panhypopitiutarism is a condition where a person does not have a pituitary gland. This means the part of your brain that helps you to grow and develop, is not thier. People with this disease have no symptoms, but have to take thyroid medicine, as well as growth hormeone and cortef.
panhypopituitarism
Panhypopituitarism
The condition is called panhypopituitarism, where there is a deficiency in all the hormones produced by the pituitary gland. This can lead to a range of symptoms such as fatigue, weight loss, and hormonal imbalances. Treatment usually involves hormone replacement therapy to manage the deficiencies.
Panhypopituitarism is a condition of inadequate or absent production of the anterior pituitary hormones. It is frequently the result of other problems that affect the pituitary gland and either reduce or destroy its function or interfere with hypothalamic secretion of the varying pituitary-releasing hormones. Panhypopituitarism can be the end result of various clinical scenarios. The signs and symptoms are diverse. Manifestations of congenital anterior hypopituitarism include micropenis, midline defects, optic atrophy, hypoglycemia, and poor growth.
The pituitary gland can be affected by various diseases and disorders, including pituitary tumors, pituitary adenomas, hypopituitarism (deficiency of one or more pituitary hormones), hyperpituitarism (excess pituitary hormone production), and pituitary apoplexy (sudden bleeding into the pituitary gland). These conditions can lead to hormonal imbalances and a range of symptoms.
Pituitary tumors are the commonest primary intracranial tumors. Panhypopituitarism is unusual as a primary result of a pituitary tumor. Endocrine dysfuncion, particulary reproductive dysfuncion, is common due to GnRh deficiency. Others problem are, hyperprolactinemia, acromegaly, diabetes insipidus, adipsic hypernatremia, syndrome of inappropriate secretion of antidiuretic hormone, hyperthyroisism or hypothyroisism, Cushing Syndrome, Addison disease, hypo or hyperaldosteronism, hypertension, etc, symptoms will dependent on what part of the gland is affect and how.
Normal anatomyThe growth hormone (GH) is a protein hormone released from the anterior pituitary gland under the control of the hypothalamus. In children, GH has growth-promoting effects on the body. It stimulates the secretion of somatomedins from the liver, which are a family of insulin-like growth factor (IGF) hormones. These, along with GH and thyroid hormone, stimulate linear skeletal growth in children. In adults, GH stimulates protein synthesis in muscle and the release of fatty acids from adipose tissue (anabolic effects). It inhibits uptake of glucose by muscle while stimulating uptake of amino acids. The amino acids are used in the synthesis of proteins, and the muscle shifts to using fatty acids as a source of energy. GH secretion occurs in a pulsatile (short, concentrated secretion) and sporadic manner. Thus, a single test of the GH level is usually not performed.IndicationsWhy the test is performed: This test is typically performed on infants and children to identify human growth hormone (hGH) deficiency as a cause of growth retardation. It is also useful in detecting a pituitary tumor.ProcedureBecause of the sporadic release of GH, the patient will have his blood drawn a total of five times over a few hours. Instead of the traditional method of blood drawing (veinipuncture), the blood is taken through an IV (angiocatheter).How to prepare for the test:You should fast and limit physical activity for 10 to 12 hours before the test. If you are taking certain medications, your health-care provider may ask that you withhold these before the test, as some can affect results.You will be asked to relax for at least 90 minutes before the test, as exercise or increased activity can alter hGH levels. Inform your health-care provider if you or your child has had a radioactive scan performed within a week of this test, as radioactive scans can affect test results.If your child is to have this test performed it may be helpful to explain how the test will feel, and even practice or demonstrate on a doll. This test requires temporary placement of an angiocatheter, an IV, and this should be explained to your child. The more familiar your child is with what will happen to him, and the purpose for the procedure, the less anxiety he will feel. How the test will feel: When the needle is inserted, some people feel moderate pain, while others feel only a prick or stinging sensation. Afterward, there may be some throbbing.What the risks are:Risks associated with venipuncture are slight:excessive bleeding fainting orfeeling lightheaded hematoma (blood accumulating under the skin)infection (a slight risk any time the skin is broken)multiple punctures to locate veinsclinical signs and symptoms of hypoglycemia if IV Insulin is adminstered.ResultsWhat abnormal results mean: A diminished amount of hGH indicates a problem either in the hypothalamus or the pituitary. Additional testing can illustrate the exact site of the deficiency. In children, a deficiency of GH results in dwarfism. In adults, it may be associated with panhypopituitarism. About 10% to 15% of people with normal functioning pituitaries may fail to respond on the first test. The test is often repeated.Reviewed ByReview Date: 04/20/2010Ari S. Eckman, MD, Division of Endocrinology and Metabolism, Johns Hopkins School of Medicine, Baltimore, MD. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.
