Talk:Hypopituitarism

doi
reviews this complicated condition. JFW | T@lk  05:54, 29 April 2007 (UTC)


 * OK, have pulled the Schneider review. These are also the people who showed the high frequency in brain injury/SAH patients in 2007 (and they think that hypopit is underdiagnosed in those cases).
 * So plans for the article: (1) Apply MEDMOS, (2) populate sections with information from Schneider, (3) research any obviously missing data ( is another recent review), (4) peer reviewage. JFW | T@lk  10:38, 16 July 2008 (UTC)


 * The same colleague suggested that we elaborate a bit on PIT1 mutations and other genetic causes of hypopituitarism. JFW | T@lk  13:58, 23 July 2008 (UTC)

Workup
Schneider doesn't really give a list of tests that should be done from the outset apart from MRI. What is the place of doing ferritin, ACE/lysozyme, viral titres etc? I don't know. Suppose I shall ask one of my friendly local hormone people. JFW | T@lk  12:57, 22 July 2008 (UTC)


 * Argh, left my papers at work again. Blah. Will have to do tomorrow. JFW | T@lk  19:35, 22 July 2008 (UTC)


 * I asked an endocrinological colleague. Apart from MRI, few specific tests are performed from the outset.
 * I need a source that details the "pituitary stalk syndrome", as Schneider is not very elaborate on that topic.
 * Hope the formatting is now less hostile (less bullet points). JFW | T@lk  13:57, 23 July 2008 (UTC)

Images
Ideally, we should have an actual MRI pituitary. A quick browse in the Image namespace and Commons has not yielded results. JFW | T@lk  15:27, 23 July 2008 (UTC)

Layout of Causes section
Is there any way to increase the font size if a table must be used? --Steven Fruitsmaak (Reply) 08:27, 26 July 2008 (UTC)

Entire article is sourced to one reference?
Could the article used more than one primary source and instead use multiple sources? The entire article is essentially dependent on a single source. Gary King ( talk ) 00:46, 27 July 2008 (UTC)


 * It is a fairly good secondary source in an area that is not exactly awash with sources. Will try to diversify. JFW | T@lk  06:45, 30 July 2008 (UTC)


 * I have found other sources (see below). Do you regard it as essential that I cut down on the 34 references to Schneider et al in favour of other sources? JFW | T@lk  15:02, 30 July 2008 (UTC)


 * I would imagine that there is a chance of bias if an entire article is referenced to one source. Gary King ( talk ) 03:42, 6 August 2008 (UTC)


 * OK. Which is why I've started offering contrasting comments from other sources if they disagree with Schneider. That's okay then. JFW | T@lk  06:29, 6 August 2008 (UTC)


 * Should be fine Gary King ( talk ) 06:44, 6 August 2008 (UTC)

Reviews
Skin problems well recognised in hypopit, yet not covered by Schneider: might be useful. JFW | T@lk  06:51, 30 July 2008 (UTC)


 * ✅ (Postgrad Med J) is another general purpose clinical review. JFW |  T@lk  06:54, 30 July 2008 (UTC)


 * ✅ (Pituitary) general review on diagnosis and treatment (Lamberts wrote the 1996 Lancet review, so clearly a renowned pituitarologist). JFW |  T@lk  06:54, 30 July 2008 (UTC)


 * (Curr Opin Genet Dev) more on genetic causes for hypopituitarism. JFW | T@lk  07:01, 30 July 2008 (UTC)


 * (Horm Res) emphasis on genetics. JFW | T@lk  07:01, 30 July 2008 (UTC)


 * (Eur J Endocrinol) hyponatraemia common in elderly. JFW | T@lk  07:01, 30 July 2008 (UTC)


 * ✅ (Endocr Rev) genetics of combined deficiencies. JFW |  T@lk  07:01, 30 July 2008 (UTC)

Trying GAN again
I have again submitted this for good article status. Since the previous review, I have consulted a much wider range of sources and contrasted them with the Schneider source whenever posssible. I have reduced the number of references to that source to 30, which is about the minimum because I also use Schneider to support my choice of a couple of primary sources (the Regal study, for instance). I think that otherwise the article covers the subject pretty well, and I have added substantial content about the rare genetic causes, as well as the more common adult forms that are due to brain injury or pituitary adenomas. I have limited professional experience with the condition, so reading up about it was very educational. JFW | T@lk  20:14, 10 August 2008 (UTC)


