II. Definitions
- Hypopituitarism
- Decreased or loss of pituitary Hormone secretion due to surgery, radiation, CNS mass, infarction or Pituitary Apoplexy
- Decreased Luteinizing Hormone (LH), Follicle Stimulating Hormone (FSH), Somatotropin (GH) and Corticotropin (ACTH)
- Sheehan Syndrome
- Associated with severe Postpartum Hemorrhage with prolonged Hypovolemia
- Secondary pituitary ischemia and necrosis
- Presents with peripartum failed Lactation, Fatigue and Hypotension; later Amenorrhea
- Severe cases may be associated with Adrenal Insufficiency
- Best outcomes with early pituitary Hormone Replacement
- Associated with severe Postpartum Hemorrhage with prolonged Hypovolemia
- Pituitary Apoplexy
- Hemorrhage or infarction of the Pituitary Gland
- Causes include Pituitary Adenoma (most common), Sheehan Syndrome, and various hormonal medications
- Presents with severe Headache, Hypotension, Altered Level of Consciousness and bitemporal Hemianopsia
III. Causes
- Congenital
- Perinatal Injury
- Developmental Disorders
- Anencephaly
- Lipid storage disease
- Genetic
-
Trauma
- Closed Head Injury
- CNS Surgery
- Irradiation to brain, pituitary or nasopharynx
- CNS Mass (may be associated with Pituitary Apoplexy, CVA related dysfunction)
- Intrasellar
- Pituitary Adenoma
- Craniopharyngioma
- Parasellar
- Meningioma
- Optic Nerve glioma
- Metastatic cancer
- Other malignancy
- Intrasellar
- Ischemic Pituitary necrosis
- Vascular conditions
- Cavernous Sinus Thrombosis
- Internal carotid aneurysm (intracranial)
- Infectious Disease
- Tuberculous Meningitis
- Malaria
- HIV Infection
- Fungal infections
- Infiltrative Disease
- Hemochromatosis
- Amyloidosis
- Lipid storage disease
- Granulomatous Disease
- Sarcoidosis
- Hypophysitis
- Miscellaneous Primary Causes
- Primary Empty Sella Syndrome
- Monohormonal idiopathic defects
- Miscellaneous Secondary Causes
- Nutritional Deficiency (Starvation, Anorexia Nervosa)
IV. Findings: ACTH Deficiency (Corticotroph Deficiency)
- See Adrenal Insufficiency (Addison's Disease)
- Acute
- Chronic
- Fatigue
- Pallor
- Weight loss
- Hypoglycemia
V. Findings: TSH Deficiency (Thyrotropin Deficiency)
- See Hypothyroidism
- Fatigue
- Cold Intolerance
- Constipation
- Weight gain
- Alopecia
- Dry Skin
- Bradycardia
- Hoarse voice
- Cognitive slowing
VI. Findings: LH or FSH Deficiency (Gonadotropin Deficiency)
- See Hypogonadotropic Hypogonadism
- Male
- See Male Hypogonadism or Testicular Failure
- Decreased sexual function and decreased libido
- Decreased Muscle mass
- Decreased Bone Mineral Density
- Decreased body hair
- Female
- See Premature Ovarian Failure
- Amenorrhea or Oligomenorrhea
- Infertility
- Decreased libido
- Osteoporosis
VII. Findings: GH Deficiency (Growth Hormone Deficiency)
- See Growth Hormone Deficiency
- Child (Congenital GH Deficiency)
- Decreased linear growth
- Normal size at birth
- Subsequently falls off height growth curve
- Weight for age is preserved
- Episodic Hypoglycemia
- Prolonged Neonatal Jaundice
- Microphallus
- Midline craniofacial abnormalities
- Decreased linear growth
- Adult
VIII. Findings: Prolactin Deficiency
IX. Findings: ADH Deficiency (Antidiuretic Hormone Deficiency)
- See Central Diabetes Insipidus
- Polyuria
- Polydipsia
- Nocturia
X. Labs
- Functional or stimulation tests are typically not needed for diagnosis
- Obtain Basal Hormone levels (morning Fasting levels)
- Growth Hormone (GH)
- Luteinizing Hormone (LH)
- Follicle Stimulating Hormone (FSH)
- Thyroid Stimulating Hormone (TSH) with reflex to Free Thyroxine (Free T4)
- Adrenocorticotropic Hormone (ACTH)
XI. Management
- Treat specific Hormone deficiencies affected and the underlying cause
