Hypopituitarism

(Pituitary Insufficiency)
  • Definition

    The pituitary gland is in the brain. It produces several important hormones that control the production of other hormones made by glands in the body.
    The pituitary gland is responsible for many body functions, including the following:
    • Growth
    • Blood pressure
    • Sex organ function
    • Thyroid gland function
    • Breast milk production and other aspects of pregnancy and birth
    • Water balance in the body
    • Some reactions to stress
    Hypopituitarism is an insufficient production of one or more hormones. A problem in the pituitary can cause the amount of hormones from other glands to diminish as well.
    Pituitary Gland
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  • Causes

    There are several factors which may cause this condition:
    • Tumors of the pituitary gland, hypothalamus, or brain
    • Poor blood supply to the pituitary gland
    • Head trauma
    • Radiation to pituitary gland, head, or neck
    • Stroke
    • Infections and inflammatory diseases
    • Uncommon immune system or metabolic diseases
    • A rare complication after pregnancy, called Sheehan’s syndrome
    • Metastatic cancer from lung, colon, prostate, or melanoma
  • Risk Factors

    Factors that increase your the chance for hypopituitarism include:
  • Symptoms

    Compression of the tumor on local structures, especially the nerves of the eyes, can cause:
    • Blurred vision
    • Loss of visual field
    • Poor temperature control
    Symptoms often begin gradually and are not specific since hormones control a variety of body functions. They may not be recognized for a while. Specific symptoms will depend on the type and level of hormone affected. For example:
    • Growth hormone deficiency:
      • Poor overall growth
      • Short stature
      • obesity
      • Muscle weakness
    • Thyroid-stimulating hormone deficiency:
      • Sensitivity to cold
      • Weight gain
      • Constipation
      • Hair that is brittle and coarse
      • Slow heart rate
      • Dry skin
      • Muscle weakness or fatigue
    • Adrenocorticotropic hormone (ACTH) deficiency:
      • Fatigue and weakness
      • Weight loss
      • Decrease in skin pigmentation
      • The absence of a menstrual period in women of reproductive age
    • Follicle-stimulating hormone and luteinizing hormone deficiency:
      • Infertility in men and women
      • Vaginal dryness
      • Loss of some gender-specific sexual characteristics—women may lose hair from their underarms, body, and pubic area
      • Reduced interest in sex
      • The absence of a menstrual period in women of reproductive age
      • Difficulty maintaining an erection
      • Muscle weakness
      • Small testes
      • Breast enlargement in men
  • Diagnosis

    You will be asked about your symptoms and medical history. A physical exam will be done. You may be referred to an endocrinologist. This is a type of doctor that focuses on hormone disorders.
    Tests to determine hypopituitarism include taking a blood sample to do the following:
    • Measure the levels of hormones produced by the pituitary gland
    • Measure the levels of hormones produced by target endocrine glands, which are influenced by the pituitary gland
    Pituitary function tests may be done such as:
    • Growth hormone-releasing hormone (GHRH) test
    • Arginine stimulation test
    • Clonidine stimulation test
    • Insulin tolerance test
    • Adrenocorticotropic hormone (ACTH) stimulation test
    After the diagnosis is confirmed, imaging tests will be done to identify problems such as tumors or abnormal tissue and growth or shrinkage of the pituitary gland. This can be done with an MRI scan.
  • Treatment

    Talk with your doctor about the best treatment plan for you. This condition is likely permanent, depending on the cause. It will likely need to be treated for life. Treatment options include:
    Medications
    If the condition is caused by a tumor, it may be first treated with medications such as:
    • Bromocriptine
    • Cabergoline
    • Octreotide
    Surgery
    Medication may not always work. In this case, surgery may be needed. If a tumor is involved, then it will be removed. Part or all of the gland may be removed as well.
    Hormone replacement therapy is needed after surgery or if other hormone deficiencies are found.
    Hormone Replacement Therapy
    When the target hormone levels are inadequate, they must be replaced. In most cases, therapy does not replace the hormones that the pituitary gland produces. Instead, the hormones of the other target glands that it stimulates are replaced. Examples include:
    • Glucocorticoids (adrenal hormone)—prednisone, hydrocortisone, dexamethasone
    • Thyroid hormone such as levothyroxine
    • Testosterone (male)—can be replaced with patches, gels, or injections
    • Estrogen and progesterone (female)—can be replaced with oral pill or patches
    • Growth hormone—usually a daily injection
    • Antidiuretic hormone (ADH)—can be given as pill, subcutaneous injection, or nasal puff
    Radiation Therapy
    Treatment with radiation may be used after drug or surgical treatment or if they have failed.
  • Prevention

    In general, this condition is not preventable. Be aware of the risks and symptoms. This will make early diagnosis and treatment possible.
  • RESOURCES

    Pituitary Disorders Education and Support http://www.pituitarydisorder.net

    The Pituitary Society http://www.pituitarysociety.org

    CANADIAN RESOURCES

    Health Canada http://www.hc-sc.gc.ca

    Thyroid Foundation of Canada http://www.thyroid.ca

    References

    Hypopituitarism. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated November 7, 2012. Accessed February 27, 2014.

    Schneider HJ, Aimaretti G , Kreitschmann-Andermahr I, et al. Hypopituitarism. Lancet. 2007;369:1461-1470.

    Tomlinson JW. Association between premature mortality and hypopituitarism. West Midlands Prospective Hypopituitary Study Group. Lancet. 2001; 357:425.

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