Hipopituitarismo

Descripción General

Definición

El hipopituitarismo es la condición resultante de una producción inadecuada de hormonas hipofisarias:

• Hipopituitarismo primario: trastornos de la hipófisis
• Hipopituitarismo secundario: trastornos del hipotálamo

Epidemiología

• < 200 000 personas afectadas en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum Estados Unidos
• Tasa de incidencia anual promedio de 4.21 casos por 100 000
• No hay diferencia en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la incidencia entre sexos

Etiología

• Masas/tumores:
  • Adenoma/tumores hipofisarios (aproximadamente el 50% de los LOS Neisseria casos)
  • Quiste de la bolsa de Rathke
  • Meningioma Meningioma Meningiomas are slow-growing tumors that arise from the meninges of the brain and spinal cord. The vast majority are benign. These tumors commonly occur in individuals with a history of high doses of skull radiation, head trauma, and neurofibromatosis 2. Meningioma
  • Craneofaringioma
  • Hipofisitis linfocitaria (infiltración de linfocitos que provoca un aumento de tamaño de la hipófisis)
• Causas sistémicas:
  • Sarcoidosis Sarcoidosis Sarcoidosis is a multisystem inflammatory disease that causes noncaseating granulomas. The exact etiology is unknown. Sarcoidosis usually affects the lungs and thoracic lymph nodes, but it can also affect almost every system in the body, including the skin, heart, and eyes, most commonly. Sarcoidosis
  • Granulomatosis con poliangeítis
  • Hemocromatosis
  • Histiocitosis X
  • Amiloidosis
• Causas congénitas:
  • Displasia hipofisaria: hipoplasia/ aplasia Aplasia Cranial Nerve Palsies/desarrollo ectópico
  • Síndrome de Kallmann: síntesis defectuosa de la hormona liberadora de gonadotropina (GnRH, por sus siglas en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum inglés)/ síntesis de GnRH
  • Síndrome de Prader-Willi: diversos grados de hipopituitarismo con hiperfagia-obesidad, hipotonía, retraso en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum el desarrollo y diabetes Diabetes Diabetes mellitus (DM) is a metabolic disease characterized by hyperglycemia and dysfunction of the regulation of glucose metabolism by insulin. Type 1 DM is diagnosed mostly in children and young adults as the result of autoimmune destruction of β cells in the pancreas and the resulting lack of insulin. Type 2 DM has a significant association with obesity and is characterized by insulin resistance. Diabetes Mellitus mellitus
  • Mutaciones de los LOS Neisseria factores de transcripción específicos del tejido
• Causas traumáticas:
  • Lesión cerebral
  • Cirugía
  • Radioterapia
• Causas infecciosas
  • Tuberculosis Tuberculosis Tuberculosis (TB) is an infectious disease caused by Mycobacterium tuberculosis complex bacteria. The bacteria usually attack the lungs but can also damage other parts of the body. Approximately 30% of people around the world are infected with this pathogen, with the majority harboring a latent infection. Tuberculosis spreads through the air when a person with active pulmonary infection coughs or sneezes. Tuberculosis
  • Sífilis
  • Candidiasis Candidiasis Candida is a genus of dimorphic, opportunistic fungi. Candida albicans is part of the normal human flora and is the most common cause of candidiasis. The clinical presentation varies and can include localized mucocutaneous infections (e.g., oropharyngeal, esophageal, intertriginous, and vulvovaginal candidiasis) and invasive disease (e.g., candidemia, intraabdominal abscess, pericarditis, and meningitis). Candida/Candidiasis
• Causas vasculares:
  • Síndrome de Sheehan: necrosis Necrosis The death of cells in an organ or tissue due to disease, injury or failure of the blood supply. Ischemic Cell Damage hipofisaria posparto causada por la pérdida de sangre durante el parto
  • Apoplejía hipofisaria: hemorragia repentina de la hipófisis, a menudo en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum presencia de un adenoma hipofisario
  • Aneurisma de la arteria carótida
  • Hemorragia subaracnoidea
• Síndrome de la silla vacía (hallazgo radiológico):
  • Puede resultar de:
    • Tumor Tumor Inflammation hipofisario extirpado quirúrgicamente
    • Líquido cefalorraquídeo que fluye a través de un defecto y llena el espacio
  • El hipopituitarismo puede surgir de forma insidiosa debido a los LOS Neisseria procesos anteriores.

