Hypopituitarism and pituitary lesions — structured clinical encounter

Structured encounter testing the approach to a child with short stature, a falling height velocity, morning headache and a visual field defect: the recognition of a suprasellar lesion, the paired-hormone and dynamic work-up, the imaging and germ-cell markers, the safe replacement order, and the conversation with a family facing a pituitary tumour and lifelong hormone replacement.

structured clinical encounter2 min readVerification in progress

Prompt

A 10-year-old boy presents with two years of slow growth, recent early-morning headaches and, on questioning, difficulty seeing to the sides. His height has fallen below the third percentile with a low height velocity, he has not started puberty, and confrontation testing shows a bitemporal field defect. You are the paediatric registrar working through the diagnosis, the confirmatory work-up, the replacement plan and the conversation with the family.

Station brief (candidate)

You have ten minutes to assess this boy, establish the likely diagnosis, outline the investigation and replacement plan, and address the family's questions. The examiner will prompt you at intervals. A suprasellar lesion causing hypopituitarism is the leading diagnosis, and the family is anxious about the word "tumour". ^[5]

References5Show

[1]Higham CE; Johannsson G; Shalet SM Hypopituitarism. Lancet, 2016.PMID 27041067
[5]Müller HL; Merchant TE; Warmuth-Metz M; et al Craniopharyngioma. Nat Rev Dis Primers, 2019.PMID 31699993
[7]Grimberg A; DiVall SA; Polychronakos C; et al Guidelines for Growth Hormone and Insulin-Like Growth Factor-I Treatment in Children and Adolescents: Growth Hormone Deficiency, Idiopathic Short Stature, and Primary Insulin-Like Growth Factor-I Deficiency. Horm Res Paediatr, 2016.PMID 27884013
[10]Fleseriu M; Hashim IA; Karavitaki N; et al Hormonal Replacement in Hypopituitarism in Adults: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab, 2016.PMID 27736313
[11]Di Iorgi N; Napoli F; Allegri AE; et al Diabetes insipidus--diagnosis and management. Horm Res Paediatr, 2012.PMID 22433947

Hypopituitarism and pituitary lesions — structured clinical encounter

structured clinical encounter2 min readVerification in progress

Station brief (candidate)

References5Show

[1]Higham CE; Johannsson G; Shalet SM Hypopituitarism. Lancet, 2016.PMID 27041067
[5]Müller HL; Merchant TE; Warmuth-Metz M; et al Craniopharyngioma. Nat Rev Dis Primers, 2019.PMID 31699993
[7]Grimberg A; DiVall SA; Polychronakos C; et al Guidelines for Growth Hormone and Insulin-Like Growth Factor-I Treatment in Children and Adolescents: Growth Hormone Deficiency, Idiopathic Short Stature, and Primary Insulin-Like Growth Factor-I Deficiency. Horm Res Paediatr, 2016.PMID 27884013
[10]Fleseriu M; Hashim IA; Karavitaki N; et al Hormonal Replacement in Hypopituitarism in Adults: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab, 2016.PMID 27736313
[11]Di Iorgi N; Napoli F; Allegri AE; et al Diabetes insipidus--diagnosis and management. Horm Res Paediatr, 2012.PMID 22433947