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Hypopituitarism

Pituitary insufficiency

 

Hypopituitarism is a condition in which the pituitary gland does not produce normal amounts of some or all of its hormones.

Causes

 

The pituitary gland is a small structure that is located just below the brain. It is attached by a stalk to the hypothalamus . The hypothalamus is the area of the brain that controls the pituitary gland's function.

The hormones released by the pituitary gland (and their functions) are:

  • Adrenocorticotropic hormone (ACTH) -- stimulates the adrenal gland to release cortisol; cortisol helps to maintain blood pressure and blood sugar
  • Antidiuretic hormone (ADH) -- controls water loss by the kidneys
  • Follicle-stimulating hormone (FSH) -- controls sexual function and fertility in males and females
  • Growth hormone (GH) -- stimulates growth of tissues and bone
  • Luteinizing hormone (LH) -- controls sexual function and fertility in males and females
  • Oxytocin -- stimulates the uterus to contract during labor and the breasts to release milk
  • Prolactin -- stimulates female breast development and milk production
  • Thyroid-stimulating hormone (TSH) -- stimulates the thyroid gland to release hormones that affect the body's metabolism

In hypopituitarism, there is a lack of 1 or more pituitary hormones. Lack of a hormone leads to loss of function in the gland or organ the hormone controls. For example, lack of TSH leads to loss of normal function of the thyroid gland.

Hypopituitarism may be caused by:

  • Brain surgery
  • Brain tumor
  • Head trauma (traumatic brain injury)
  • Infections or inflammation of the brain and the tissues that support the brain
  • Death of an area of tissue in the pituitary gland ( pituitary apoplexy )
  • Radiation therapy to the brain
  • Stroke
  • Subarachnoid hemorrhage (from a burst aneurysm)
  • Tumors of the pituitary gland or hypothalamus

Sometimes, hypopituitarism is due to uncommon immune system or metabolic diseases, such as:

  • Too much iron in the body ( hemochromatosis )
  • Abnormal increase in immune cells called histiocytes ( histiocytosis X )
  • Autoimmune condition that causes inflammation of the pituitary (lymphocytic hypophysitis)
  • Inflammation of various tissues and organs ( sarcoidosis )

Hypopituitarism is also a rare complication after pregnancy of a condition called Sheehan syndrome .

 

Symptoms

 

Symptoms of hypopituitarism include any of the following:

  • Abdominal pain
  • Decreased appetite
  • Lack of sex drive (in men or women)
  • Dizziness or fainting
  • Excessive urination and thirst
  • Failure to release milk (in women)
  • Fatigue , weakness
  • Headache
  • Infertility (in women) or stopping of menstrual periods
  • Loss of armpit or pubic hair
  • Loss of body or facial hair (in men)
  • Low blood pressure
  • Low blood sugar
  • Sensitivity to cold
  • Short height (less than 5 feet or 1.5 meters) if onset is during a growth period
  • Slowed growth and sexual development (in children)
  • Vision problems
  • Weight loss

Symptoms may develop slowly and may vary greatly, depending upon:

  • The number of hormones that are missing and the organs they affect
  • The severity of the disorder

Other symptoms that may occur with this disease:

  • Face swelling
  • Hair loss
  • Hoarseness or changing voice
  • Joint stiffness
  • Weight gain (unintentional)

 

Exams and Tests

 

To diagnose hypopituitarism, there must be low hormone levels due to a problem with the pituitary gland. The diagnosis must also rule out diseases of the organ that is affected by this hormone.

Tests may include:

  • Brain CT scan
  • Pituitary MRI
  • Serum ACTH
  • Serum cortisol
  • Serum estradiol (estrogen)
  • Serum follicle-stimulating hormone (FSH)
  • Serum insulin-like growth factor 1 (IGF-1)
  • Serum luteinizing hormone (LH)
  • Serum testosterone level
  • Serum thyroid-stimulating hormone (TSH)
  • Thyroid hormone ( T4 )

Levels of a pituitary hormone may be high in the bloodstream if you have a pituitary tumor that is producing too much of that hormone. The tumor may crush other cells of the pituitary, leading to low levels of other hormones.