DefinitionThe growth hormone (GH) stimulation test measures the level of growth hormone (GH) in the blood after you receive medication that triggers the release of GH, such as arginine or GH-releasing hormone. The test measures the ability of the pituitary gland to release GH.See also:Growth hormone deficiencyShort statureAlternative NamesArginine test; Arginine-GHRH testHow the test is performedThe site is cleaned with germ-killing medicine (antiseptic). An IV is usually placed in a vein, typically in the inside of the elbow or the back of the hand.The health care provider wraps an elastic band around the upper arm to apply pressure to the area and make the vein swell with blood.Next, the health care provider gently inserts a needle into the vein. The needle is removed while the IV is left in the vein. The elastic band is removed from your arm.Your blood will be drawn five times. To prevent many punctures of the vein, samples will be taken through the IV line instead of re-inserting the needle each time.The first sample will be drawn between 6 a.m. and 8 a.m. Then you will receive arginine through a vein for 30 minutes. After the 30-minute infusion, GH-releasing hormone is given to you through a vein. Then four more blood samples are drawn, once every 30 minutes.Sometimes arginine or GH-releasing hormone is given alone for this test. Which form of the test is used depends on your health care provider's preferences.Let your doctor know if you have severe kidney or liver disease, because an infusion of arginine could be risky for you.How to prepare for the testDo not eat and limit physical activity for 10 - 12 hours before the test to avoid changing the results.Your health care provider may ask that you stop taking certain medications before the test, as some medications can affect results. (Do not stop taking any medications without first talking to your health care provider.)You will be asked to relax for at least 90 minutes before the test, because exercise or increased activity can change GH levels.If your child is going to have this test performed, it may be helpful to explain how the test will feel. You may want to practice or demonstrate on a doll.This test requires temporary placement of an IV, and you should explain this to your child. The more familiar your child is with what will happen and the purpose of the procedure, the less anxiety he or she will feel.How the test will feelWhen the needle is inserted to draw blood, some people feel moderate pain, while others feel only a prick or stinging sensation. Afterward, there may be some throbbing, or a bruise may develop at the site where the needle was inserted. These symptoms are temporary.Why the test is performedThis test is typically performed to determine whether GH deficiency is causing slowed growth.Normal ValuesNormal peak value -- at least 10 ng/mLIndeterminate -- 5 - 10 ng/mLSubnormal -- 5 ng/mL(A normal value rules out hGH deficiency; in some laboratories, the normal level is 7 ng/mL.)Note: ng/mL = nanogram per milliliter.Normal value ranges may vary slightly among different laboratories. Talk to your doctor about the meaning of your specific test results.What abnormal results meanIf this test does not raise GH levels, there is a reduced amount of hGH stored in the anterior pituitary.In children, this results in growth hormone deficiency. In adults, it may be associated with panhypopituitarism or adult growth hormone deficiency.What the risks areVeins and arteries vary in size from one patient to another and from one side of the body to the other. Obtaining a blood sample from some people may be more difficult than from others.Other risks associated with having blood drawn are slight, but may include:Excessive bleedingFainting or feeling light-headedHematoma (blood accumulating under the skin)Infection (a slight risk any time the skin is broken)ReferencesMelmed S, Kleinberg D. Anterior pituitary. In: Kronenberg HM, Melmed S, Polonsky KS, Larsen PR, eds. Williams Textbook of Endocrinology. 11th ed. Philadelphia, PA: Saunders Elsevier; 2008:chap 8.Reiter EO, Rosenfeld RG. Normal and aberrant growth. In: Kronenberg HM, Melmed S, Polonsky KS, Larsen PR, eds. Williams Textbook of Endocrinology. 11th ed. Philadelphia, Pa: Saunders Elsevier; 2008:chap 23.
Max's sister, Esther, is nine years old; the family adopted her just recently. Esther says she is "different." She's from Russia, but speaks perfect English with a slight accent. She cuts her food perfectly-so perfectly that brother Danny thinks it is "weird." At school she wears gorgeous, old-fashioned dresses when other girls are wearing jeans and tee-shirts. She paints like a gifted adult. While taking baths, she sings a song that's way before her time: "That's the story of, that's the glory of looooove!" She understands the "F***" word as more than just a naughty word that adults say sometimes ("That's what grownups do. They F***."), expertly loads a gun, puts on a black dress and make-up and tries to seduce her adoptive father. ("What are you doing, Esther!?") But shortly after Esther comes to live with them, weird things start to happen: the girl who made fun of Esther at school slips off the slide at the playground and breaks her ankle, the orphanage's Sister Abigail disappears after visiting the Colemans, John and Kate find themselves increasingly at each other's throats and, eventually, Kate is busy Googling antisocial personality disorder. "I think there's something wrong with Esther," she says throughout the the film, in one form or another. Eventually, Kate contacts the orphanage that Esther originally came from, and learns that it's not an orphanage: It's a mental hospital. Esther, you see, is not a little girl at all. Aside from being a serial killer, she has a form of hypopituitarism-panhypopituitarism is my guess-and is thirty-three years old. Her name's not Esther, either. Her real name is Leena Klammer. She tries to kill everyone else so she can have the father all to herself but when the father doesn't show the same gratitude towards Esther she has a plan to destroy the family. The doctor tells Kate that Leena is extremely dangerous and violent and has killed a number of people in the past, including an entire family that had adopted her previously. Esther, angry and hurt at being spurned by John, ransacks her room. Then, after removing the makeup, false teeth and body wrappings that enhanced her illusion as youthful Esther, Leena attacks John with a knife. Max sees Leena stabbing her father repeatedly and hides. Kate, unable to get John on the phone, rushes home, only to find John lying dead. Leena fetches a gun from their safe and shoots Kate in the arm before she goes to search for Max, finding her in the greenhouse. While Leena shoots at Max, Kate manages to crawl out onto the greenhouse roof, breaks through the glass above Leena and knocks her out. Kate takes the gun and leaves the greenhouse with Max, thinking Leena is dead. Leena regains consciousness and finds Kate outside near a frozen pond where she lunges at her, hurling them both onto the ice as Max watches from a hill above. Max picks up the gun that was dropped by Kate during the struggle and shoots at Leena, but breaks the ice instead, causing Kate and Leena to drop into the water. After a brief struggle, Kate climbs out with Leena desperately clinging to her legs. Leena begs Kate not to let her die, calling her "Mommy" while holding a knife behind her back. Kate angrily responds that she's not her mother and kicks her in the face, snapping her neck and sending her back into the water, where she slowly sinks. Max and Kate are met by the police, who arrive moments later.