Fisiopatología

Hipófisis

• También llamada glándula pituitaria
• Función: estimulación y/o supresión de la actividad de las principales glándulas endocrinas mediante la secreción de hormonas
• Dos lóbulos con su propio conjunto de productos secretores y ejes de retroalimentación:
  • Anterior (adenohipófisis):
    • Hormona del crecimiento (GH, por sus siglas en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum inglés)
    • Hormona luteinizante ( LH LH A major gonadotropin secreted by the adenohypophysis. Luteinizing hormone regulates steroid production by the interstitial cells of the testis and the ovary. The preovulatory luteinizing hormone surge in females induces ovulation, and subsequent luteinization of the follicle. Luteinizing hormone consists of two noncovalently linked subunits, alpha and beta. Within a species, the alpha subunit is common in the three pituitary glycoprotein hormones (TSH, LH, and FSH), but the beta subunit is unique and confers its biological specificity. Menstrual Cycle, por sus siglas en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum inglés)
    • Hormona foliculoestimulante ( FSH FSH A major gonadotropin secreted by the adenohypophysis. Follicle-stimulating hormone stimulates gametogenesis and the supporting cells such as the ovarian granulosa cells, the testicular sertoli cells, and leydig cells. Fsh consists of two noncovalently linked subunits, alpha and beta. Within a species, the alpha subunit is common in the three pituitary glycoprotein hormones (TSH, LH, and FSH), but the beta subunit is unique and confers its biological specificity. Menstrual Cycle, por sus siglas en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum inglés)
    • Prolactina (PRL)
    • Hormona estimulante de la tiroides (TSH, por sus siglas en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum inglés)
    • Hormona adrenocorticotrópica (ACTH, por sus siglas en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum inglés)
  • Posterior (neurohipófisis):
    • Hormona antidiurética (ADH, por sus siglas en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum inglés) o vasopresina
    • Oxitocina
• La disminución de la función, o hipopituitarismo, es más notoria con el daño del lóbulo anterior de la hipófisis, ya que constituye el 80% de la glándula.

Pérdida de la función hipofisaria

• Daños en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la hipófisis → pérdida sucesiva de las hormonas de la hipófisis anterior:
  • Debido a la vulnerabilidad a la presión, las células secretoras de GH (somatotropas) se ven afectadas primero → se produce ↓ GH
  • Seguido de ↓ LH LH A major gonadotropin secreted by the adenohypophysis. Luteinizing hormone regulates steroid production by the interstitial cells of the testis and the ovary. The preovulatory luteinizing hormone surge in females induces ovulation, and subsequent luteinization of the follicle. Luteinizing hormone consists of two noncovalently linked subunits, alpha and beta. Within a species, the alpha subunit is common in the three pituitary glycoprotein hormones (TSH, LH, and FSH), but the beta subunit is unique and confers its biological specificity. Menstrual Cycle y FSH FSH A major gonadotropin secreted by the adenohypophysis. Follicle-stimulating hormone stimulates gametogenesis and the supporting cells such as the ovarian granulosa cells, the testicular sertoli cells, and leydig cells. Fsh consists of two noncovalently linked subunits, alpha and beta. Within a species, the alpha subunit is common in the three pituitary glycoprotein hormones (TSH, LH, and FSH), but the beta subunit is unique and confers its biological specificity. Menstrual Cycle (gonadotropinas) → ↓ TSH → ↓ ACTH
  • La PRL raramente se ve VE Ventilation: Mechanics of Breathing afectada (si es deficiente, sugiere una insuficiencia total de la hipófisis anterior)
• Efecto general: disminución de la producción hormonal de las glándulas diana

Presentación Clínica

Deficiencias hormonales

Los LOS Neisseria signos y síntomas dependen de la patología subyacente, la rapidez de aparición y la gravedad del hipopituitarismo (parcial o completo).

