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A case of Hypopituitarism
• Mrs Selin, 49 year old House wife
• k/c/o Hypothyroidism/DLP/GERD
Presenting complaints
• Vomiting x multiple episodes x 1 week
• Increased Tiredness x 1 week
• Dry cough x 3 weeks
History of presenting complaints
• Prior to this presentation she was recently
admitted and evaluated in KMCH Coimbatore
for vomiting and unresponsiveness, in feb
2023. After 1 week of hospital stay, pt got
discharged on request.
• Pt was reportedly normal for next 2 weeks,
then again started vomiting
• h/o slow movement and slow speech +
• h/o facial edema, and periorbital edema+
• h/o dry skin +, loss of hair +
• h/o c/c fatigue +, anorexia +
• No h/o dyspnoea, head ache, visual
disturbances
• No h/o weight loss, hyper pigmentation
• No h/o cold intolerance
• no h/o ascites, galactorhea, breast atrophy
• No h/o head trauma/surgery/radiation
• No h/o abdominal pain/chest pain
• No h/o infertility
• No h/o hoarseness of voice, constipation/
weight gain, sleep disturbance
• No h/o poyuria/polydipsia,nocturia
Past medical history
• h/o abortion in first pregnancy
• h/o lactation failure after third pregnancy
Personal history
• Premature menopause at 41 years of age, not
evaluated
• Lives with husband and daughter
• Non veg by diet
Examination
• Pt drowsy
• Afebrile, pallor +
• PR 84, Bp 100/74, RR 22, SpO2 98
• CVS S1S2+ no murmurs
• RS b/l air entry +, NVBS+
• P/A non tender
• CNS NO FND
Investigations
CBC
• Hb 8.7, TC 4300, N 69.6, L 22.3, M 5.3, E 2.3
• Plt 2.6 L
• URE NAD
• Procal 1.7
• CRP 1.6
RFT Ur 7, Cr 0.7, UA 1.5
• NA 107, K 3.3, Cl 78, Ca 7.9, Mg 2
LFT OT 43, Pt14
• ALP 84
• T bili 0.6
• D bil 0.1, indirect 0.;5
• CPK MB 8.1
• Trop T .02
• Serum osmolality 221, urine osmolality 169
• Cortisol 3.8
• Urine sodium 37
• TSH 1.3, FT4 0.11, FT3 0.71, TPO 41
• T chol 189, TG 174,HDl 38, LDL 116
• VLDL 35
• Iron 123, IBC 101, b12 5344
• Ferritin 796
• FSH
• LH
• ACTH
• S cortisol
• ANA profile- negative
• ECG- T inv v1-v4
• ECHO- RWMA , god lv function EF 62%
• USG abdomen-Normal study
• CXR- normal study
• 1. Lack of FSH LH
• 1. Hypogonadim amenorrhea
• 2. hypothyroidism
• 3. Ladrenocortical insufficiency
• 4. Prolactin deficiency -FAILURE OF
POSTPARTUM LACTATION
Summary
Diagnosis
• Pan hypopituitarism
• Secondary to sheehans syndrome

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hypopit.pptx

  • 1. A case of Hypopituitarism
  • 2. • Mrs Selin, 49 year old House wife • k/c/o Hypothyroidism/DLP/GERD
  • 3. Presenting complaints • Vomiting x multiple episodes x 1 week • Increased Tiredness x 1 week • Dry cough x 3 weeks
  • 4. History of presenting complaints • Prior to this presentation she was recently admitted and evaluated in KMCH Coimbatore for vomiting and unresponsiveness, in feb 2023. After 1 week of hospital stay, pt got discharged on request. • Pt was reportedly normal for next 2 weeks, then again started vomiting
  • 5. • h/o slow movement and slow speech + • h/o facial edema, and periorbital edema+ • h/o dry skin +, loss of hair + • h/o c/c fatigue +, anorexia +
  • 6. • No h/o dyspnoea, head ache, visual disturbances • No h/o weight loss, hyper pigmentation • No h/o cold intolerance • no h/o ascites, galactorhea, breast atrophy • No h/o head trauma/surgery/radiation • No h/o abdominal pain/chest pain • No h/o infertility
  • 7. • No h/o hoarseness of voice, constipation/ weight gain, sleep disturbance • No h/o poyuria/polydipsia,nocturia
  • 8. Past medical history • h/o abortion in first pregnancy • h/o lactation failure after third pregnancy
  • 9. Personal history • Premature menopause at 41 years of age, not evaluated • Lives with husband and daughter • Non veg by diet
  • 10. Examination • Pt drowsy • Afebrile, pallor + • PR 84, Bp 100/74, RR 22, SpO2 98 • CVS S1S2+ no murmurs • RS b/l air entry +, NVBS+ • P/A non tender • CNS NO FND
  • 11. Investigations CBC • Hb 8.7, TC 4300, N 69.6, L 22.3, M 5.3, E 2.3 • Plt 2.6 L • URE NAD • Procal 1.7 • CRP 1.6 RFT Ur 7, Cr 0.7, UA 1.5 • NA 107, K 3.3, Cl 78, Ca 7.9, Mg 2 LFT OT 43, Pt14 • ALP 84 • T bili 0.6 • D bil 0.1, indirect 0.;5 • CPK MB 8.1 • Trop T .02
  • 12. • Serum osmolality 221, urine osmolality 169 • Cortisol 3.8 • Urine sodium 37 • TSH 1.3, FT4 0.11, FT3 0.71, TPO 41 • T chol 189, TG 174,HDl 38, LDL 116 • VLDL 35 • Iron 123, IBC 101, b12 5344 • Ferritin 796
  • 13. • FSH • LH • ACTH • S cortisol
  • 14. • ANA profile- negative • ECG- T inv v1-v4 • ECHO- RWMA , god lv function EF 62% • USG abdomen-Normal study • CXR- normal study
  • 15. • 1. Lack of FSH LH • 1. Hypogonadim amenorrhea • 2. hypothyroidism • 3. Ladrenocortical insufficiency • 4. Prolactin deficiency -FAILURE OF POSTPARTUM LACTATION
  • 17. Diagnosis • Pan hypopituitarism • Secondary to sheehans syndrome