Pickardt Syndrome

Synonyms: Pickardt-Fahlbusch Syndrome, Pickardt's Syndrome
German: Pickardt-Syndrom

1 Definition

The term Pickardt Syndrome refers to a rare form of tertiary Hypothyroidism that is caused by interruption of portal vessels connecting hypothalamus and pituitary.

2 Etiology

Occlusion of portal vessels may origin from tumors or thrombosis. The most common cause is pituitary adenomas with suprasellar extension. Blood flow may also be interrupted by inflammatory diseases.

A congenital form of Pickardt-Fahlbusch syndrome is referred to as Pituitary stalk interruption syndrome (PSIS).

3 Pathophysiology

Pickardt-Fahlbusch syndrome represents a form of set point disease: In the consequence of interrupted blood flow, an inadequately low amount of TRH reaches the anterior pituitary lobe and hence release of TSH is very low, leading to understimulation of the thyroid with consecutive hypothyroidism, in spite of functional thyrotropic feedback control.

4 Other consequences

Other endocrine dysfunctions associated with Pickardt's Syndrome are suprasellar malfunctions like secondary hypogonadism or hyperprolactinemia. Rarely, posterior pituitary failure including diabetes insipidus may ensue.

5 Reference

• Pickardt, C. R., und R. Fahlbusch, Chronische Hyperosmolalität, Adipsie und "sekundäre" Hypophysenvorderlappeninsuffizienz bei Hypothalamus-Schädigung. Internist 13 (1972), 45-51. PMID 4554749
• Pickardt CR, Geiger W, Fahlbusch R, Scriba PC, Stimulation der TSH-Sekretion durch TRF-Belastung bei hypothalamischen und hypophysären Krankheitsbildern. Klin Wochenschr. 1972 Jan 1;50(1):42-52. PMID 4621744
• Pickardt, C. R.; Erhardt, F.; Fahlbusch, R. and Scriba, P. C. (1973): Portal Vessels Occlusion. A Cause for Pituitary Insufficiency in Patients with Pituitary Tumors. European Journal of Clinical Investigation. 3: 262
• Pickardt, C. R.; Erhardt, F.; Fahlbusch, R.; Grüner, J. und Scriba, P. C. (1973): The diagnostic significance of the Stimulation of TSH secretion by administration of thyrotropin releasing hormone ( TRH ) in diseases of the hypothalamus and pituitary. Pitutitary tumors 23. Annual meeting, 25. - 27. September 1972, Hamburg, Deutschland.
• von Werder, K.; Pickardt, C. R.; Glöckner, B.; Gottsmann, M.; Rjosk, H. K. und Scriba, Peter Christian (1974): Prolactin secretion in patients with pituitary tumors. Symposion der Deutschen Gesellschaft für Endokrinologie, 1974
• Reynaud R, Albarel F, Saveanu A, Kaffel N, Castinetti F, Lecomte P, Brauner R, Simonin G, Gaudart J, Carmona E, Enjalbert A, Barlier A, Brue T. Pituitary Stalk Interruption Syndrome in 83 patients: novel HESX1 mutation and severe hormonal prognosis in malformative forms. Eur J Endocrinol. 2011 Jan 26. PMID 21270112.