• La deficiencia hormonal de la hipófisis anterior puede ser multihormonal o, en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum algunos casos, aislada.
  • ↓ Hormona del crecimiento (deficiencia de GH):
    • En EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum adultos: menor densidad ósea, atrofia muscular, dislipidemia, obesidad central
    • En EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum niños: baja estatura, retraso del crecimiento
  • ↓ LH LH A major gonadotropin secreted by the adenohypophysis. Luteinizing hormone regulates steroid production by the interstitial cells of the testis and the ovary. The preovulatory luteinizing hormone surge in females induces ovulation, and subsequent luteinization of the follicle. Luteinizing hormone consists of two noncovalently linked subunits, alpha and beta. Within a species, the alpha subunit is common in the three pituitary glycoprotein hormones (TSH, LH, and FSH), but the beta subunit is unique and confers its biological specificity. Menstrual Cycle y FSH FSH A major gonadotropin secreted by the adenohypophysis. Follicle-stimulating hormone stimulates gametogenesis and the supporting cells such as the ovarian granulosa cells, the testicular sertoli cells, and leydig cells. Fsh consists of two noncovalently linked subunits, alpha and beta. Within a species, the alpha subunit is common in the three pituitary glycoprotein hormones (TSH, LH, and FSH), but the beta subunit is unique and confers its biological specificity. Menstrual Cycle (hipogonadismo secundario):
    • Mujeres: hipofunción ovárica (amenorrea, infertilidad, atrofia mamaria, ↓ libido)
    • Hombres: hipofunción testicular (testículos atróficos, ↓ libido, ↓ masa muscular)
  • ↓ TSH (hipotiroidismo secundario):
    • Signos y síntomas: fatiga, piel seca, retraso en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum los LOS Neisseria reflejos tendinosos profundos, estreñimiento, intolerancia al AL Amyloidosis frío, bradicardia
    • Puede tener menos síntomas o síntomas similares a los LOS Neisseria del hipotiroidismo primario
    • En EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum los LOS Neisseria niños: se observa un retraso en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum el crecimiento
  • ↓ ACTH (insuficiencia suprarrenal secundaria):
    • Signos y síntomas: hipoglucemia, anorexia Anorexia The lack or loss of appetite accompanied by an aversion to food and the inability to eat. It is the defining characteristic of the disorder anorexia nervosa. Anorexia Nervosa, vómitos, malestar, pérdida de peso, colapso circulatorio
    • No hay pérdida de sal/hiperpotasemia ni contracción del volumen (la secreción de aldosterona es parcialmente independiente de la hipófisis)
    • Sin hiperpigmentación
  • ↓ Prolactina: fracaso de la lactancia (cese de la producción de leche materna)
• Deficiencia de las hormonas de la hipófisis posterior:
  • Solo la deficiencia de ADH ( diabetes Diabetes Diabetes mellitus (DM) is a metabolic disease characterized by hyperglycemia and dysfunction of the regulation of glucose metabolism by insulin. Type 1 DM is diagnosed mostly in children and young adults as the result of autoimmune destruction of β cells in the pancreas and the resulting lack of insulin. Type 2 DM has a significant association with obesity and is characterized by insulin resistance. Diabetes Mellitus insípida ( DI DI Diabetes insipidus (DI) is a condition in which the kidneys are unable to concentrate urine. There are 2 subforms of di: central di (CDI) and nephrogenic di (NDI). Both conditions result in the kidneys being unable to concentrate urine, leading to polyuria, nocturia, and polydipsia. Arginine Vasopressin Disorders (Diabetes Insipidus))) se manifiesta clínicamente.
  • Signos y síntomas: poliuria, polidipsia, hiponatremia, letargo
  • Los LOS Neisseria síntomas pueden mejorar en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum el contexto de la deficiencia de ACTH (↓ ACTH → secreción inapropiada de ADH o ( SIADH SIADH Syndrome of inappropriate antidiuretic hormone secretion (SIADH) is a disorder of impaired water excretion due to the inability to suppress the secretion of antidiuretic hormone (ADH). SIADH is characterized by impaired water excretion leading to dilutional hyponatremia, which is mainly asymptomatic but may cause neurologic symptoms. S Syndrome of Inappropriate Antidiuretic Hormone Secretion (SIADH), por sus siglas en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum inglés) debido a la deficiencia de cortisol Cortisol Glucocorticoids).
• Panhipopituitarismo: disminución de la secreción de la mayoría o de todas las hormonas hipofisarias

Características clínicas no hormonales

• Tumores (causan un efecto de compresión en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum las estructuras):
  • Cefalea
  • Defectos del campo visual (e.g., hemianopsia bitemporal homónima) y diplopía
• Síndrome de Sheehan:
  • Hemorragia posparto asociada a hipotensión
  • Letargo, anorexia Anorexia The lack or loss of appetite accompanied by an aversion to food and the inability to eat. It is the defining characteristic of the disorder anorexia nervosa. Anorexia Nervosa, incapacidad para lactar
• Apoplejía hipofisaria:
  • Cefalea repentina e insoportable
  • Diplopía
  • La pérdida aguda de ACTH causa hipotensión potencialmente mortal.
• Enfermedades genéticas y/o sistémicas: Los LOS Neisseria síntomas que acompañan a la enfermedad dependen de la condición o condiciones subyacentes.

