Simmonds disease Symptoms

Partial pituitary hypofunction is common than all pituitary hypofunction. The involvement order is luteinizing hormone (LH) and GH, and thenfollicle-stimulating hormone (FSH), ACTH, thyroid-stimulating hormone (TSH), and finally vasopressin (VP).The lack of prolactin (PRL) secretion is rare, but except for pituitary necrosis after delivery. Hyperprolactinemia may be due to the tumor (eg, prolactin tumor), but more to see as a result of dysfunction of the hypothalamus, so that the normal glands secret PRL to increase. Hypothalamic lesions in patients with diabetes insipidus is occurring more frequently.

Anterior pituitary dysfunction (Simmonds disease) normally have the primary disease: such as postpartum hemorrhage, pituitary tumors, pituitary surgery or radiation therapy, head trauma, infection or inflammation (tuberculosis, syphilis, meningoencephalitis), systemic diseases (leukemia, lymphoma, cerebral arteriosclerosis, malnutrition), as well as autoimmune pituitary.

Based on lack of different pituitary hormones, so simmonds disease have some symptoms and signs as follow:

1. the lack of gonadotropin (Gn or LH and FSH): before puberty, symptoms is delayed puberty; after puberty, symptoms is secondary gonadal dysfunction. Patients with delayed puberty have non-genital development, small and soft testes, length <3cm, the lack of beard, pubic hair; primary amenorrhea. Patients with the onset after puberty is armpit hair falling, skin wrinkles; loss of libido, testicular atrophy, oligospermia or azoospermia; menopause, impotence, infertility.

2. the lack of growth hormone (GH): In children and adolescents often cause bone growth retardation, short stature. No obvious characteristics in the adult, but variable in patients with thin skin, internal organs become smaller and occasionally have fasting hypoglycemia.

3. the lack of prolactin (PRL): post-partum non-breast, breast atrophy, often is the first symptom of post-partum pituitary necrosis.

4. the lack of thyroxin stimulating hormone (TSH): can lead to thyroid gland hypofunction. Patients may have symptoms include fatigue, cold, dry skin, delayed Achilles tendon reflex, but not necessarily obvious myxedema. If occurred in childhood, then the growth retardation, delayed epiphyseal closure. GH secretion may be suppressed by TSH lack.

5. the lack of adrenocorticotropic hormone (ACTH): ACTH is often part lack, common see in after the pituitary surgery or pituitary radiotherapy. Onset occult, such as weakness, nausea, vomiting, low blood pressure, low blood sugar, weakness and coma, pale skin. Mineralocorticoid secretion is controlled by renin - angiotensin system, so in the cortex pituitary dysfunction, less cause electrolyte imbalance.

6. pituitary crisis: because the anterior pituitary hypofunction is the lower stress response, so the infections, diarrhea, vomiting, dehydration, hunger, trauma, surgery, anesthesia, cold and sedative-hypnotic, sedative, also can make more serious primary disease and lead to pituitary crisis, the clinical manifestations and symptoms of pituitary crisis have the following types.

1) low blood sugar coma: the most common. Often occurs when the fasting, palpitations, sweating, dizziness, disturbance of consciousness, mental disorders and sometimes epileptic seizures or convulsions, and finally coma.

2) infective shock: a low resistance, high incidence of infection may be associated with high fever; and occurs unconsciousness, coma.

3) low-temperature coma: more common in winter.

4) water toxicity coma: a result of the lack of cortical hormone, on the regulation of water metabolism in decline, after too much fluid and water delivery, easily occur the water toxicity coma. The performance of water intoxication are nausea, vomiting, exhaustion, mental confusion, convulsions and coma.

5) coma after resection of pituitary: unconsciousness in postoperative, coma, can continued for several days to several weeks, and low pulse rate, body temperature is higher or lower then normal, serum sodium or blood glucose is normal or lower.

6) Pituitary Apoplexy: be caused by acute hemorrhage of Pituitary tumor. Symptoms is headache, dizziness, vomiting, decreased vision, blindness, and even shock.