Hypopituitarism in children
Summary/Definition
The pituitary gland is a gland located in the brain and consists of the anterior lobe, which produces growth hormone and thyroid—stimulating hormone, and the posterior lobe, which is responsible for the production of antidiuretic hormone and oxytocin. Hypopituitarism is a pathological condition in which there is a decrease in the secretion of one or more pituitary hormones.
Hypopituitarism can occur as a congenital disease without a well-defined cause, and be the result of genetic mutations, underdevelopment, injuries, hemorrhages, tumor formation and other factors.
Symptoms
The symptoms of hypopituitarism depend on which hormone is not enough in the body. The first symptom that usually manifests itself is a deficiency of growth hormone. This deficiency is usually accompanied by a consistent decrease in the level of gonadotropins, thyrotropin and adrenocorticotropin. The symptoms of growth hormone deficiency may not be obvious, but with age, similar symptoms may occur that are characteristic of a decrease in growth hormone levels due to pituitary gland problems. Thyroid hormone deficiency is manifested by symptoms such as fatigue, swelling, weight gain, dry skin and problems with the intestinal tract. In children, it can also cause growth retardation. Deficiency of adrenocorticotropic hormone, as a rule, does not manifest itself with characteristic symptoms, but in the case of physical stress, for example, surgery, serious symptoms such as severe fatigue, nausea, vomiting, abdominal pain and even shock due to hypoglycemia, electrolyte imbalance and a decrease in blood pressure may appear. A deficiency of gonadotropins leads to a complete absence of secondary sexual characteristics, and a deficiency of antidiuretic hormones can cause dehydration and electrolyte imbalance.
Diagnostics
To establish the diagnosis of hypopituitarism, various methods are used, including blood tests, imaging examination and genetic analysis related to the function of the pituitary gland. One of the main hormonal tests is a comprehensive test known as the pituitary stimulation test. This comprehensive test is designed to assess the overall function of the pituitary gland. In addition, growth hormone stimulation tests and water deprivation tests are conducted. For a more detailed study of the pituitary gland structure, a magnetic resonance imaging (MRI) can be performed. If necessary, an X-ray or visual field examination may also be required.
Treatment and course of the disease
Hypopituitarism is treatable using the missing hormones, which can be taken orally or injected. For children in the growth period, growth hormone medication is given subcutaneously before bedtime, or thyroid hormone medication is given once a day. In the case of adrenal hormone deficiency, cortisol is used, which belongs to the class of steroids. It is important to emphasize that with a deficiency of antidiuretic hormone, regular fluid intake is of great importance. This disease requires a long and systematic replenishment of various hormones, so regular injections are one of the most important components of treatment.
Complications
If acute hormonal insufficiency persists for a long time, this may be accompanied by the occurrence of a number of complications. Long-term growth hormone deficiency can lead to negative consequences such as underdevelopment, obesity and osteoporosis. In newborns with hypothyroidism, developmental disorders may occur, and a sudden deficiency of adrenal cortex hormones increases the risk of developing a state of shock due to severe hypoglycemia, low blood pressure and electrolyte imbalance. In case of insufficient control of antidiuretic hormone deficiency, there may be disturbances in the electrolyte balance and renal dysfunction caused by dehydration. In addition, hypopituitarism increases the risk of developing diabetes or fatty hepatosis.
