I- Introduction / Definition :
- The IAH or anterior hypopituitarism is defined as the & rsquo; insufficient production of hormones from the adenohypophysis or anterior pituitary.
- His signs are linked d & rsquo; a part in the failure of pituitary gonadotropins (TSH, ACTH, LH and FSH, GH, PRL) and d & rsquo; secondly deficit of the production of each of the endocrine glands submitted to pituitary stimulation (thyroid, corticosurrénale, gonads……….).
II- REMINDERS :
A- anatomy :
- The pituitary and the hypothalamus are small hazelnut-shaped gland located at the base of the brain.
- The Pituitary measure 5 mm high 15 mm wide and 10 mm. It weighs 60g, it is contained in a bony box called the sella saddle dug into the sphenoid bone.
- The drift hypothalamus primitive diencephalic vesicle. It is located in the middle part of the skull base, behind the optic chiasm, and forms the floor of the 3rd ventricle.
- between these 2 glands found nerve fibers and blood vessels that constitute the pituitary stalk and allows communication between these 2 organs.
- Vascularization is ensured by the pituitary arterial system and the hypothalamic pituitary portal system.
B- Physiology :
- L & rsquo; hypothalamus is a hub of interrelations between the nervous system (I sensorialité, emotional life, memory…) and the endocrine system
- The pituitary gland has two parts :
* the adénohvpophvse : glandular part of the pituitary gland that secretes hormones six: GH, TSH, FSH, LH, PRL, ACTH whose actions on target tissues are summarized below (Table 1).
* and neurohvnophvse or rear portion which contains two hormones ADH (or vasopressin) and oxytocin (OT)
- Each hormone produced in response to a stimulus acts on the pituitary hypothalamic-pituitary system to regulate its own level of secretion (the feedback or Feed back).
III- CLINIOUE :
A- Type Description : overall hypopituitarism of & rsquo; adult :
- pale facies, alabaster hue, with a very expressive and youthful face.
- thin skin, atrophic, dried.
- hypopilosité face, axilla and sexual regions.
- Thin hair, brittle, areolas breasts depigmented.
- subject adynamic, asthenic,indifferent, chilly.
- in humans : voice change : low, female atonality.
B- own signs to deficits of each pituitary axis: see tableau.2
C- clinical forms :
* At the & rsquo; child = irtfantilo-dwarfism :
- harmonious stature, acromicrie, abdominal adiposité, mi crop enis, impuberism
* In the elderly : Table depressed or insane pace,falls repeatedly.
IV- EXPLORATIONS OF IAH :
- The hypothalamic-pituitary MRI is the key examination for the etiologic diagnosis of hypothalamic-pituitary region.
- Fundus and visual field: looking for a decrease in visual acuity, a compression of the optical channels : hémianopsie bitemporale, quadrantanopia higher oral Temp sometimes scotoma.
- Hormonal exploration according to each pituitary deficiency are summarized in Table 2.
V- THE etiologies of IAH :
WE- TREATMENT :
The etiological treatment if possible :
- resection of a tumor.
- of corticosteroids hypophysites.
Replacement therapy in LIFE :
– Treatment of adrenocorticotropic deficiency :
- Education +++
- Hydrocortisone: 20 30mg per day, dose increase under stress, d’infection, trauma
- normosalée Food.
– Treatment of thyroid stimulating deficit :
- LEVOTHYROX dose escalation to reach the average dose of 100 microg/j.
- Monitoring of treatment by measuring the plasma T4.
– Treatment of gonadotropin deficiency :
- Man ;.IM injection every 3 Testosterone weeks late (ANDROTARDYL):250mg.
*Women : estrogen plus progestin to produce an artificial cycle.
– Treatment of growth hormone deficiency :
At the & rsquo; child +++ to correct stunting by the synthetic GH.
VII- CONCLUSION :
- It is important not to miss a possible pituitary insufficiency based on clinical history and clinical.
- So it must actively search for suspected.
- The adrenal hormone therapy is the most vital.
- Be sensitive to small signs
- vital treatment for adrenocorticotropic deficiency and thyroid stimulating
- Supplementation with sex hormones is needed for sexuality and bone mineralization.
- GH supplementation is proposed.
Course Dr S. BENSALEM – Faculty of Constantine