医学精品课件：（参考翻译）02.2Hypopituitarism大课课件.ppt

1、Hypopituitarism(腺垂体功能减退症腺垂体功能减退症)Endocrinology department,the 1st affiliated hospital,chongqing medical universityJian longSella turcica（蝶鞍）（蝶鞍）Bean-shapedWeight:5 g Thyroid gland Adrenal gland Ovary(甲状腺）甲状腺）（肾上腺）（卵巢）（肾上腺）（卵巢）TargetglandAnterior part （前叶）（前叶）(Adenohypophysis)(腺垂体腺垂体)Posterior part (

2、后叶后叶)(Neurohypophysis)(神经垂体）神经垂体）Pituitary stalk (垂体柄垂体柄)Hypothalamus （下丘脑）（下丘脑）1）Positive feedback2）Negative feedbackHypothalamus Pituitary gland Target glands（下丘脑）（下丘脑）（垂体）（垂体）Hypothalamus Pituitary gland Target glands（下丘脑）（下丘脑）（垂体）（垂体）Feedback(反馈反馈)HypothalamusPIF(prolactin inhibiting factor 催乳素抑

3、制因子)GHRH(GH releasing hormone 生长激素释放激素)LHRH(LH releasing hormone 黄体生成素释放激素)TRH(TSH releasing hormone 促甲状腺激素释放激素)CRH(Corticotropic releasing hormone 促肾上腺皮质激素释放激素)Anterior pituitary glandPRL(Prolactin)（催乳素）GH（growth hormone）(生长激素)LH(luteinizing hormone)(黄体生成素)FSH(follicle stimulating hormone)（卵泡刺激素）TS

4、H（thyroid stimulating hormone)（促甲状腺激素）ACTH(adrenal cortex stimulating hormone)促肾上腺皮质激素)Target glandE2、E3(estrogen 雌激素)T(testosterone 睾酮)T3、T4CortisoneHormonesHypopituitarismDefinition:Hypopituitarism is a condition in which the pituitary gland does not produce one or more of its hormones or not enou

5、gh of them.Etiology(病因学):Primary Secondary1、tumor 2、ischemic necrosis（坏死）3、surgery、trauma、radiotherapy（放疗）3、infection、infiltration（浸润）4、hereditary disease（遗传）5、autoimmune disease（自身免疫）1.Secondary:damage to hypothalamus or pituitary stalk2.Primary:damage to pituitarySecondaryPrimary SecondarySimmond

6、disease:is one kind of hypopituitarism,which accures only in adult.Sheehans syndrome:is one kind of hypopituitarism,in which the decreased productions of the anterior pituitary hormones are due to ischemic postpartum（产后）pituitary necrosis（坏死）or septicemia（败血症）after delivery.HypopituitarismSimmond di

7、seaseSheehans syndrome primary disease u the kind of deficient pituitary hormonesu the degree of the deficiency u the rate of disease progression1 kind2 kinds3 kindsall kindsFunction loss Symptoms and signs50%insidious（隐匿的）75%obvious（显著的）95%serious（严重的）prolactin(PRL)gonadotropin(LH、FSH)growth hormon

8、e(GH)thyrotropin(TSH)corticotropin(ACTH)PRL can not lactate(泌乳）after delivery2、Gonadotropin deficiencyAmenorrhoea（闭经）、Infertility（不孕）Regression of secondary sexal characteristics 第二性征退化3、Growth hormone(GH)deficiency In adult it is not obvious.Symptoms and signs of hypopituitarismSymptoms and signs o

9、f hypopituitarism4、TSH deficiency Intolerance of cold 畏寒畏寒dry skinpallor（苍白）（苍白）Periorbital puffiness（浮肿）（浮肿）horseness of voice 声嘶声嘶bradycardia（心动过缓）（心动过缓）weight gain 增重增重constipation（便秘）（便秘）loss of hairSymptoms and signs hypopituitarism5、fatigue(乏力）乏力）anorexia（厌食）（厌食）nausea、vomiting loss of hairpos

10、tural hypotension 体位性低体位性低血压血压hypoglycemia（低血糖）（低血糖）hypopigmentation（色素减少）（色素减少）Hypopituitarism Primary hypoadrenocorticism(原发性肾上腺皮质功能减退原发性肾上腺皮质功能减退)POMC前阿片黑素细胞皮质激素decreasedincreasedPigment 色素hypopigmentation hyperpigmentation They possess several kinds of hormone deficiency,or all kinds.Symptoms an

11、d signs in hypopituitarism are combined by each kind of symptoms and signs due to hormones deficiency.Investigation 调查调查1、Measurement of hormones 2、Stimulating test Investigation1、Measurement of hormones level pituitary hormonestarget glands hormonesPRLGHGnRH(LH、FSH)E2、TTSHT3、T4ACTHCortisonehypopitu

12、itarism normal range 2、Stimulating test：1）assess pituitary function 2)assess target gland function1)Assessment of the functions of pituitary GHRH or CRF 促皮质素释放因子or LHRH is injecting into humans body,then measure the level of pituitary hormones and target gland hormones.Hormone from hypothalamus Horm

13、one from pituitary glandGHRHGH CRFACTHLHRHLH、FSHCan not be elevatedHormone from pituitary glandTarget gland hormonesACTHcortisoneTSHT3、T42)Assessment of the function of target glandsInsulin-hypoglycemia 低血糖 stimulating testinsulin injection to induce hypoglycemiacortisoneAdrenal gland3、others Hypogl

14、ycemia 低血糖 Hypotension 低血压 Hyposalemia(低钠血症)Anemia（贫血）4、Imageological examination（影像学检测）（影像学检测）CT or MRI X-rayDiagnosis1)history of damage to pituitary gland or hypothalamus2)symptoms and signs related to hormone deficiency3)evidency of anterior pituitary hormone deficiencyTreatmentHormone replaceme

15、ntAll life replacement1、Adrenal hormone replacement must be first Hydrocortisone 20mg 8AM 10mg 4PM Cortisone 5mg 8AM 2.5mg 4PM Fludrocortisone 氟氢可的松 may be not required if necessary 0.1-0.2mg/d Goal:No symptoms and signs due to adrenal gland hormone deficiency.No symptoms and signs of due to adrenal

16、 gland hormone overdose 过量.2、Thyroid hormone replacement L-T4 original dose 12.5-25ug/d maintenance dose 100-200ug/d 3、Sexal hormone Replacement For people in reproductive age or anxiety for fertility Estrgen(雌激素)the first 25 days in each month Prosteron（孕激素）day 15 through 25 Goal:T3 T4 in normal ra

17、ngePituitary crisis 垂体危象垂体危象Pituitary crisis occurred on the basis of pituitary dysfunction in various stress reactions.Treatment of pituitary crisis 1.Supplement of glucose First 50%glucose,40 to 60 ml,rescue hypoglycemia.10%glucose to maintain input2.Corticosteroids applications 应用皮质类固醇 Hydrocortisone 200 of 300 mg decreasing the amount gradully to oral.3.Thyroid hormone replacement4.remove incentives(去除诱因)5.supportive treatment