Hypopituitarism, Panhypopituitarism

The pituitary gland produces a number of hormones, which are released into the blood to control other glands in the body (thyroid, adrenal, ovary or testicles). If the pituitary is not producing one or more of these hormones, the condition is called hypopituitarism. If all the hormones produced by the anterior pituitary are decreased, the condition is called panhypopituitarism. Hypopituitarism is most often caused by large benign tumors of the pituitary gland, or of the brain in the region of the hypothalamus. Pituitary underactivity may be caused by the direct pressure of the tumor mass on the normal pituitary or by the effects of surgery or radiotherapy used to treat the pituitary tumors.

Less frequently, hypopituitarism can be caused by infections in or around the brain (such as meningitis) or by severe blood loss, by head injury, or by other rare diseases. Some of the clinical features that may be associated with hypopituitarism include excessive tiredness and decreased energy, irregular periods (oligomenorrhea) or loss of normal menstrual function (amenorrhea), impotence (in men), infertility, increased sensitivity to cold, constipation, dry skin, low blood pressure and lightheadedness upon standing (postural hypotension). Treatment of hypopituitarism consists of long-term hormone replacement therapy, since pituitary hormone deficits are rarely reversed after tumor removal.

Deficient Hormone Symptoms Treatment

GH

Adults: Decreased muscle mass, increased body fat, elevated cholesterol, low bone density (osteoporosis), impaired psychological well-being, poor quality of life

Recombinant Human Growth Hormone given once daily as an injection under the skin

LH/FSH

Decreased libido, erectile dysfunction, irregular or absent menses, decreased body hair, decreased muscle strength, hot flashes, mood changes

Men: Testosterone given as either topical gel, patch or injections
Women: Estrogen and Progesterone given as either topical patch or pills

ACTH

Poor appetite, nausea, weakness, vomiting, low blood sugar, low blood pressure, dizziness, body aches

Hydrocortisone or Prednisone given as daily pills

TSH

Fatigue, weakness, cold intolerance, dry skin, constipation, heavy/painful menses, weight gain, memory loss, mood disturbance

Levothyroxine given as daily pills (some examples include Synthroid, Levoxyl, Levothroid or Armour Thyroid)

Prolactin

Inability to lactate

No treatment available

Vasopressin (ADH)

Increased thirst and frequent urination

DDAVP given either as daily pills or nasal spray

Causes of Pituitary Hormone Deficiencies or Hypopituitarism

  • Congenital malformations of the pituitary gland
  • Large pituitary tumors or cysts or their treatment
  • Systemic diseases
  • Infections or inflammation

How is Hypopituitarism Diagnosed

  • Blood measurements of pituitary hormones as well as hormones secreted by glands regulated by the pituitary
  • Stimulation tests are necessary for diagnosis of adrenal and growth hormone deficiency