Pitutary dwarfism

Made easy, Simple , simplified .

 

Etiology:

• Congenital: agenesis, aplasia, dysplasia. Traumatic.
• Infection: T.B., sarcoidosis.
• Neoplastic: cranio-pharyngioma, pituitary adenoma. Iatrogenic: surgical excision, irradiation.

Clinical Picture:

• Congenital: agenesis, aplasia, dysplasia. Traumatic.
• Infection: T.B., sarcoidosis.
• Neoplastic: cranio-pharyngioma, pituitary adenoma. Iatrogenic: surgical excision, irradiation.

a- At birth:

• normal size & wt.
• may be hypotonia, hypoglycemia.

b- During childhood:

• Short stature.
• Rounded head.
• Prominent head.
• Broad face.
• Depressed nasal bridge.
• Saddle small nose.
• Undeveloped Mandible & chin.
• Short neck.
• Proportionate limbs with small hand & feet.
• Underdeveloped genitalia & absent body hair.
• Normal IQ.

c- Cases with destructive pituitary lesion:

• Initially normal, then growth failure.
• Multiple hormonal : - TSH – ACTH – ADH – GnTH - GH
• Headache, vomiting, squint.

Treatment:  Of the cause.

• Recombinat human growth hormone (r HGH). S.C
• Replacement therapy for other hormones.

Causes of delayed puberty?

a- Hypogonadotropic conditions	b- Hypergondotropic conditions
1- Multiple pituitary horm. . 2- Isolated G.H. . 3- Isolated GnTH 4- Syndromes (Parder - Willi syndr). 5- Systemic dise.: Nutritional, psychologic. 6- Other endocrinal cause: hypothyroidism. Hyperprolactinemia. 7- Polycystic ovary dise. 8- Constitutional delay in growth.	1- Ovarian and testicular dysgenesis. 2- Enzyme defect. 3- Androgen in sensitivity. 4- Gonadal toxins or radiation ttt. 5- Other miscellaneous causes.

Casues of precocious puberty?
Central:
Idiopathic true precoious pouberty.
CNS disorders ( meningitis, encephalitis ) .
CNS tumors ( Hamartoma, hypothalam. Tumor ).
Peripheral:

Male
A- Adrenal tumors
C- Congenital adrenal hyperplasia.
L- Leyding cell testicular tumor.
T- Testotoxicosis.

Female

• Adrenal tumors.
• Ovarian tumors
• Follicular cysts.
• Exogenous estrogen.