 * I've added the Van Aken & Lamberts review. That pretty much covers it. JFW | T@lk  23:01, 11 August 2008 (UTC)


 * First half of my review is here. I'll finish it tomorrow. — Cyclonenim T@lk? 00:13, 18 August 2008 (UTC)

GAN
I've passed the article, a big thank you to anywho who has contributed to making these article better in any way, shape or form. — Cyclonenim T@lk? 19:58, 18 August 2008 (UTC)

Better look into this further
http://en.wikipedia.org/w/index.php?title=Hypopituitarism&diff=234429637&oldid=234426991 That study saying cause is pituitary tumor 61% of the time is terribly wrong. I've been helping people (over 2500 easy) with hypopituitarism for 5 years. Because one reference says this doesn't mean it's so. The vast majority of hypopit cases, their MRI shows no pit tumor. The figure of tumor cause is for sure less than 10%. From what I've seen 90% of hypopituitarism is due to previous head injury, usually from years or decades earlier (pituitary is easily damaged in even a mild head bump, doesn't have to be one that cause unconciousness or lands you in the hospital)  Up to 5 percent have autoimmunity as the cause of their hypopituitarism (usually found alongside Hashimoto's).


 * "Terribly wrong". The problem is that Regal's study is the most systematic study we have, and your data is original research. If you look in Schneider you will see that head injury is probably the tip of the iceberg with hypopit. If you have a reliable source, we can discuss it in the article. JFW | T@lk  22:45, 2 September 2008 (UTC)


 * Then Regal is terribly wrong on many counts. They are either fudging numbers, guessing or whatever.  They are a terrible source from what I've seen so far.Chrisgj (talk) 00:44, 4 September 2008 (UTC)


 * In that case, please complain to the journal's editors and peer reviewers. But for the purposes of this article it is a very good source. Just because its conclusions don't reflect your personal experiences is unfortunate, but I can't help that. JFW | T@lk  05:54, 4 September 2008 (UTC)


 * I think it bears remembering (like Schneider says) that much hypopituitarism is undiagnosed in head injury victims. The Regal study only looked at diagnosed cases. I think we are making this qualification in the "epidemiology" section. JFW | T@lk  06:04, 4 September 2008 (UTC)

first intro paragraph, second sentence, that reference does not mention panhypopituitarism at all which is total lack of all pituitary hormones in at least the anterior.


 * I'm not sure what you are trying to say. There are various definitions of the term. I think the term itself is not helpful. JFW | T@lk  22:45, 2 September 2008 (UTC)


 * What part of "the reference does not mention panhypopituitarism at all..." do you not understand?


 * You are correct that the Dorlands source doesn't mention it. In fact, you will be hard pressed to find a source that defines panhypopituitarism; Emedicine uses the terms interchangably: www.emedicine.com/med/TOPIC1137.HTM. JFW | T@lk  05:54, 4 September 2008 (UTC)

2nd intro paragraph, 3rd sentence "Most hormones of the pituitary can be replaced by tablets or injections." This is incorrect. Only two hormones (growth hormone and vasotocin) can be replaced. That is only about 1/6 of the total of major pituitary hormones.


 * The article qualifies later that the replacement is usually of the target hormone. The point is that the symptoms of hypopituitarism can be treated with oral medications very often. Please sofixit if you think there is a better way of putting it. JFW | T@lk  22:45, 2 September 2008 (UTC)


 * That is fine, but the above state is still untrue.  I just explained it's not "most". Chrisgj (talk) 00:44, 4 September 2008 (UTC)


 * I've rephrased the sentence that bothered you. Hope it's better now. JFW | T@lk  05:54, 4 September 2008 (UTC)

2nd intro paragraph, 4th sentence "Hypopituitarism is a rare disease, but may be significantly underdiagnosed in people with previous traumatic brain injury.[1]"

Hypopituitarism is very commonly diagnosed, not rare at all. Under diagnosed is two words.


