腺垂体功能减退症Hypopituitarism大课VIP专享VIP免费

Hypopituitarism(腺垂体功能减退症)Sellaturcica（蝶鞍）Bean-shapedWeight:5gThyroidglandAdrenalglandOvary(甲状腺）（肾上腺）（卵巢）TargetglandAnteriorpart（前叶）(Adenohypophysis)(腺垂体)Posteriorpart(后叶)(Neurohypophysis)(神经垂体）Pituitarystalk(垂体柄)Hypothalamus（下丘脑）1）Positivefeedback2）NegativefeedbackHypothalamusPituitaryglandTargetglands（下丘脑）（垂体）HypothalamusPituitaryglandTargetglands（下丘脑）（垂体）Feedback(反馈)HypothalamusPIF(prolactininhibitingfactor)GHRH(GHreleasinghormone)LHRH(LHreleasinghormone)TRH(TSHreleasinghormone)CRH(Corticotropicreleasinghormone)AnteriorpituitaryglandPRL(Prolactin)（催乳素）GH（growthhormone）(生长激素)LH(luteinizinghormone)(黄体生成素)FSH(folliclestimulatinghormone)（卵泡刺激素）TSH（thyroidstimulatinghormone)（促甲状腺激素）ACTH(adrenalcortexstimulatinghormone)促肾上腺皮质激素)TargetglandE2、E3(estrogen)T(testosterone)T3、T4CortisoneHormonesHypopituitarismDefinition:Hypopituitarismisaconditioninwhichthepituitaryglanddoesnotproduceoneormoreofitshormonesornotenoughofthem.Etiology(病因学):PrimarySecondary1、tumor2、ischemicnecrosis（坏死）3、surgery、trauma、radiotherapy（放疗）3、infection、infiltration（浸润）4、hereditarydisease（遗传）5、autoimmunedisease（自身免疫）1.Secondary:damagetohypothalamusorpituitarystalk2.Primary:damagetopituitarySecondaryPrimarySecondarySimmonddisease:isonekindofhypopituitarism,whichaccuresonlyinadult.Sheehan’ssyndrome:isonekindofhypopituitarism,inwhichthedecreasedproductionsoftheanteriorpituitaryhormonesareduetoischemicpostpartum（产后）pituitarynecrosis（坏死）orsepticemia（败血症）afterdelivery.HypopituitarismSimmonddiseaseSheehan’ssyndromemanifestationofmanifestationofprimarydiseasemanifestationofhypopituitarismmanifestationofhypopituitarismSymptomsandsignsaredependingonSymptomsandsignsaredependingonthekindofdeficientpituitaryhormonesthedegreeofthedeficiencytherateofdiseaseprogressionClinicalmanifestationClinicalmanifestation1kind2kinds3kindsallkindsFunctionlossSymptomsandsigns50%insidious（隐匿的）>75%obvious（显著的）95%serious（严重的）TheclassiclosssequenceofpituitaryhormoneTheclassiclosssequenceofpituitaryhormoneisinthefollowingisinthefollowingininsheehan'syndromesheehan'syndrome::prolactin(PRL)gonadotropin(LH、FSH)growthhormone(GH)thyrotropin(TSH)corticotropin(ACTH)11、、PRLdeficiency:deficiency:cannotlactate(泌乳）afterdelivery2、GonadotropindeficiencyAmenorrhoea（闭经）、Infertility（不孕）Regressionofsecondarysexalcharacteristics3、Growthhormone(GH)deficiencyInadultitisnotobvious.SymptomsandsignsofhypopituitarismSymptomsandsignsofhypopituitarism4、TSHdeficiencyIntoleranceofcolddryskinpallor（苍白）Periorbitalpuffiness（浮肿）horsenessofvoicebradycardia（心动过缓）weightgainconstipation（便秘）lossofhairSymptomsandsignshypopituitarism5、ACTHdeficiencyACTHdeficiencyfatigue(乏力）anorexia（厌食）nausea、vomitinglossofhairposturalhypotensionhypoglycemia（低血糖）hypopigmentation（色素减少）HypopituitarismPrimaryhypoadrenocorticism(原发性肾上腺皮质功能减退)POMCdecreasedincreasedpigmenthypopigmentationhyperpigmentationThePresentationisvariableandcomplex.ThePresentationisvariableandcomplex.Theypossessseveralkindsofhormonedeficiency,orallkinds.Symptomsandsignsinhypopituitarismarecombinedbyeachkindofsymptomsandsignsduetohormonesdeficiency.Investigation1、Measurementofhorm...