Neuropsychologist and Patient Perspectives

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Neuropsychologist and Patient Perspectives There are many classifications of tumors that compress or destroy the hypothalamus. A few forms are craniopharyngioma, germinoma, and glioma. Symptoms of craniopharyngioma include headaches, visual disturbances, pituitary hormone deficiencies, retardation of growth, and calcification of the sella region in children. Germinoma, also called ectopic pineoloma or atypical teratoma, has similar effects to serninoma of the testis or dysgerminoma of the ovary. Another destructive cancer is glioma of the hypothalamus. Hand-Schuller-Christian disease produces hypopituitarism with delayed puberty, growth retardation, and diabetes insipidus; this type of cancer occurs in children (Yen and Jaffe 1986). Since the hypothalamus regulates release of hormones through the pituitary gland, one of the most common effects of damage to the hypothalamus is disruption of hormone release or hormone deficiency. Some common types of hormone deficiencies are gonadotropin, thyroid stimulating, adrenocorticotopic, growth, multiple, and panhypopituitarism. Gonadotropin deficiency is characterized by low levels of luteinizing hormone and follicle-stimulating hormone. This deficiency can lead to decreased fertility, disrupted menstruation, decreased sex drive, headaches, sexual dysfunction, and loss of body hair. Typical treatment is hormone replacement therapy. Deficiency of thyroid stimulating hormone and subsequent lack of thyroid gland stimulation lead to a condition called hypothyroidism. Common symptoms include intolerance to cold, weight gain, constipation, fatigue, and pale, waxy skin. Before hormone replacement is used to stimulate the thyroid, it is typical to try treating the adrenal glands with steroids. Adrenocorticotopic hormone deficiency is the name for low levels of corticotropin (ACTH), a hormone that stimulates the adrenal gland to produce cortisol. Some signs of ACTH deficiency are low blood pressure, weakness, fatigue, weight loss, and in women nausea, pale skin, and loss of pubic hair. Daily doses of hydrocortisone or cortisone are used to correct this deficiency. Deficiency of growth hormone before physical maturity will impair growth, and in adults may be noticeable by obesity or skin wrinkling. Careful doses of growth hormone are administered to children with this condition and in adults may help restore the healthy muscle to fat ratio. Multiple hormone deficiency is more common than deficiency of a single hormone and usually loss occurs in a specific order: first growth, then luteinizing, follicle- stimulating, thyroid stimulating, and adrenocorticotopic. This process is typically slow and occurs over months and years, but hypopituitarism can start suddenly as in the case of traumatic brain injury. Panhypopituitarism is the loss of all hormones released by the pituitary, also called complete pituitary failure.

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