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necrosis of pituitary

Description

Necrosis of the Pituitary Gland: A Rare but Serious Condition

Necrosis of the pituitary gland, also known as Sheehan syndrome or postpartum pituitary necrosis, is a rare and serious condition that occurs when the pituitary gland is damaged due to significant blood loss and hypovolemic shock. This can happen during childbirth, leading to decreased functioning of the pituitary gland (hypopituitarism).

Causes and Risk Factors

The pituitary gland is a kidney-bean-sized gland at the base of the brain that plays a crucial role in producing hormones. In cases of Sheehan syndrome, a severe spasm of the blood vessels feeding the pituitary gland leads to lack of oxygen in the pituitary (pituitary ischemia) and various degrees of cellular damage depending on the severity and duration of arteriolar spasm.

Symptoms and Effects

When this happens, there's less blood flowing to the cells in the pituitary gland, and that tips them over - resulting in ischemic necrosis. This can lead to insufficient production of all the anterior pituitary hormones, causing a range of symptoms including:

  • Fatigue
  • Weight gain or loss
  • Hair loss
  • Cold intolerance
  • Infertility

Prevalence and Treatment

Sheehan syndrome is a rare cause of pituitary apoplexy and hypopituitarism. It only occurs in postpartum females who experience large volume hemorrhage and shock. Advances in obstetrical care have reduced the incidence of this condition, but it still remains a significant cause of morbidity and mortality in less developed countries.

References

  • [1] Sheehan's syndrome is also known as post-partum pituitary necrosis, occurs when the pituitary gland is damaged due to significant blood loss and hypovolemic shock (ischemic necrosis) or stroke.
  • [2] The pituitary gland is a kidney-bean-sized gland at the base of your brain. It is part of the body's system of glands that make hormones, called the endocrine system.
  • [3] Reduced blood supply of the pituitary gland is attributed to Sheehan’s syndrome, a common cause of hypopituitarism in post-partum women.
  • [4] Necrosis of cells of the anterior pituitary gland following significant post-partum bleeding, hypovolemia, and shock.

Additional Characteristics

  • Necrosis of the pituitary gland
  • Sheehan syndrome
  • postpartum pituitary necrosis
  • ischemic necrosis
  • hypopituitarism

Signs and Symptoms

The signs and symptoms of necrosis of the pituitary gland, also known as Sheehan syndrome or postpartum pituitary necrosis, can vary from person to person and depend on the extent to which the pituitary gland is failing to produce its hormones.

Common Symptoms:

  • Prolactin deficiency, leading to difficulty with lactation (1)
  • Decreased production of other hormones, such as growth hormone, thyroid-stimulating hormone, and adrenocorticotropic hormone (2)
  • Fatigue, weakness, and weight loss due to decreased production of hormones that regulate metabolism (3)
  • Decreased libido and fertility issues in both men and women (4)

Variable Symptoms:

  • The clinical features of Sheehan syndrome are highly variable and depend on the degree of failure of secretion of pituitary hormones (3)
  • Some people may experience a decrease in blood pressure, leading to dizziness or fainting spells (5)
  • Others may have difficulty with wound healing due to decreased production of growth hormone (6)

Rare but Serious Symptoms:

  • In rare and more serious cases, referred to as acute Sheehan's syndrome, the symptoms appear right after childbirth and can include:
    • Severe headache
    • Nausea
    • Vomiting
    • Visual loss or double vision
    • Loss of consciousness
    • Fever
    • Stiff neck (7)
    • Hormone insufficiency (8)

It's essential to note that the symptoms of Sheehan syndrome can be similar to those of other conditions, such as pituitary apoplexy. A proper diagnosis by a healthcare professional is necessary to determine the underlying cause of these symptoms.

References: (1) - [1] (2) - [2] (3) - [3] (4) - [4] (5) - [5] (6) - [6] (7) - [7] (8) - [8]

Diagnostic Tests

Diagnostic Tests for Pituitary Necrosis

Pituitary necrosis, also known as Sheehan syndrome, can be diagnosed through various tests that measure hormone levels and image the pituitary gland.

