PDF(Pubmed)
Abstract：
Hypopituitarism is defined as a complete or partial deficiency in one or more pituitary hormones. Anterior hypopituitarism includes secondary adrenal insufficiency, central hypothyroidism, hypogonadotropic hypogonadism, growth hormone deficiency and prolactin deficiency. Patients with hypopituitarism suffer from an increased disability and sick days, resulting in lower health status, higher cost of care and an increased mortality. In particular during adulthood, isolated pituitary deficits are not an uncommon finding; their clinical picture is represented by vague symptoms and unclear signs, which can be difficult to properly diagnose. This often becomes a challenge for the physician. Aim of this narrative review is to analyse, for each anterior pituitary deficit, the main related etiologies, the characteristic signs and symptoms, how to properly diagnose them (suggesting an easy and reproducible step-based approach), and eventually the treatment. In adulthood, the vast majority of isolated pituitary deficits are due to pituitary tumours, head trauma, pituitary surgery and brain radiotherapy. Immune-related dysfunctions represent a growing cause of isolated pituitary deficiencies, above all secondary to use of oncological drugs such as immune checkpoint inhibitors. The diagnosis of isolated pituitary deficiencies should be based on baseline hormonal assessments and/or dynamic tests. Establishing a proper diagnosis can be quite challenging: in fact, even if the diagnostic methods are becoming increasingly refined, a considerable proportion of isolated pituitary deficits still remains without a certain cause. While isolated ACTH and TSH deficiencies always require a prompt replacement treatment, gonadal replacement therapy requires a benefit-risk evaluation based on the presence of comorbidities, age and gender of the patient; finally, the need of growth hormone replacement therapies is still a matter of debate. On the other side, prolactin replacement therapy is still not available. In conclusion, our purpose is to offer a broad evaluation from causes to therapies of isolated anterior pituitary deficits in adulthood. This review will also include the evaluation of uncommon symptoms and main etiologies, the elements of suspicion of a genetic cause and protocols for diagnosis, follow-up and treatment.
摘要：
垂体功能低下被定义为一种或多种垂体激素的完全或部分缺乏。前垂体功能减退症包括继发性肾上腺功能不全，中枢甲状腺功能减退症,低促性腺激素性性腺功能减退,生长激素缺乏和催乳素缺乏。垂体功能减退症患者的残疾和病假增加，导致健康状况下降，更高的护理成本和死亡率的增加。特别是在成年期间，孤立的垂体缺陷并不少见；他们的临床表现表现为模糊的症状和不清楚的迹象，这可能很难正确诊断。这常常成为医生的挑战。这篇叙事评论的目的是分析，对于每个垂体前叶缺陷，主要相关病因，特征性的体征和症状，如何正确诊断它们(建议一种简单且可重复的基于步骤的方法)，最终的治疗。成年后,绝大多数孤立的垂体缺陷是由于垂体肿瘤，头部外伤,垂体手术和脑放疗。免疫相关的功能障碍代表了孤立的垂体缺陷的一个增长的原因，首先是次要使用肿瘤药物，如免疫检查点抑制剂。孤立的垂体缺陷的诊断应基于基线激素评估和/或动态测试。建立正确的诊断可能非常具有挑战性：事实上，即使诊断方法越来越完善，相当比例的孤立的垂体缺陷仍然没有一定的原因。虽然孤立的ACTH和TSH缺陷总是需要及时的替代治疗，性腺替代疗法需要根据合并症的存在进行获益-风险评估，患者的年龄和性别；最后，生长激素替代疗法的需要仍然是一个争论的问题。在另一边,催乳素替代疗法仍然不可用。总之,我们的目的是对成年后孤立性垂体前叶缺陷的病因和治疗方法进行广泛评估.这篇综述还将包括对罕见症状和主要病因的评估，怀疑遗传原因的要素和诊断方案，随访和治疗。