Diagnóstico

Pruebas de laboratorio

Deficiencia de ACTH:

• Obtener cortisol Cortisol Glucocorticoids sérico por la mañana (entre las 8 y las 9 am):
  • Normal: ≥ 18 mcg/dL: suficiente ACTH
  • Cortisol Cortisol Glucocorticoids bajo (≤ 3 mcg/dL) + ACTH sérica baja: confirma ACTH baja
• Si el cortisol Cortisol Glucocorticoids es indeterminado (4–17 mcg/dL):
  • Prueba de la metirapona:
    • Lógica: La metirapona bloquea la conversión del 11-deoxicortisol en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum cortisol Cortisol Glucocorticoids.
    • Administración de metirapona por vía oral; obtención de los LOS Neisseria niveles de 11-deoxicortisol y cortisol Cortisol Glucocorticoids al AL Amyloidosis cabo de 24 horas
    • La reserva de ACTH intacta aumentaría el 11-deoxicortisol.
    • Se confirman la reserva de ACTH baja si 11-deoxicortisol < 10 mcg/dl y cortisol Cortisol Glucocorticoids sérico < 7 mcg/dl
  • Prueba de estimulación de la cosintropina:
    • Lógica: La disminución crónica de ACTH conduce a la atrofia suprarrenal ( cortisol Cortisol Glucocorticoids bajo).
    • Obtener ACTH basal.
    • Administrar cosintropina (ACTH) IM o IV.
    • Un cortisol Cortisol Glucocorticoids bajo después de 30 y 60 minutos indica insuficiencia suprarrenal.
    • Insuficiencia suprarrenal secundaria (↓ reserva de ACTH) confirmada si la ACTH basal es baja
  • Prueba de hipoglucemia inducida por insulina:
    • Lógica: La insulina provoca ↓ glucosa, que a su vez desencadena la secreción de cortisol Cortisol Glucocorticoids en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum circunstancias normales.
    • Inyectar insulina.
    • La glucosa, la ACTH y el cortisol Cortisol Glucocorticoids se miden en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum intervalos.
    • Deficiencia de ACTH se confirma si es inadecuado el ↑ en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum el cortisol Cortisol Glucocorticoids paralelo a la ACTH al AL Amyloidosis inicio de la hipoglucemia

Deficiencia de GH:

• ↓ Factor de crecimiento similar a la insulina-1 (IGF-1, por sus siglas en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum inglés) en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum el suero de pacientes con deficiencia de GH
• Pruebas de provocación:
  • Prueba de la hormona liberadora de GH ( GHRH GHRH A peptide of 44 amino acids in most species that stimulates the release and synthesis of growth hormone. GHRF (or GRF) is synthesized by neurons in the arcuate nucleus of the hypothalamus. After being released into the pituitary portal circulation, GHRF stimulates gh release by the somatotrophs in the pituitary gland. Hypothalamic and Pituitary Hormones) +/- arginina: El aumento inadecuado de GH confirma la deficiencia de GH.
  • Prueba de tolerancia a la insulina: aumento inadecuado de la glucosa en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la deficiencia de GH

Deficiencia de TSH:

• Obtener tiroxina libre (T₄) y TSH.
• Deficiencia confirmada en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum:
  • Nivel de T₄ libre (tiroxina) bajo o normal
  • Nivel sérico bajo de TSH

Deficiencia de LH LH A major gonadotropin secreted by the adenohypophysis. Luteinizing hormone regulates steroid production by the interstitial cells of the testis and the ovary. The preovulatory luteinizing hormone surge in females induces ovulation, and subsequent luteinization of the follicle. Luteinizing hormone consists of two noncovalently linked subunits, alpha and beta. Within a species, the alpha subunit is common in the three pituitary glycoprotein hormones (TSH, LH, and FSH), but the beta subunit is unique and confers its biological specificity. Menstrual Cycle/ FSH FSH A major gonadotropin secreted by the adenohypophysis. Follicle-stimulating hormone stimulates gametogenesis and the supporting cells such as the ovarian granulosa cells, the testicular sertoli cells, and leydig cells. Fsh consists of two noncovalently linked subunits, alpha and beta. Within a species, the alpha subunit is common in the three pituitary glycoprotein hormones (TSH, LH, and FSH), but the beta subunit is unique and confers its biological specificity. Menstrual Cycle:

• En EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum los LOS Neisseria hombres: testosterona baja, LH LH A major gonadotropin secreted by the adenohypophysis. Luteinizing hormone regulates steroid production by the interstitial cells of the testis and the ovary. The preovulatory luteinizing hormone surge in females induces ovulation, and subsequent luteinization of the follicle. Luteinizing hormone consists of two noncovalently linked subunits, alpha and beta. Within a species, the alpha subunit is common in the three pituitary glycoprotein hormones (TSH, LH, and FSH), but the beta subunit is unique and confers its biological specificity. Menstrual Cycle baja
• En EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum mujeres:
  • Un ciclo menstrual normal es indicativo de una función hipofisaria-ovárica intacta.
  • La FSH FSH A major gonadotropin secreted by the adenohypophysis. Follicle-stimulating hormone stimulates gametogenesis and the supporting cells such as the ovarian granulosa cells, the testicular sertoli cells, and leydig cells. Fsh consists of two noncovalently linked subunits, alpha and beta. Within a species, the alpha subunit is common in the three pituitary glycoprotein hormones (TSH, LH, and FSH), but the beta subunit is unique and confers its biological specificity. Menstrual Cycle/ LH LH A major gonadotropin secreted by the adenohypophysis. Luteinizing hormone regulates steroid production by the interstitial cells of the testis and the ovary. The preovulatory luteinizing hormone surge in females induces ovulation, and subsequent luteinization of the follicle. Luteinizing hormone consists of two noncovalently linked subunits, alpha and beta. Within a species, the alpha subunit is common in the three pituitary glycoprotein hormones (TSH, LH, and FSH), but the beta subunit is unique and confers its biological specificity. Menstrual Cycle baja/normal y el estradiol Estradiol The 17-beta-isomer of estradiol, an aromatized C18 steroid with hydroxyl group at 3-beta- and 17-beta-position. Estradiol-17-beta is the most potent form of mammalian estrogenic steroids. Noncontraceptive Estrogen and Progestins bajo sugieren una deficiencia hipofisaria.

Deficiencia de ADH:

• La prueba de privación de agua y la prueba de estimulación de la vasopresina se utilizan para diagnosticar la DI DI Diabetes insipidus (DI) is a condition in which the kidneys are unable to concentrate urine. There are 2 subforms of di: central di (CDI) and nephrogenic di (NDI). Both conditions result in the kidneys being unable to concentrate urine, leading to polyuria, nocturia, and polydipsia. Arginine Vasopressin Disorders (Diabetes Insipidus).
  • La osmolalidad de la orina no aumenta con la osmolalidad del suero.
  • Cuando se administra vasopresina, la osmolalidad de la orina aumenta.
• Prueba utilizada también para diferenciar la polidipsia psicógena y la DI DI Diabetes insipidus (DI) is a condition in which the kidneys are unable to concentrate urine. There are 2 subforms of di: central di (CDI) and nephrogenic di (NDI). Both conditions result in the kidneys being unable to concentrate urine, leading to polyuria, nocturia, and polydipsia. Arginine Vasopressin Disorders (Diabetes Insipidus) nefrogénica.

Exámenes adicionales

• Las pruebas de campo visual buscan defectos causados por la compresión del nervio óptico.
• Pruebas metabólicas (comprobación de electrolitos, glucosa)
• Pruebas de laboratorio dirigidas a la enfermedad sistémica subyacente
• Imagenología: Resonancia magnética (RM) cerebral o tomografía computarizada (TC) para detectar tumores hipofisarios/patología intracraneal