- See Adrenal Insufficiency (Addison's Disease)
- See Hypothyroidism
- See Hypogonadotropic Hypogonadism
- See Male Hypogonadism or Testicular Failure
- See Premature Ovarian Failure
- See Growth Hormone Deficiency
- See Central Diabetes Insipidus
XII. References
- Gounden (2021) Hypopituitarism, in StatPearls, Treasure Island, accessed 3/28/2022
- Kim (2015) Endocrinol Metab 30:443-55 [PubMed]
Images: Related links to external sites (from Bing)
Related Studies
| Definition (NCI) | A condition of diminution or cessation of secretion of one or more hormones from the anterior pituitary gland. This may result from surgical or radiation ablation, non-secretory pituitary neoplasms, metastatic tumors, infarction, pituitary apoplexy, infiltrative or granulomatous processes, and other conditions. |
| Definition (MSH) | Diminution or cessation of secretion of one or more hormones from the anterior pituitary gland (including LH; FOLLICLE STIMULATING HORMONE; SOMATOTROPIN; and CORTICOTROPIN). This may result from surgical or radiation ablation, non-secretory PITUITARY NEOPLASMS, metastatic tumors, infarction, PITUITARY APOPLEXY, infiltrative or granulomatous processes, and other conditions. |
| Definition (CSP) | diminution or cessation of secretion of one or more hormones from the anterior pituitary gland (including luteinizing hormone, follicle stimulating hormone, somatotropin; and corticotropin); may result from surgical or radiation ablation, non-secretory pituitary neoplasms, metastatic tumors, infarction, pituitary apoplexy, infiltrative or granulomatous processes, and other conditions. |
| Concepts | Disease or Syndrome (T047) |
| MSH | D007018 |
| ICD10 | E23.0 |
| SnomedCT | 267482009, 237681002, 154703006, 190469009, 74728003 |
| French | HYPOPITUITARISME, INSUFFICIANCE HYPOPHYSAIRE, Hypopituitarisme, Insuffisance antéhypophysaire, Insuffisance hypophysaire |
| English | HYPOPITUITARISM, PITUITARY INSUFFICIENCY, Hypopituitarism NOS, Hypopituitarism, HYPOSECRET SYNDROME ANTERIOR PITUITARY, ANTERIOR PITUITARY HYPOSECRET SYNDROME, ADENOHYPOPHYSEAL HYPOSECRET, HYPOSECRET ADENOHYPOPHYSEAL, hypopituitarism (diagnosis), hypopituitarism, Hypopituitalism, Insufficiency pituitary, Adenohypophyseal Hyposecretion, Hyposecretion, Adenohypophyseal, Anterior Pituitary Hyposecretion Syndrome, Hyposecretion Syndrome, Anterior Pituitary, Pituitary insufficiency NOS, Hypopituitarism [Disease/Finding], pituitary failure, insufficiency pituitary, pituitary insufficiency, deficiencies pituitary, pituitary hypofunction, Hypopituitarism NOS (disorder), Pituitary deficiency, Pituitary failure, Pituitary insufficiency, Deficient secretion of one OR more pituitary hormones, Hypopituitarism (disorder), Pituitary hypofunction, hypofunction; pituitary, hypopituitarism; syndrome, insufficiency; pituitary, pituitary; hypofunction, pituitary; insufficiency, syndrome; hypopituitarism, Deficient secretion of one or more pituitary hormones, Hypopituitarism, NOS, Pituitary insufficiency, NOS, Insufficiency, Pituitary, Pituitary Insufficiency |
| Portuguese | HIPOPITUITARISMO, Insuficiência hipofisária, INSUFICIENCIA PITUITARIA, Hipossecreção Adeno-Hipofisária, Hipossecreção Adenoipofisária, Hipofunção hipofisária, Hipopituitarismo, Síndrome da Hipossecreção Hipofisária Anterior |
| Dutch | hypofyse-insufficiëntie, insufficiëntie hypofyse, hypofunctie; hypofyse, hypofyse; hypofunctie, hypofyse; insufficiëntie, hypopituïtarisme; syndroom, insufficiëntie; hypofyse, syndroom; hypopituïtarisme, hypopituïtarisme, Adenohypofyse-hyposecretie, Hyposecretiesyndroom, adenohypofyse-, Ziekte van Simmonds-Sheehan, Hypopituïtarisme |