  • Blood tests: Blood tests are used to measure the levels of hormones produced by the pituitary gland, such as ACTH (adrenocorticotropic hormone), cortisol, FSH (follicle-stimulating hormone), growth hormone, LH (luteinizing hormone) [6]. These tests can help identify hormonal imbalances that may indicate pituitary necrosis.
  • Imaging tests: Imaging tests, such as MRI (magnetic resonance imaging), are used to visualize the pituitary gland and detect any abnormalities, including tumors or necrotic tissue [9][11].
  • Measurement of pituitary hormone levels: Blood tests can also measure the levels of pituitary hormones after various provocative stimuli to confirm the diagnosis [15].

Additional Tests

In some cases, additional tests may be required to rule out other conditions that may cause similar symptoms. These tests may include:

  • Electrolyte tests: To check for electrolyte imbalances, such as hyponatremia [5].
  • Complete Blood Count (CBC): To check for anemia or other blood-related disorders [5].

Early Diagnosis and Treatment

Early diagnosis and treatment are essential to reduce morbidity and mortality associated with pituitary necrosis. A healthcare provider may order these tests to confirm the diagnosis and develop a treatment plan.

References:

[5] - Context result 5 [6] - Context result 6 [9] - Context result 9 [11] - Context result 11 [15] - Context result 15

Treatment

Based on the provided context, it appears that there are several drug treatments available for necrosis of the pituitary gland.

  • Hydrocortisone: This medication is used to decrease inflammation by suppressing migration of cells into inflamed areas. It can be administered in high doses to patients with hypopituitarism (1) and is a lifesaving measure in cases of classical pituitary apoplexy (2).
  • Dexamethasone: This corticosteroid has been used to treat patients with pituitary necrosis, particularly when surgery is not indicated. It can be administered intravenously in doses ranging from 2.0-16.0 mg/day (3).
  • Pasireotide: This medication works by lowering the amount of ACTH a pituitary adenoma makes and is taken as a shot twice a day (6).

Additionally, patients with hypopituitarism may require replacement therapy for various hormones, including growth hormone, sex hormones (estrogen/testosterone), thyroid hormone, and vasopressin (ADH) (5).

It's worth noting that the treatment of pituitary necrosis can vary depending on the individual case, and a clinical practice guideline with recommendations based on medical evidence is available (8).

Differential Diagnosis

The differential diagnosis for necrosis of the pituitary gland includes several conditions that can present with similar symptoms and imaging findings.

Common Differential Diagnoses

  • Pituitary Apoplexy: This is a condition where there is sudden hemorrhage or infarction of the pituitary gland, leading to necrosis. It can be caused by various factors such as pre-existing pituitary adenoma, hypertension, and vascular events [8].
  • Sheehan Syndrome (Postpartum Pituitary Necrosis): This condition occurs when there is significant post-partum bleeding, hypovolemia, and shock leading to necrosis of the anterior pituitary gland cells [1].
  • Pituitary Metastases: These are metastatic tumors that involve the pituitary gland, which can present with similar imaging findings as pituitary apoplexy [6].
  • Meningioma: This is a type of tumor that arises from the meninges surrounding the brain and spinal cord. When it grows into the sellar region, it can be difficult to differentiate from pituitary apoplexy on MRI [14].

Other Conditions

  • Subarachnoid Hemorrhage (SAH): This is a condition where there is bleeding in the space between the brain and the skull, which can present with similar symptoms as pituitary apoplexy [2].
  • Infectious Meningitis: This is an infection of the meninges that can cause inflammation and necrosis of the surrounding tissues.
  • Cavernous Sinus Thrombosis: This is a condition where there is clotting in the cavernous sinus, which can lead to necrosis of the surrounding tissues.

Imaging Findings

The differential diagnosis for pituitary necrosis can be challenging on imaging studies. MRI with advanced techniques such as T2*GE can help differentiate between these conditions [15]. The most common findings include:

  • Hyperintensity on T1WI: This is a common feature of pituitary apoplexy, but it can also be seen in other conditions such as meningioma and metastases.
  • Sellar region involvement: This is a key feature that differentiates pituitary necrosis from other conditions.

Clinical Presentation

The clinical presentation of pituitary necrosis can vary depending on the underlying cause. However, common symptoms include:

  • Acute or subacute onset: This is a characteristic feature of pituitary apoplexy and Sheehan syndrome.
  • Headache: This is a common symptom that can be seen in various conditions including SAH and meningitis.

In conclusion, the differential diagnosis for necrosis of the pituitary gland includes several conditions that can present with similar symptoms and imaging findings. A thorough clinical evaluation and advanced imaging techniques are essential to differentiate between these conditions.

Additional Information

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