Tratamiento

Reemplazo hormonal

• Insuficiencia suprarrenal:
  • Reemplazo con hidrocortisona (se pueden utilizar otros corticosteroides)
  • Aumento de la dosis necesaria en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum caso de estrés, enfermedad o cirugía
• Deficiencia de TSH:
  • L-tiroxina
  • La tiroxina disminuye el cortisol Cortisol Glucocorticoids y puede agravar su deficiencia.
  • No administrar hasta que se trate la deficiencia de ACTH o se confirme la reserva de ACTH.
• Deficiencia de GH:
  • Inyecciones diarias de una preparación de GH humana recombinante ( en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum niños)
  • Controlar la respuesta y la adherencia con IGF-1.
• Deficiencia de gonadotropinas (sin deseo de fertilidad):
  • Mujer: estradiol Estradiol The 17-beta-isomer of estradiol, an aromatized C18 steroid with hydroxyl group at 3-beta- and 17-beta-position. Estradiol-17-beta is the most potent form of mammalian estrogenic steroids. Noncontraceptive Estrogen and Progestins + progestina ( en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum mujeres posmenopáusicas, administrar solo si es necesario para los LOS Neisseria sofocos)
  • Hombre: reemplazo con testosterona
• Deficiencia de gonadotropinas (con deseo de fertilidad):
  • Mujer: inducción de la ovulación con gonadotropinas
  • Hombre: inyecciones de hCG
• Deficiencia de ADH:
  • Desmopresina
  • Dieta baja en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum solutos, diuréticos tiazídicos

Tratamientos específicos

• Crisis suprarrenal:
  • Emergencia con riesgo de muerte: más común en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la insuficiencia suprarrenal primaria
  • Puede ocurrir en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la insuficiencia suprarrenal secundaria en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum situaciones como:
    • Infarto hipofisario
    • Cirugías que involucran la hipófisis
  • No se asocia a disminución del volumen, pero hay disminución del tono vascular → hipotensión
  • ¡No retrase el tratamiento!
  • Administrar líquidos intravenosos e hidrocortisona intravenosa.
• Apoplejía hipofisaria: descompresión quirúrgica
• Macroadenoma Macroadenoma Pituitary Adenomas hipofisario: cirugía transesfenoidal para lesiones grandes que causan síntomas neurológicos
• Antibióticos para las infecciones
• Tratamientos dirigidos a la etiología de las enfermedades sistémicas