 

Treatment

 

If hypopituitarism is caused by a tumor, you may need surgery to remove the tumor. Radiation therapy may also be needed.

You will need lifelong hormone medicines to replace hormones that are no longer made by organs under the control of the pituitary gland. These may include:

  • Corticosteroids (cortisol)
  • Growth hormone
  • Sex hormones ( testosterone for men and estrogen for women)
  • Thyroid hormone

Drugs are also available to treat related infertility in men and women.

 

Outlook (Prognosis)

 

Hypopituitarism is usually permanent. It requires lifelong treatment with 1 or more medicines. But you can expect a normal life span.

 

Possible Complications

 

Side effects of medicines can develop. Stopping corticosteroid and thyroid supplementation can be life threatening.

 

When to Contact a Medical Professional

 

Call your health care provider if you develop symptoms of hypopituitarism.

 

Prevention

 

In most cases, the disorder is not preventable. Awareness of risk may allow early diagnosis and treatment.

 

 

Open References

References

Burt MG, Ho KKY. Hypopituitarism and growth hormone deficiency. In: Jameson JL, De Groot LJ, de Kretser DM, et al, eds. Endocrinology: Adult and Pediatric . 7th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 11.

Clemmons DR, Nieman LK. Approach to the patient with endocrine disease. In: Goldman L, Schafer AI, eds. Goldman's Cecil Medicine . 25th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 221.

 
  • Endocrine glands

    Endocrine glands - illustration

    Endocrine glands release hormones (chemical messengers) into the bloodstream to be transported to various organs and tissues throughout the body. For instance, the pancreas secretes insulin, which allows the body to regulate levels of sugar in the blood. The thyroid gets instructions from the pituitary to secrete hormones which determine the pace of chemical activity in the body (the more hormone in the bloodstream, the faster the chemical activity; the less hormone, the slower the activity).

    Endocrine glands

    illustration

  • The pituitary gland

    The pituitary gland - illustration

    The pituitary is a gland attached to the base of the brain which secretes hormones that govern the onset of puberty, sexual development and reproductive function.

    The pituitary gland

    illustration

  • Pituitary hormones

    Pituitary hormones - illustration

    The pituitary gland controls the release of FSH (follicle-stimulating hormone) and LH (luteinizing hormone), which govern the onset of puberty, sexual development and reproductive function.

    Pituitary hormones

    illustration

  • Pituitary and TSH

    Pituitary and TSH - illustration

    The pituitary secretes thyroid stimulating hormone (TSH), which stimulates the thyroid gland to secrete hormones that affect body metabolism.

    Pituitary and TSH

    illustration

    • Endocrine glands

      Endocrine glands - illustration

      Endocrine glands release hormones (chemical messengers) into the bloodstream to be transported to various organs and tissues throughout the body. For instance, the pancreas secretes insulin, which allows the body to regulate levels of sugar in the blood. The thyroid gets instructions from the pituitary to secrete hormones which determine the pace of chemical activity in the body (the more hormone in the bloodstream, the faster the chemical activity; the less hormone, the slower the activity).

      Endocrine glands

      illustration

    • The pituitary gland

      The pituitary gland - illustration

      The pituitary is a gland attached to the base of the brain which secretes hormones that govern the onset of puberty, sexual development and reproductive function.

      The pituitary gland

      illustration

    • Pituitary hormones

      Pituitary hormones - illustration

      The pituitary gland controls the release of FSH (follicle-stimulating hormone) and LH (luteinizing hormone), which govern the onset of puberty, sexual development and reproductive function.

      Pituitary hormones

      illustration

    • Pituitary and TSH

      Pituitary and TSH - illustration

      The pituitary secretes thyroid stimulating hormone (TSH), which stimulates the thyroid gland to secrete hormones that affect body metabolism.

      Pituitary and TSH

      illustration

    Tests for Hypopituitarism

     
       

      Review Date: 10/28/2015

      Reviewed By: Brent Wisse, MD, Associate Professor of Medicine, Division of Metabolism, Endocrinology & Nutrition, University of Washington School of Medicine, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.

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