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Hormone Replacement after Pituitary Surgery

What are the hormones secreted by the pituitary?

What are the hormones secreted by the pituitary?

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

Is hormone replacement mandatory after pituitary surgery?

Hormone replacement may not be needed after surgery for small pituitary microadenomas. However after surgery of large macroadenomas or craniopharyngiomas, hormone replacement will be needed.
Endocrinologists will do the necessary hormonal tests and decide whether treatment is needed.

What are the symptoms?

  • Decreased appetite
  • Fatigue, headache, giddiness
  • Low blood pressure
  • Cessation of menstrual periods/amenorrhoea (in women)
  • Sensitivity to cold
  • Weight loss
  • Increased urination/ increased thirst
  • Decreased sexual interest (in men)
  • Lack of sex drive (in women)

What are the tests to confirm?

To diagnose hypopituitarism, there must be low hormone levels which are secreted by pituitary gland. Tests include:

  • Serum cortisol (8 AM), T4, TSH,FSH,LH,Testosterone,Prolactin, IGF1, ACTH

How do we treat?

Hormone therapy is needed to replace hormones that are no longer made by organs under the control of the pituitary gland. These may include:

  • Corticosteroids (cortisol)
  • Thyroxine
  • Sex hormones (testosterone for men and estrogen for women)
  • Growth hormone (Must in children and optional in adults)
  • Desmopressin (ADH)

Out of these, steroid hormone and thyroxine are absolutely essential. Deficiency of these 2 hormones can be life threatening, if not replaced in timely manner. Desmopressin may be needed rarely in people developing ‘diabetes insipidus’.

 

Sex hormone supplementation is required in the long run to restore libido, sexual function and to prevent osteoporosis.

 

Drugs (Recombinant hCG and FSH) are also available to treat related infertility in men and women.

How is the prognosis?

Hypopituitarism may be permanent and may require lifelong treatment. Recovery is possible in few patients after few months (rarely after years). Regular monitoring (once in 3-6 months) of clinical features and hormonal testing is useful in identifying recovery and under/over replacement.

When to Contact an Endocrinologist?

If anyone develops symptoms of hypopituitarism; unexplained low blood pressure after pituitary surgery, better to meet an Endocrinologist. (As they are trained in managing hypopituitary conditions unlike other specialities).

Watch for hypopituitarism after pituitary surgery.
Lifelong replacement may be needed in few.
Thyroxine and steroid replacement: Life saving.
Regular monitoring: Key for adequate replacement.

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