| German | Insuffizienz, Hypophyse, HYPOPHYSE UNTERFUNKTION, Hypopituitarismus, Hyposekretionssyndrom des Hypophysenvorderlappens, Adenohypophysäre Hyposekretion, Hypophyseninsuffizienz, Hyposekretion, adenohypophysäre |
| Italian | Insufficienza ipofisaria, Iposecrezione adenoipofisaria, Sindrome dell'iposecrezione dell'ipofisi anteriore, Insufficienza pituitaria, Ipopituitarismo |
| Spanish | Insuficiencia hipofisaria, Insuficiencia pituitaria, INSUFICIENCIA HIPOFISARIA, hipopituitarismo, SAI, hipopituitarismo, SAI (trastorno), Hipofunción Pituitaria Anterior, hipopituitarismo, insuficiencia hipofisaria (trastorno), insuficiencia hipofisaria, insuficiencia pituitaria, secreción insuficiente de una O más hormonas hipofisarias, Hipopituitarismo, Hiposecreción Adenohipofisiaria, Síndrome de Hiposecreción Pituitaria Anterior |
| Swedish | Hypopituitarism |
| Japanese | ｶｽｲﾀｲｷﾉｳﾃｲｶｼｮｳ, ｶｽｲﾀｲｷﾉｳﾌｾﾞﾝ, 下垂体機能不全症, 下垂体低下症, Simmonds病, 脳下垂体機能低下症, 下垂体不全症, シーハン症候群, 下垂体機能低下, 下垂体機能不全, 下垂体不全, シモンズ病, 下垂体前葉機能低下症, 下垂体低下, Sheehan症候群, 下垂体機能低下症 |
| Czech | hypopituitarismus, Hypopituitarismus, Hypofyzární insuficience, Hypofyzární nedostatečnost |
| Finnish | Hypopituitarismi |
| Russian | SHIKHANA SINDROM, GIPOPITUITARIZM, SIMMONDSA SINDROM, ГИПОПИТУИТАРИЗМ, СИММОНДСА СИНДРОМ, ШИХАНА СИНДРОМ |
| Korean | 뇌하수체 기능저하증 |
| Croatian | Not Translated[Hypopituitarism] |
| Polish | Choroba Glińskiego-Simmondsa, Niedoczynność przysadki, Zespół podwzgórzycy pociążowej, Zespół Sheehana |
| Hungarian | Hypophysis elégtelenség, Hypopituitarismus, Hypophysis insufficientia |
| Norwegian | Hypopituitarisme, For lav hormonproduksjon i hypofysen |
Ontology: Pituitary Apoplexy (C0032001)
| Definition (NCI) | A rare, potentially life-threatening disorder caused by acute ischemic infarction or hemorrhage in the pituitary gland. It is most often associated with the presence of a pituitary gland adenoma. Signs and symptoms include headache, vomiting, visual disturbances, and endocrine dysfunction. |
| Definition (MSH) | The sudden loss of blood supply to the PITUITARY GLAND, leading to tissue NECROSIS and loss of function (PANHYPOPITUITARISM). The most common cause is hemorrhage or INFARCTION of a PITUITARY ADENOMA. It can also result from acute hemorrhage into SELLA TURCICA due to HEAD TRAUMA; INTRACRANIAL HYPERTENSION; or other acute effects of central nervous system hemorrhage. Clinical signs include severe HEADACHE; HYPOTENSION; bilateral visual disturbances; UNCONSCIOUSNESS; and COMA. |
| Concepts | Disease or Syndrome (T047) |
| MSH | D010899 |
| SnomedCT | 237701005 |
| English | Apoplexy, Pituitary, Pituitary Apoplexy, Pituitary Gland Apoplexy, pituitary apoplexy, pituitary apoplexy (diagnosis), Pituitary Apoplexy [Disease/Finding], Pituitary apoplexy, Pituitary apoplexy (disorder) |
| Dutch | hypofyse apoplexie, Apolexie, hypofysaire, Hypofysaire apoplexie |
| Italian | Apoplessia dell'ipofisi, Apoplessia ipofisaria |
| Portuguese | Apoplexia hipofisária, Apoplexia Hipofisária |
| Spanish | Apoplejía pituitaria, apoplejía hipofisaria (trastorno), apoplejía hipofisaria, Apoplejia Pituitaria, Apoplejia Hipofisaria |
| Swedish | Hypofysär apoplexi |
| Japanese | ｶｽｲﾀｲｿｯﾁｭｳ, 下垂体卒中, アポプレキシー-下垂体, 下垂体アポプレキシー, 下垂体出血, 下垂体卒中症, 出血-下垂体, 卒中-下垂体, 脳下垂体出血, 脳下垂体卒中 |
| Czech | hypofýza - apoplexie, Apoplexie hypofýzy |
| Finnish | Pituitaarinen apopleksia |
| Russian | GIPOFIZA APOPLEKSIIA, APOPLEKSIIA GIPOFIZA, АПОПЛЕКСИЯ ГИПОФИЗА, ГИПОФИЗА АПОПЛЕКСИЯ |
| Polish | Udar przysadki |
| Hungarian | Hypophysis apoplexia |
| Norwegian | Hypofyseapopleksi, Hypofysenekrose |
| German | Apoplexie, Hypophysen-, Hypophysenapoplexie |
| French | Apoplexie hypophysaire, Apoplexie pituitaire |
