NRIMC Endocrinology HYPOPITUITARISM HYPOPITUITARISM Dr Srikanth M.D., Dr Srikanth M.D., D.M. D.M. Associate Associate Professor Professor Dept. of Dept. of Endocrinology Endocrinology NRIAS NRIAS Dr Sirisha M.D. Dr Sirisha M.D. Senior Resident Senior Resident Dept. of Dept. of Endocrinology Endocrinology NRIAS NRIAS
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NRIMC Endocrinology HYPOPITUITARISM HYPOPITUITARISM Dr Srikanth M.D., D.M. Associate Professor Dept. of Endocrinology NRIAS Dr Sirisha M.D. Senior Resident.
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NRIMC
Endocrinology
HYPOPITUITARISMHYPOPITUITARISM
Dr Srikanth M.D., D.M.Dr Srikanth M.D., D.M.Associate ProfessorAssociate Professor
Dept. of EndocrinologyDept. of EndocrinologyNRIASNRIAS
Dr Sirisha M.D.Dr Sirisha M.D.Senior ResidentSenior Resident
Dept. of EndocrinologyDept. of EndocrinologyNRIASNRIAS
NRIMC
Endocrinology
HypopituitarismHypopituitarism
• Underdiagnosed entityUnderdiagnosed entity
• Diagnosis Requires Diagnosis Requires – High index of suspicionHigh index of suspicion
– Low threshold for investigationsLow threshold for investigations
– Availability of all dynamic endocrine investigations Availability of all dynamic endocrine investigations
– Endocrine expertise while carrying out investigationsEndocrine expertise while carrying out investigations
• Not so rareNot so rare
NRIMC
Endocrinology
..
A 26 year old male patient, a product ofA 26 year old male patient, a product of consangenous parentage presented with consangenous parentage presented with
Growth RetardationGrowth Retardation
Failure to develop secondary sexual charactersFailure to develop secondary sexual characters normallynormally
Decreased frequency of nocturnal erectionsDecreased frequency of nocturnal erections
No facial hair & hair in other androgen dependent areas No facial hair & hair in other androgen dependent areas
Axillary hair – present but minimalAxillary hair – present but minimal Other systemic examination is normalOther systemic examination is normalAnosmia –ve, CNS - NormalAnosmia –ve, CNS - Normal
NRIMC
Endocrinology
Bone ageBone age
• Bone age -Bone age - 13 years13 years– DelayedDelayed– Chronological age – 26 yearsChronological age – 26 years– Epiphyses – still unfusedEpiphyses – still unfused
NRIMC
Endocrinology
Thyroid function testsThyroid function testsParameter Result Units Normal range
T3 0.92 ng/ml 0.8-1.81
FT3 2.38 pg/ml 0.92-11.25
T4 3.3 gm/dl 4.0 -12.6
FT4 0.29 ng/dl 0.89-1.76
TSH 11.34 IU/ml 0.35 -5.50
Comment Central Hypothyroidism / Primary hypothyroidism
NRIMC
Endocrinology
Gonadal axis evaluationGonadal axis evaluation
Parameter Result Units Comment
FSH 0.60 mIU/ml Low
LH 0.29 U/L Low
Testosterone 0.02 ng/ml Low
Impression Central Hypogonadism
NRIMC
Endocrinology
Growth AxisGrowth Axis
• IGF 1 IGF 1 – Active form of GHActive form of GH– < 25 ng/ml< 25 ng/ml– Normal range ( 116-358 ng/ml)Normal range ( 116-358 ng/ml)