 * "Very commonly" - please review the definition of "rare disease", e.g. for purposes of orphan drug approval. JFW | T@lk  22:45, 2 September 2008 (UTC)

Signs and symptoms

"The hormones of the pituitary have different actions in the body, and the symptoms of hypopituitarism therefore depend on which hormone is deficient. The symptoms may be subtle and are often initially attributed to other causes.[1][4] In most of the cases, three or more hormones are deficient.[5] The most common problem is insufficiency of follicle-stimulating hormone (FSH) and/or luteinizing hormone (LH) leading to sex hormone abnormalities. Growth hormone deficiency is more common in people with an underlying tumor than those with other causes."

ACTH deficiency is just about as common as LH and FSH since these three tend to happen together. No reference on this.


 * See Regal and Schneider. Have you got a reference for your claim that "these three tend to happen together"? How can you explain this pathophysiologically? JFW | T@lk  22:45, 2 September 2008 (UTC)

Posterior pituitary

"ADH deficiency may be masked if there is ACTH deficiency, with symptoms only appearing when cortisol has been replaced."[6]

That statement is terribly wrong. That reference, you have to sign up on that website to access the article. It doesn't say anything remotely close to that statement. I've never seen anyone have that happen when they get on cortisol replacement. ADH deficiency bad enough to treat is very uncommon whether or not one is on cortisol replacement.


 * "Terribly wrong" = you disagree with a reliable source. You write to Dr Van Aken if you are bothered by errors in his article. JFW | T@lk  22:45, 2 September 2008 (UTC)


 * What part of "It doesn't say anything remotely close to that statement" do you not get. It doesn't say that, period, end story, he made this up.  It doesn't happen.Chrisgj (talk) 00:37, 4 September 2008 (UTC)


 * Please control your rhetoric. Have you read the study? It says precisely what I've quoted, namely that DI may be present but only come to the forefront when cortisol deficiency is replaced. To do you the favour I will reread the paper. JFW | T@lk  05:54, 4 September 2008 (UTC)


 * It was actually Prabakhar rather than Van Aken. Prabakhar says, in the section called "ADH deficiency": "ACTH deficiency can mask DI clinically, symptoms only becoming apparent on starting steroid replacement." This seems to reflect the experience of two clinicians well known for being experts in pituitary problems. JFW | T@lk  06:04, 4 September 2008 (UTC)

Well, I'd have to say this article is a long way from GA. Is lacking accuracy and neutrality. I've been up all night, not feeling well, but I will look the rest of this article over later.

Chrisgj (talk) 11:29, 2 September 2008 (UTC)


 * I'm unsure where to begin. You are relying on personal experience, and I rely on sources. I think it is thoroughly cited and fairly accurate, and I cannot see any specific neutrality issues. Please think again before throwing these accusations around willy-nilly. JFW | T@lk  22:45, 2 September 2008 (UTC)


 * You are relying on flawed sources and sources that don't back up the statements in this article. This sums up everything I've been saying.  I pointed out the made up source backing up the ADH, adrenal insufficiency connection.  The sources doesn't say anything about it. Geez.  That is a legitamate accussation is it not?  Everything I've said is true.  Relying so much on Regal when they are obviously wrong is making this article flawed. Chrisgj (talk) 00:44, 4 September 2008 (UTC)


 * You will need to present better sources if you want me to make the amendments you are insisting on. Again, just because your personal experience is not reflected in the article is no grounds for making these loud complaints. The article is based on three high-quality reviews in The Lancet, Postgraduate Medical Journal and Pituitary, as well as the sixteenth edition of Harrison's Principles of Internal Medicine. If I had to take the word of these sources against your unpublished personal experiences, I'd take the sources anytime. Sorry. JFW | T@lk  05:54, 4 September 2008 (UTC)