Ontology: Sheehan Syndrome (C0242342)
| Definition (NCI) | An uncommon cause of hypopituitarism seen after severe postpartum hemorrhaging. Prolonged hypovolemia leads to ischemic necrosis of the pituitary. Clinical signs typically present in the puerperium and include failure to begin lactation, fatigue, hypotension and eventual amenorrhea. Clinical course is usually mild, however extreme cases may progress to adrenal failure. Prognosis is most favorable when hormone replacement is initiated soon after symptom onset. |
| Concepts | Disease or Syndrome (T047) |
| MSH | D007018 |
| ICD10 | E23.0 |
| SnomedCT | 237684005, 154703006, 267482009, 190469009, 15045007, 32390006, 290653008 |
| English | Sheehan's Syndrome, Sheehans Syndrome, Syndrome, Sheehan's, SIMMONDS DIS, Sheehan's syndrome (diagnosis), postpartum pituitary necrosis, Sheehan's syndrome (postpartum necrosis), Syndrome, Sheehan, Sheehan syndrome, sheehan syndrome, simmonds disease, sheehan's syndrome, postpartum hypopituitarism, sheehans's syndrome, simmond's disease, simmonds' disease, sheehans syndrome, Ischemic postpartum pituitary necrosis, Ischemic postpartum pituitary necrosis (disorder), Ischaemic postpartum pituitary necrosis, postpartum hypopituitarism (diagnosis), Simmond's disease, Sheehan's syndrome, Postpartum pituitary necrosis, Simmonds' disease, Postpartum hypopituitarism, Postpartum hypopituitarism (disorder), Sheehan's syndrome (disorder), Sheehan, Simmonds, hypopituitarism; postpartum, postpartum; hypopituitarism, postpartum; panhypopituitarism, syndrome, syndrome; postpartum panhypopituitary, Postpartum pituitary infarction, Reye-Sheehan syndrome, Ischemic postpartum pituitary necrosis (disorder) [Ambiguous], Simmonds disease, Sheehan Syndrome, Postpartum necrosis of pituitary, Simmonds Disease, Simmonds' Disease, Simmond's Disease, Disease, Simmonds, Postpartum Hypopituitarism, Hypopituitarism, Postpartum, Panhypopituitarism, Postpartum, Pituitary Insufficiency, Postpartum, Postpartum Panhypopituitarism, Postpartum Pituitary Insufficiency |
| Dutch | syndroom van Sheehan, hypopituïtarisme; post partum, post partum; hypopituïtarisme, post partum; panhypopituïtarisme, syndroom, syndroom; post partum panhypopituïtarisme, postpartum hypopituïtarisme, Sheehan-ziekte |
| Japanese | シーハン症候群, 分娩後下垂体機能低下症, ｼｰﾊﾝｼｮｳｺｳｸﾞﾝ, ﾌﾞﾝﾍﾞﾝｺﾞｶｽｲﾀｲｷﾉｳﾃｲｶｼｮｳ |
| French | Syndrome de Sheehan, Hypopituitarisme du post-partum, Cachexie hypophysaire, Maladie de Simmonds, Nécrose hypophysaire du post-partum, Nécrose pituitaire du post-partum |
| German | Postpartaler Hypopituitarismus, postpartaler Hypopituitarismus, Simmonds-Sheehan-Syndrom, Sheehan-Syndrom, Simmonds-Krankheit, Postpartale Hypophyseninsuffizienz, Postpartaler Panhypopituitarismus |
| Italian | Morbo di Simmonds, Insufficienza pituitaria postpartum, Sindrome di Sheehan, Ipopituarismo postpartum, Panipopituitarismo postpartum |
| Czech | Poporodní hypopituitarismus, poporodní hypopituitarismus, Simmondsova nemoc, Sheehanův syndrom |
| Hungarian | Postpartum hypopituitarismus, Sheehan-syndroma |
| Spanish | necrosis pituitaria isquémica posparto, infarto pituitario postparto, necrosis hipofisaria isquémica postparto, infarto hipofisario postparto, síndrome de Reye - Sheehan, enfermedad de Simmonds, hipopituitarismo posparto (trastorno), hipopituitarismo posparto, hipopituitarismo postparto, necrosis hipofisaria posparto, necrosis pituitaria posparto, síndrome de Sheehan (concepto no activo), síndrome de Sheehan (trastorno), síndrome de Sheehan, Hipopituitarismo postparto, Enfermedad de Simmonds, Síndrome de Sheehan |
| Portuguese | Hipofunção hipofisária pós-parto, Doença de Simmonds, Síndrome de Sheehan |
