Hyperpituitarism

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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 (eg, 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[edit]

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

Associated conditions[edit]

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

Symptoms[edit]

Symptoms caused by hormone excess and associated mass effects include:

See also[edit]

References[edit]

  1. ^ 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.
  2. ^ a b Diaz-Thomas, A., Shim, M. Hyperpituitarism. Medscape Reference. WebMD. 2012.[1]
  3. ^ Ciccarelli, A, Daly, AF, Beckers, A. The epidemiology of prolactinomas. Pituitary. 2005;8:3-6.
  4. ^ Colao, A, Lombardi, G. Growth-hormone and prolactin excess. Lancet. Oct 31 1998;352(9138):1455-61.