Moved
"I HAVE A 3 YEAR OLD SON THAT WAS BORN WITH "HYPOPITUITARISM" HE WAS BORN WITH A BLOOD SUGAR LEVEL AT 11/ ALMOST DEATH.HE IS CORTISOL DEPENDENT AND TAKES A THYROID, ALSO A GROWTH HORMON SHOT EVERYDAY. HE WAS FULL TERM SO I WAS INDUCED WHEN I WENT INTO LABOR WITH HIM; THIS WOULD BE MY THIRD SON, AND THE LABOR WAS INTENSE, HIS HEART RATE WENT DOWN SEVERAL TIMES WITH THE POTASIUM THEY GIVE YOU TO GO INTO LABOR. I WAS A SECOND AWAY TO GOING FOR A C-SECTION. MY QUESTION IS COULD THIS BE THE REASON WHY IS HIS PITUITARY IS DEFORMED ONLY A SMALL PART OF THE PITUITARY? THE "SPECIALIST" SAY THAT IT COULD BE GENETIC.. MY SECOND CONCERN IS HE HAS A EXTREMELY BAD ECZEMA AND THE DERMOTOLOGY STILL HAVE NOT FOUND ANYTHING TO CALM HIS SKIN, I FEEL THAT THE PITUITARY HAS SOMETHING TO DO WITH HIS SKIN PROBLEMS, BUT ENDOCRINOLGY WILL NOT AGREE WITH ME. IF YOU HAVE ANY SUGGESTIONS OR COMMENTS PLEASE RESPOND--Indigo3 (talk) 03:13, 1 July 2009 (UTC)


 * To my knowledge there is no direct link between hypopituitarism and eczema, and in fact if I search PubMed with those terms, no journal articles are returned. That means that nobody has ever written about it in the medical literature since 1966 or so. Eczema is very common so this may all be coincidental. But your child's condition is really rare so it may well be that the association has not been reported yet. JFW | T@lk  06:05, 1 July 2009 (UTC)
 * Actually not very rare at large children's hospitals, which may get several kids a year with congenital hypopituitarism (neonatal hypoglycemia, jaundice, small genitalia, missing GH, cortisol, thyroid); the MRI usually shows an undersized, underdeveloped pituitary, which is generally understood to indicate that the pituitary failed to develop far earlier in the pregnancy than delivery. Some of the children born with this have identifiable genetic mutations, others don't. There is no statistical association with eczema, which is a common skin problem in infants, although one cannot ever "prove" a non-association for an individual person. You can assume they are related if you wish, but it doesnt change the treatment of either condition. alteripse (talk) 10:53, 1 July 2009 (UTC)

The MRI showed that the pituitary was partially not formed so with the gland not being formed and not working correctly the article did say that you would have skin problems, hair and nail. Another concern is his penis does look smaller than "normal" but endocrinolgy does not agree. What age would this be able to be determined? Thank you for your responses and if you have any suggestions where to go to talk with other parents that have small children with Hypopituitarism, a support group.--Indigo3 (talk) 14:14, 2 July 2009 (UTC)
 * Try http://www.magicfoundation.org/www    Go over these questions with your pediatric endocrinologist. These are common issues and this is a well-known condition to a pediatric endocrinologist. alteripse (talk) 18:40, 2 July 2009 (UTC)

Causes of Hypopituitarism
Firstly my apologies. I edited this page (under Causes/Physical) without being aware of any protocols about so doing. I will leave it amended so that it be discussed, at least, before deletion. I am not a medical professional, in this instance I am a patient. Secondly, my sources seem reliable, but I cannot provide a citation and hope that this can be done by others.

I am under long term treament for pain resulting from a torn L4 nerve root in my spine - and on Oxycontin. I was asked, at the pain clinic, whether I suffered from erectile dysfunction and, on affirming this, was informed that long term use of morphine affects the pituitary gland such as to reduce testosterone production. My own research did not produce any detailed corroboration.

Subsequently I was referred to a local endocrinologist who is currently investigating me for suspected panhypopit (I am already on testosterone replacement and await further test results) He has written to my GP and mentions that he has found some recent proceedings in which opioid depression of pituitary function was reported and discussed, but so far I am unable to find those proceedings. If I find this difficult and nobody has provided the citation, I will seek it when I next meet this consultant.

