Hyperpituitarism

Hyperpituitarism
Classification and external resources
ICD-10	E22
ICD-9	253.1
eMedicine	ped/1092
MeSH	D006964

Hyperpituitarism is the primary hypersecretion of pituitary hormones. It typically results from a pituitary adenoma. Most pituitary adenomas are functional and secrete a hormone that produces clear symptoms characteristic of their condition.^[1] In children with hyperpituitarism, disruption of growth regulation and/or sexual maturation is common, either because of hormone hypersecretion or because of manifestations caused by local compression of the adenoma. Pituitary adenomas are rare in children, accounting for only 3-6% of all adenomas, whereas they comprise 30% of adenomas in adults.

There are three hormones that are oversecreted resulting in the pituitary adenoma: prolactin, adrenocorticotropic hormone (ACTH), and growth hormone (GH).^[2]

Excess prolactin may result in a prolactinoma. The symptoms may vary, depending on the age and sex of the child. Prepubertal children typically experience a combination of headaches, visual disturbance, and growth failure. Pubertal females frequently have symptoms of pubertal arrest or hypogonadism due to suppression of gonadotropin secretion or local compression of the pituitary. Pubertal males may have symptoms of headaches, visual impairment, and pubertal arrest or growth failure.^[3]

Excess ACTH commonly results in weight gain. Hirsutism and premature adrenarche may occur in prepubertal children. Pubertal arrest, acne, fatigue, and depression are also common.^[1]

Excess GH results in gigantism. The severity of gigantism depends on whether the epiphyseal plate is open. Before epiphyseal fusion, accelerated growth velocity is prominent. As epiphyseal fusion approaches, the spectrum of symptoms resembles that in adults (e.g., coarsening of facial features, change in ring and shoe size).^[4]

The four most common types of hyperpituitarism are prolactinoma, corticotropinoma (Cushing's disease), somatotropinoma (gigantism), and thyrotropinoma (a rare pituitary cancer).^[2]

Clinical manifestations 1
Associated conditions 2
Symptoms 3
See also 4
References 5

Clinical manifestations

Depending on the cell type(s) affected, clinical manifestations of hormone excess may include:

Associated conditions

When there is an enlargement of the pituitary tissue, hyperpituitarism is often associated with:

Visual field defects, classically bitemporal hemianopia
Radiographic abnormalities of the sella turcica, such as sellar expansion, bony erosion and disuption of the diaphragma sellae
Increased intracranial pressure

Symptoms

Symptoms caused by hormone excess and associated mass effects include:

References

^ ^a ^b Colao, A, Loche, S, Cappabianca, P. Pituitary adenomas in children and adolescents. Clinical presentation, diagnosis, and therapeutic strategies. The Endocrinologist. 2000;10:314-27.
^ ^a ^b Diaz-Thomas, A., Shim, M. Hyperpituitarism. Medscape Reference. WebMD. 2012.[1]
^ Ciccarelli, A, Daly, AF, Beckers, A. The epidemiology of prolactinomas. Pituitary. 2005;8:3-6.
^ Colao, A, Lombardi, G. Growth-hormone and prolactin excess. Lancet. Oct 31 1998;352(9138):1455-61.

Endocrine pathology: endocrine diseases (E00–E35, 240–259)

Pancreas/
glucose
metabolism

Hypofunction	Diabetes mellitus types: type 1 type 2 MODY 1 2 3 4 5 6 complications coma angiopathy ketoacidosis nephropathy neuropathy retinopathy cardiomyopathy insulin receptor (Rabson–Mendenhall syndrome) Insulin resistance

Hyperfunction	Hypoglycemia beta cell (Hyperinsulinism) G cell (Zollinger–Ellison syndrome)

Hypothalamic/
pituitary axes

Hypothalamus

gonadotropin
- Kallmann syndrome
- Adiposogenital dystrophy
CRH (Tertiary adrenal insufficiency)
vasopressin (Neurogenic diabetes insipidus)
general (Hypothalamic hamartoma)

Pituitary

Hyperpituitarism	anterior Acromegaly Hyperprolactinaemia Pituitary ACTH hypersecretion posterior (SIADH) general (Nelson's syndrome)

Hypopituitarism	anterior Kallmann syndrome Growth hormone deficiency ACTH deficiency/Secondary adrenal insufficiency GnRH insensitivity FSH insensitivity LH/hCG insensitivity posterior (Neurogenic diabetes insipidus) general Empty sella syndrome Pituitary apoplexy Sheehan's syndrome Lymphocytic hypophysitis

Thyroid

Hypothyroidism	Iodine deficiency Cretinism Congenital hypothyroidism Myxedema Euthyroid sick syndrome

Hyperthyroidism	Hyperthyroxinemia Thyroid hormone resistance Familial dysalbuminemic hyperthyroxinemia Hashitoxicosis Thyrotoxicosis factitia Graves' disease

Thyroiditis	Acute infectious Subacute De Quervain's Subacute lymphocytic Autoimmune/chronic Hashimoto's Postpartum Riedel's

Goitre	Endemic goitre Toxic nodular goitre Toxic multinodular goiter Thyroid nodule

Parathyroid

Hypoparathyroidism	Hypoparathyroidism Pseudohypoparathyroidism Pseudopseudohypoparathyroidism

Hyperparathyroidism	Primary Secondary Tertiary Osteitis fibrosa cystica

Adrenal

Hyperfunction	aldosterone: Hyperaldosteronism/Primary aldosteronism Conn syndrome Bartter syndrome Glucocorticoid remediable aldosteronism AME Liddle's syndrome 17α CAH cortisol: Cushing's syndrome (Pseudo-Cushing's syndrome) sex hormones: 21α CAH 11β CAH

Hypofunction/ Adrenal insufficiency (Addison's, WF)	aldosterone: Hypoaldosteronism 21α CAH 11β CAH cortisol: CAH Lipoid 3β 11β 17α 21α sex hormones: 17α CAH

Gonads

testicular: enzymatic
Androgen receptor (Androgen insensitivity syndrome)

general: Hypogonadism (Delayed puberty)
Hypergonadism
- Precocious puberty
Hypoandrogenism
Hypoestrogenism
Hyperandrogenism
Hyperestrogenism

Height

Multiple

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Hyperpituitarism