Clinical Investigation Of Hormonal Profile In Patients With Hypopituitarism

With the development of clinical diagnostic techniques, hypopituitarism isno longer rare disease. The disease may cause hormonal deficiency in multipleendocrine axis, which affects the quality of life for the patients, and evenserious threat to the life and health of patients. Hormone levels in patients withhypopituitarism is important indexes of diagnosis, treatment and prognosis.Because of the nonspecial clinical performance, various involvement of targetgland and diverse change of hormone level, hypopituitarism is oftenmisdiagnosed. Therefore, it is important to have comprehensive analysis forhormone level and biochemical changes in the patients with hypopituitarism,which should draw attention to medical workers.Objective：1. To analyze the changes of pituitary and its target glandhormone, biochemical studies and blood pressure in patients withhypopituitarism.2.To compare the differences of the hormone level in patientswith the secondary or primary hypothyroidism.3. To reduce the clinicalmisdiagnosis, provide appropriate treatment and improve the survival quality ofpatients with hypopituitarismMaterials and methods:86patients with hypopituitarism were enrolledfrom January2004to February2012in the Bethune First Hospital of JilinUniversity; and81patients were diagnosed as primary hypothyroidism.1、Inclusion criteria of hypopituitarism:(1) hypopituitarism is diagnosedaccording to the history, clinical symptoms and signs, combined with endocrinefunction and imaging (head CT or MRI) examination.(2) age between18to75years.(3) clinical course between1to240months; Inclusion criteria of primaryhypothyroidism：(1) signs and symptoms of hypothyroidism.(2) thyroid function test shows thyroid stimulating hormone (TSH)) increasedsignificantly, accompanied by free T4(FT4) decreased and free T3(FT3)decreased or normal.2、Exclusion criteria of hypopituitarism:(1) patientswith primary hypothyroidism, primary adrenal insufficiency or primary sexualinsufficiency.(2) women in pregnancy stage.(3) with other multipleinterferential factors; Exclusion criteria of primary hypothyroidism：(1) patientswith severe heart insufficiency.(2) with chronic liver or kidney functioninsufficiency.(3) women in pregnancy stage. Methods: For all the researchobject ask for details and record the history, including age, gender, course,clinical symptoms and signs, past medical history, surgery history, etc.ACCESS chemical luminescence instrument produced by BECKMANcompany was used to measure all hormones. Baseline characteristics wererecorded in86patients; and medical history, duration of hypopituitarism, bloodpressure and number of pituitary hormonal and target gland hormonaldeficiencies were documented; as well as FPG, Ka+, Na+, Cl-, Ca2+, P, TG, TC,HDL-C, LDL-C; patients with hypothyroidism record levels of TSH, FT3,FT4. Statistical method: Duration of hypopituitarism is expressed by mediannumber, the counting data is expressed by example(%) and the measurementdata was expressed by mean±standard deviation. SPSS17.0statistics softwarewas used for data processing.Results：(1) In patients with hypopituitarism, decreased levels of estrogen,testosterone, cortisol and thyroid hormone and unconsistency levels of pituitaryhormones; pituitary-gonadal axis was involved in more than half hypopituitarypatients (even100%shows lower testosterone level), while39.3%showshigher level of PRL.(2) In cases of hypopituitarism with COR (am) levelsbelow normal, only40%of patients shows declined ACTH(am) level.(3) Incases of central hypothyroidism with decreased FT4levels, TSH levels changesas follow:17%was below normal level,64%were normal and19%were higher than normal level.(4) Hypopituitary patients with impaired sexual gland,levels of LH declined dramatically than FSH.(5) Compared with secondaryhypothyroidism group,Levels of FT3and FT4in patients with primaryhypothyroidism decreased obviously,but without statistical significance; andTSH level increased significantly with statistical significance（P=0.000）.(6)Hypertension, hypoglycemia, electrolyte disturbance and hyperlipidemia canoften occur in patients with hypotituitarismConclusions：(1) Although the corresponding pituitary hormone level maystay nomal or increased in patients with hypopituitarism these conditions havecompromised sexual, adrenal and thyroid function.(2) In patients withhypopituitarism, sexual gland is most involved, and replacement therapy ofsex hormone is not enough.(3) Different from primary hypothyroidism, inpatients with hypopituitarism induced hypothyroidism, we should take FT4fortherapy index.(4) Hyponatremia, hypocalcemia and hypochloride is usuallyfound in patients with hypopituitarism.(5) TG rise is more common than anyother kind of dyslipidemia in patient with hypopituitarism.