Once again, my apologies for any rules broken, but I guess my view is that the pursuit of truth is far more important than quibbling over niceties! Ian Intelfam (talk) 23:43, 28 July 2009 (UTC)


 * The important question is whether there is a definite link reported in high-grade medical sources. If this has been very sporadically reported, it may not be appropriate to mention it here. Let us know if your consultant can show a source. I can't imagine why opiates would interfere with pituitary action. JFW | T@lk  17:01, 30 July 2009 (UTC)

Proposed new section
Should there be an "In popular culture" section about, for example, the fact that the titular protagonist in Orphan has hypopituitarism, possibly with a bit about how the portrayal of the condition was inaccurate? There are probably other occurrences of the condition in popular culture, but even if there aren't, it might be worth making the section anyway.  Penguin  of  Death   18:02, 6 November 2009 (UTC)


 * On the whole that would be WP:TRIVIA and I would only include such a piece of information if the cultural depiction has measurably changed public perception of a particular illness. JFW | T@lk  22:59, 7 November 2009 (UTC)

Hypothalamus?
I noticed the first sentence of the article states that hypopituitarism is marked by "decreased secretion of one or more of the eight hormones normally produced by the pituitary gland." Should this be corrected to read "normally produced or secreted?" I believe some of the hormones (e.g. ADH) are actually produced by the hypothalamus and released by the pituitary. —Preceding unsigned comment added by 99.224.145.231 (talk) 05:46, 20 December 2009 (UTC)


 * That is technically correct. Feel free to fix it if you find the time before I do. Perhaps all the sentence should say that the hormones are secreted in the pituitary. JFW | T@lk  01:18, 21 December 2009 (UTC)

Question
Can pituitary failure be cause by solvent abuse? —Preceding unsigned comment added by 92.21.132.44 (talk) 22:30, 19 June 2010 (UTC)


 * Don't know, not according to the sources I used. JFW | T@lk  22:22, 29 June 2010 (UTC)

Sheehan syndrome
I initially misread this as describing ischemia in an infant rather than in a female who has just given birth. I am going to alter the wording to make this a little clearer if there are no objections. Bobsagat (talk) 21:52, 11 December 2010 (UTC)


 * Lovely, thanks for that. JFW &#124; T@lk  22:09, 11 December 2010 (UTC)

Using dfn tags
has tried to put more emphasis on the names of the eight pituitary hormones in the "signs and symptoms" section. Initially this was boldface, but this doesn't seem to follow the criteria from MOS:BOLD. I have now also reverted the second attempt, which revolves around the use of italics and the dfn function. I am unsure whether this is necessary. The dfn template seems to be very rarely used (not in articles anyway), and I don't think I agree that the criteria from MOS:ITALIC have been met. I would prefer a discussion here. JFW &#124; T@lk  17:55, 9 August 2012 (UTC)


 * I do not insist on the changes. I changed it because I found it difficult to find the eight hormones mentioned in the first sentence. It was like Chekhov's gun for me. More correctly I should have put the dfn tag not around the hormones, but around the hormone deficiencies instead – they are after all the parts that constitute hypopituitarism. Maybe rework it as a list instead?


 * BTW, this article does a better job describing the hormones of the pituitary, and what they do, than the pituitary article, IMHO. Maybe someone should copy the Hypothalamic-pituitary-end organ axis table to the main article? This would be helpful IMHO, but I don't know how to do it, copyright and all. Tony Mach (talk) 18:24, 9 August 2012 (UTC)


 * Thanks - I wrote most of this, so I will take the credit. A lot of anatomy and physiology articles need tidying up.
 * I am quite happy with any changes that will decrease the level of surprise. The principle of least astonishment applies. JFW &#124; T@lk  19:19, 9 August 2012 (UTC)


 * So I'll add happily the table to the pituitary article.
 * One more thing, I'll like to add a link to pituitary disease here in this article, it'll be probably be best in the from "Hypopituitarism is a disease of the pituitary … “ or some such, but a "See also" section would be fine as well. What do you think? Tony Mach (talk) 15:07, 10 August 2012 (UTC)

why is levothyroxine the only treatment mentioned in this article for hypothyroidism?
Please can you tell me why you only mentioned levothyroxine as treatment for hypothyroidism when there is also Natural Desiccated Thyroid Hormones (NDT) and Liothyronine? (also these 3 drugs are used in combination therapy, some take NDT and T3, some NDT and levothyroxine and some Levothyroxine and Liothyronine by the way) I tried to edit your article a few times and I have been HIGHLY told off by user Novangelis saying that I did not provide reputable references to my additions of NDT and liothyronine and also 'accusing me' of not agree with the 'reputable' endocrinologists organisations recommendations. I never stated my preference and if I agree/disagree to any treatment I merely ask for an edit on this article to ACKNOWLEDGE that 3 main medications are used for treating hypothyroidism, that is all, nothing more nothing less. I am new to this wikipedia staff so please be patient with me, I'll learn. Respectfully — Preceding unsigned comment added by Paleohack (talk • contribs) 19:27, 6 September 2012 (UTC)
 * The stuff you tried to add did not comply with WP:MEDRS, among other policies, so check that one out first. Dbrodbeck (talk) 19:43, 6 September 2012 (UTC)