Diagnóstico Diferencial

• Insuficiencia suprarrenal primaria: producción inadecuada de hormonas suprarrenales (glucocorticoides, mineralocorticoides y andrógenos suprarrenales) causada por un daño en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la glándula suprarrenal. Se debe sospechar esta condición, también llamada enfermedad de Addison, en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum pacientes hiponatrémicos con hiperpotasemia (causada por la reducción de la aldosterona). En EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la insuficiencia suprarrenal secundaria, la aldosterona no se ve VE Ventilation: Mechanics of Breathing afectada.
• Hiponatremia: Una concentración de sodio sérico de < 135 mEq/L puede deberse a otros trastornos endocrinos, como el hipocortisolismo o el hipoaldosteronismo causado por la insuficiencia suprarrenal. El diagnóstico puede realizarse mediante pruebas de estimulación con ACTH u hormona liberadora de corticotropina (CRH, por sus siglas en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum inglés).
• Hipotiroidismo: Las causas secundarias de hipotiroidismo, como el hipopituitarismo, pueden diferenciarse de los LOS Neisseria trastornos primarios de tiroides mediante pruebas hormonales. Los LOS Neisseria niveles bajos de TSH se observan en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum el hipotiroidismo secundario.
• Diabetes Diabetes Diabetes mellitus (DM) is a metabolic disease characterized by hyperglycemia and dysfunction of the regulation of glucose metabolism by insulin. Type 1 DM is diagnosed mostly in children and young adults as the result of autoimmune destruction of β cells in the pancreas and the resulting lack of insulin. Type 2 DM has a significant association with obesity and is characterized by insulin resistance. Diabetes Mellitus insípida: condición resultante de la disminución de la secreción de ADH. Los LOS Neisseria pacientes presentan poliuria, sed y fatiga. La prueba de privación de agua diferencia la DI DI Diabetes insipidus (DI) is a condition in which the kidneys are unable to concentrate urine. There are 2 subforms of di: central di (CDI) and nephrogenic di (NDI). Both conditions result in the kidneys being unable to concentrate urine, leading to polyuria, nocturia, and polydipsia. Arginine Vasopressin Disorders (Diabetes Insipidus) de la polidipsia primaria. Para determinar la DI DI Diabetes insipidus (DI) is a condition in which the kidneys are unable to concentrate urine. There are 2 subforms of di: central di (CDI) and nephrogenic di (NDI). Both conditions result in the kidneys being unable to concentrate urine, leading to polyuria, nocturia, and polydipsia. Arginine Vasopressin Disorders (Diabetes Insipidus) central frente a la nefrogénica, administrar desmopresina; se produce un aumento de la osmolalidad de la orina si existe DI DI Diabetes insipidus (DI) is a condition in which the kidneys are unable to concentrate urine. There are 2 subforms of di: central di (CDI) and nephrogenic di (NDI). Both conditions result in the kidneys being unable to concentrate urine, leading to polyuria, nocturia, and polydipsia. Arginine Vasopressin Disorders (Diabetes Insipidus) central (posiblemente causada por hipopituitarismo).
• Hipogonadismo primario: En EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum los LOS Neisseria hombres, se presenta una disminución de la función de los LOS Neisseria testículos (producción de esperma y testosterona). En EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum las mujeres, se produce una insuficiencia ovárica que se manifiesta con irregularidades menstruales. El diagnóstico se realiza mediante la determinación de los LOS Neisseria niveles de hormonas hipofisarias y sexuales. En EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum los LOS Neisseria hombres, también se realiza un análisis de semen. Las hormonas sexuales bajas con una LH LH A major gonadotropin secreted by the adenohypophysis. Luteinizing hormone regulates steroid production by the interstitial cells of the testis and the ovary. The preovulatory luteinizing hormone surge in females induces ovulation, and subsequent luteinization of the follicle. Luteinizing hormone consists of two noncovalently linked subunits, alpha and beta. Within a species, the alpha subunit is common in the three pituitary glycoprotein hormones (TSH, LH, and FSH), but the beta subunit is unique and confers its biological specificity. Menstrual Cycle y una FSH FSH A major gonadotropin secreted by the adenohypophysis. Follicle-stimulating hormone stimulates gametogenesis and the supporting cells such as the ovarian granulosa cells, the testicular sertoli cells, and leydig cells. Fsh consists of two noncovalently linked subunits, alpha and beta. Within a species, the alpha subunit is common in the three pituitary glycoprotein hormones (TSH, LH, and FSH), but the beta subunit is unique and confers its biological specificity. Menstrual Cycle por encima de lo normal indican un fallo del órgano primario.
• Deficiencia de GH: La disminución de GH puede ser congénita o adquirida. En EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la población pediátrica, la presentación puede variar desde la disminución del tamaño de los LOS Neisseria genitales hasta la baja estatura. En EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum los LOS Neisseria adultos, se observa menor energía, con disminución de la densidad ósea y de la masa corporal magra. El tratamiento (inyecciones de hormona de crecimiento) es necesario para los LOS Neisseria niños. En EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum los LOS Neisseria adultos, el tratamiento hormonal no es rutinario.
• Hipoprolactinemia: rara vez se presenta como enfermedad aislada. Esta condición se produce con mayor frecuencia debido a una disfunción general de las hormonas de la hipófisis anterior. Las pacientes presentan una lactancia inadecuada. Si no hay producción de leche, es necesario alimentar a los LOS Neisseria bebés con biberón.
• Síndrome de Kallmann: enfermedad caracterizada por una liberación deficiente de GnRH por parte del hipotálamo, lo que provoca un hipogonadismo secundario con niveles bajos de LH LH A major gonadotropin secreted by the adenohypophysis. Luteinizing hormone regulates steroid production by the interstitial cells of the testis and the ovary. The preovulatory luteinizing hormone surge in females induces ovulation, and subsequent luteinization of the follicle. Luteinizing hormone consists of two noncovalently linked subunits, alpha and beta. Within a species, the alpha subunit is common in the three pituitary glycoprotein hormones (TSH, LH, and FSH), but the beta subunit is unique and confers its biological specificity. Menstrual Cycle, FSH FSH A major gonadotropin secreted by the adenohypophysis. Follicle-stimulating hormone stimulates gametogenesis and the supporting cells such as the ovarian granulosa cells, the testicular sertoli cells, and leydig cells. Fsh consists of two noncovalently linked subunits, alpha and beta. Within a species, the alpha subunit is common in the three pituitary glycoprotein hormones (TSH, LH, and FSH), but the beta subunit is unique and confers its biological specificity. Menstrual Cycle y GnRH. Esto puede diferenciarse del hipogonadismo primario, que se presenta con niveles elevados de GnRH. Las causas hipofisarias de hipogonadismo también se presentan con niveles bajos de gonadotropina.