitis herpetiformis with a gluten-free diet or medication, or both, to control the rash.

 
When to see a doctor

Consult your doctor if you have diarrhea or digestive discomfort that lasts for more than two weeks. Consult your child's doctor if your child is pale, irritable or failing to grow or has a potbelly and foul-smelling, bulky stools.

Be sure to consult your doctor before trying a gluten-free diet. If you stop or even reduce the amount of gluten you eat before you're tested for celiac disease, you can change the test results.

Celiac disease tends to run in families. If someone in your family has the condition, ask your doctor if you should be tested. Also ask your doctor about testing if you or someone in your family has a risk factor for celiac disease, such as type 1 diabetes.

 

Causes

Your genes combined with eating foods with gluten and other factors can contribute to celiac disease, but the precise cause isn't known. Infant-feeding practices, gastrointestinal infections and gut bacteria might contribute, as well. Sometimes celiac disease becomes active after surgery, pregnancy, childbirth, viral infection or severe emotional stress.

When the body's immune system overreacts to gluten in food, the reaction damages the tiny, hairlike projections (villi) that line the small intestine. Villi absorb vitamins, minerals and other nutrients from the food you eat. If your villi are damaged, you can't get enough nutrients, no matter how much you eat.

 
Risk factors

Celiac disease tends to be more common in people who have:

  • A family member with celiac disease or dermatitis herpetiformis

  • Type 1 diabetes

  • Down syndrome or Turner syndrome

  • Autoimmune thyroid disease

  • Microscopic colitis (lymphocytic or collagenous colitis)

  • Addison's disease

 
Complications

Untreated, celiac disease can cause:

  • Malnutrition. This occurs if your small intestine can't absorb enough nutrients. Malnutrition can lead to anemia and weight loss. In children, malnutrition can cause slow growth and short stature.

  • Bone weakening. Malabsorption of calcium and vitamin D can lead to a softening of the bone (osteomalacia or rickets) in children and a loss of bone density (osteopenia or osteoporosis) in adults.

  • Infertility and miscarriage. Malabsorption of calcium and vitamin D can contribute to reproductive issues.

  • Lactose intolerance. Damage to your small intestine might cause you abdominal pain and diarrhea after eating or drinking dairy products that contain lactose. Once your intestine has healed, you might be able to tolerate dairy products again.

  • Cancer. People with celiac disease who don't maintain a gluten-free diet have a greater risk of developing several forms of cancer, including intestinal lymphoma and small bowel cancer.

  • Nervous system problems. Some people with celiac disease can develop problems such as seizures or a disease of the nerves to the hands and feet (peripheral neuropathy).

 
Non-responsive celiac disease

Some people with celiac disease don't respond to what they consider to be a gluten-free diet. Non-responsive celiac disease is often due to contamination of the diet with gluten. Working with a dietitian can help you learn how to avoid all gluten.

People with non-responsive celiac disease might have:

  • Bacteria in the small intestine (bacterial overgrowth)

  • Microscopic colitis

  • Poor pancreas function (pancreatic insufficiency)

  • Irritable bowel syndrome

  • Difficulty digesting sugar found in dairy products (lactose), table sugar (sucrose), or a type of sugar found in honey and fruits (fructose)

  • Refractory celiac disease

 
Refractory celiac disease

In rare instances, the intestinal injury of celiac disease doesn't respond to a strict gluten-free diet. This is known as refractory celiac disease. If you still have signs and symptoms after following a gluten-free diet for six months to one year, you might need further testing to look for other explanations for your symptoms.

By Mayo Clinic Staff

https://www.mayoclinic.org/diseases-conditions/celiac-disease/symptoms-causes/syc-20352220