Hypopituitarism Simmonds disease

Causes include chromophobe adenoma, tumours of surrounding tissues (e.g. craniopharyngioma), skull fractures, infarction following postpartum haemorrhage and infection. Clinical features include loss of axillary and pubic hair, amenorrhoea, features of hypothyroidism and adrenal insufficiency, including hypotension, but with a striking pallor, in contrast to the pigmentation of Addison's disease (see p. 447).

The fluid and electrolyte disturbances are not as marked as in primary adrenal failure as a result of intact aldosterone production, but may be unmasked by surgery, trauma or infection. Anaesthesia in these patients requires steroid cover (p. 447), cautious administration of induction agent and volatile anaesthetic agents, and careful cardiovascular monitoring.

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