Ok, but I think one point here is being missed: levothyroxine also does not have a 'reputable reference' in this article so why do I have to provide a 'reputable reference' for the addition of NDT and liothyronine? Thyroid_hormone for example (which is a wiki page) does state the truth that levothyroxine is not the only treatment. How do I dispute this further please? (about this article only mentioning levothyroxine?) --Paleohack (talk) 19:59, 6 September 2012 (UTC)
 * Wait for discussion to occur here, and see what other editors think. Be patient, we work by consensus, and we are from all over the world, so you have to factor in time differences etc.  Dbrodbeck (talk) 20:02, 6 September 2012 (UTC)

Thank you Dbrodbeck, we will see ps I don't know how to do the 'answer' thing that you and others so where the reply is 'indented' so to show is a reply (sorry) --Paleohack (talk) 20:11, 6 September 2012 (UTC)


 * This had the markings of fringe advocacy, head to tail, even before these additions were proclaimed "the truth", which is ironic, given how totally wrong it is. Starting with the unusual product description emphasizing the word "natural" for a highly processed product, to the inability to find the footnotes a couple of sentences away, to the reinsertion of nonfactual material using dismal sources (the journal not listed in PubMed was the best and it went downhill from there), the nature of the post was obvious. A massive dump of "references" (241, mostly irrelevant) to my talk page was another sign. The fact that the incorrect material was repeatedly added to the article (and the "references" to my talk page) is also indicative. While out-of-date therapies can work in primary hypothyroidism, where you just have to get TSH to budge a little (but not too much), TSH is meaningless in the management of the secondary hypothyroidism from hypopituitarism. Treatment is monitored by targeting T4 to about two thirds of the way up normal range (plus clinical assessment). Administration of T3, especially in variable amounts, runs counter to the therapeutic goals. Of course, that is just the opinion of experts published in review articles in academic journals, not "truth".Novangelis (talk) 05:57, 7 September 2012 (UTC)

Excess mortality
Currently the citation for mortality is weak, and more work has recently been done in this area. 10.1210/jc.2014-3787 is a SR/MA of mortality and contains a couple of important pointers (e.g. sex differences). I will need to read it before adding specific associations. JFW &#124; T@lk  10:11, 8 February 2015 (UTC)

Post-traumatic hypopituitarism
... is often transient, usually involves GH deficiency, and has not been studied well beyond its incidence 10.1210/er.2014-1065 JFW &#124; T@lk  20:17, 10 May 2015 (UTC)

Lancet seminar
10.1016/S0140-6736(16)30053-8 - perhaps an opportunity to replace older sources. JFW &#124; T@lk  08:36, 2 September 2016 (UTC)

Guideline
10.1210/jc.2016-2118 - Endocrine Society guideline on hormone replacement. JFW &#124; T@lk  15:55, 19 October 2016 (UTC)

Pathophysiology
Under this section of the article on hypopituitarism, second paragraph, third sentence, the hormone is referred to as "Sonic hedgehog". Please edit this to contain the proper hormone name. I cannot advise what that is, as I am not an expert; I was looking for information on the condition and noticed this irregularity. I hope it will be resolved soon, thank you.

2602:306:C548:4959:1946:C273:4ADA:1933 (talk) 00:16, 26 January 2018 (UTC)25Jan2018 shg


 * It's the correct name. Read the Sonic hedgehog article. This is not about the SEGA game but simply reflects the fact that some scientists actually have a sense of humour! JFW &#124; T@lk  09:15, 26 January 2018 (UTC)

hypopituitarism
Male Stonershash (talk) 06:23, 6 July 2022 (UTC)