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Hypopituitarism

Overview

Hypopituitarism is when the pituitary gland stops making enough hormones. It may be temporary or permanent. Panhypopituitarism is the complete loss of all pituitary hormones. 

Causes Of Hypopituitarism

The hypothalamos is the part of the brain just above the pituitary, and it directs the pituitary through signals sent through the pituitary stalk.

Hypopituitarism is caused by damage to the Pituitary Gland, the pituitary stalk or the hypothalamus. Such damage can be caused by a pituitary or brain tumor, brain/pituitary surgery or radiosurgery, stroke of the pituitary (called pituitary apoplexy), pituitary inflammation (hypophysitis) and head injury.

Growth hormone (GH), luteinizing hormone (LH) and follicle-stimulating hormone (FSH) secreting cells are more vulnerable to all of these traumas than the thyroid stimulating (TSH) and adrenocorticotropic hormone (ACTH) secreting cells, so loss of the former hormones happens first, and more often.

About half of patients will have some recovery of pituitary function after surgical removal of a pituitary adenoma, and about 5% will have further decreases in pituitary function.

Types Of Hypopituitarism

 

Growth Hormone Deficiency

Growth hormone deficiency is the most common kind of pituitary hormone deficiency. Growth hormone is needed in children for growth, and in adults to muscle mass, energy levels, cardiovascular health and some mental functions. Symptoms of growth hormone deficiency in adults include fatigue, poor exercise tolerance, decreased muscle mass, increased fat mass and poor quality life. These symptoms can be reversed with daily growth hormone injections.

 

Deficiency of ACTH

Adrenocorticotropic hormone deficiency can be life- threatening.

If onset is slow, symptoms may include weight loss, fatigue, weakness, depression, apathy, nausea, vomiting and loss of appetite.

If onset is fast, or in its advanced stages,  ACTH deficiency causes confusion, stupor, psychosis, serum electrolyte changes, vascular collapse, shock and death.

Treatment with oral glucocorticoids can be life-saving. 

 

Deficiency of Thyroid Stimulating Hormone

Symptoms of thyroid stimulating hormone deficiency include diminished energy, sleepiness, cold intolerance, dry skin, constipation, muscle aches and decreased mental capacity. 

Treatment with thyroxine reverses the symptoms and signs over days or weeks.

 

Deficiency of Leutinizing Hormone and Follicular Stimulating Hormone (Hypogonadotropic Hypogonadism)

Women with hypogonadism suffer from irregular or absent periods, infertility, decreased libido, decreased vaginal secretions and osteoporosis. Treatment involves estrace given orally or as a patch.

Men with hypogonadism develop decreased libido, impotence, decreased ejaculate volume, loss of body and facial hair, weakness, fatigue and often anemia. Treatment involves daily testosterone patches or gel or of testosterone injections every 2-3 weeks.

 

Antidiuretic Hormone (ADH) Deficiency and Diabetes Insipidus (DI)

Patients with diabetes insipidus have excessive thirst and urination. Patients can become rapidly dehydrated if deprived of water. Diabetes insipidus may occur transiently in 25% of patients after transsphenoidal pituitary surgery and is a permanent condition in 1-3% of patients.

Treatment with DDAVP (a synthetic type of ADH) can be given by subcutaneous injection, intranasal spray, or a tablet taken once or twice a day.