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What is Hypopituitarism?

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

What are the hormones secreted by the pituitary?

The pituitary gland is a tiny gland that is located just below the brain. It is attached by a stalk to the hypothalamus, the area of the brain that controls its 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

 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

 

In hypopituitarism, there is a lack of one or more pituitary hormones. Lack of the hormone leads to loss of function in the gland or organ that it controls. Ex: Loss of ACTH leads to reduced functioning of the adrenal gland.

What are the causes?

Hypopituitarism may be caused by:

  • Tumors of the pituitary gland or hypothalamus
  • Post pituitary surgery
  • Radiation
  • Head trauma
  • Infections of the brain and the tissues that support the brain
Occasionally, hypopituitarism is due to uncommon immune system or metabolic diseases, such as:
  • Lymphocytic hypophysitis
  • Sarcoidosis
  • Hemochromatosis
  • Histiocytosis X
Hypopituitarism can also occur as a rare complication after pregnancy, a condition called “Sheehan’s syndrome”.

Symptoms

  • Cessation of menstrual periods/amenorrhoea (in women)
  • Failure to produce milk (in women)
  • Decreased sexual interest (in men)
  • Lack of sex drive (in women)
  • Loss of armpit, pubic hair
  • Loss of body or facial hair (in men)
  • Decreased appetite
  • Fatigue, headache
  • Infertility (in women)
  • Low blood pressure
  • Sensitivity to cold
  • Short stature (less than 5 feet) if onset in childhood
  • Slowed growth and delayed or absent/ sexual development (children/adolescents)
  • Visual disturbances
  • Weight loss

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
  • Pituitary MRI

How do we treat?

If hypopituitarism is caused by a tumor, you may need surgery to remove the tumor, with or without radiation therapy. It is often necessary to replace hormones that are lacking,even after successful treatment of a pituitary tumor.


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)

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

How is the prognosis?

Hypopituitarism is usually permanent and requires lifelong treatment. However, we can expect a normal life span.

When to Contact an Endocrinologist?

If anyone develops symptoms of hypopituitarism; unexplained low blood pressure.Consultation with an Endocrinologist is a must, as other specialities are not well versed in pituitary hormone replacement therapy.

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