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Hypopituitarism
Aka: Hypopituitarism, Panhypopituitarism, Pituitary Insufficiency, Sheehan Syndrome
- See Also
- Pituitary Gland
- Pituitary Adenoma
- Hypogonadotropic Hypogonadism
- Short Stature
- Amenorrhea
- 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, and 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
- Causes
- Congenital
- Perinatal Injury
- Developmental Disorders
- Anencephaly
- Lipid storage disease
- Genetic
- PIT-1 (affects GH, TSH and Prolactin)
- PROP-1 (affects GH, LH, FSH, TSH, ACTH, Prolactin)
- HESX1 (affects GH, LH, FSH, TSH, ACTH, ADH)
- LHX3, 4 (affects GH, LH, FSH, TSH, Prolactin)
- PITX2 (affects GH, Prolactin)
- Isolated defects affect a single pituitary Hormone (>10 genetic defects identified)
- 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
- Breast Cancer
- Lung Cancer
- Melanoma
- Renal cell cancer
- Other malignancy
- Leukemia
- Lymphoma
- Germ cell tumors
- Ischemic Pituitary necrosis
- Postpartum Hemorrhage (Sheehan Syndrome)
- Diabetes Mellitus
- Sickle Cell Disease
- Temporal Arteritis
- Eclampsia
- 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)
- Findings: ACTH Deficiency (Corticotroph Deficiency)
- See Adrenal Insufficiency (Addison's Disease)
- Acute
- Fatigue
- Weakness
- Dizziness
- Nausea or Vomiting
- Hypotension
- Hypoglycemia
- Chronic
- Fatigue
- Pallor
- Weight loss
- Hypoglycemia
- Findings: TSH Deficiency (Thyrotropin Deficiency)
- See Hypothyroidism
- Fatigue
- Cold Intolerance
- Constipation
- Weight gain
- Alopecia
- Dry Skin
- Bradycardia
- Hoarse voice
- Cognitive slowing
- 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
- 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
- Adult
- Fatigue
- Decreased Muscle mass and strength
- Increased visceral fat
- Premature atherosclerosis
- Findings: Prolactin Deficiency
- See Prolactin
- Lack of Breast alveolar milk secretion in pregnancy and failed Lactation
- Findings: ADH Deficiency (Antidiuretic Hormone Deficiency)
- See Central Diabetes Insipidus
- Polyuria
- Polydipsia
- Nocturia
- 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)
- 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
- References
- Gounden (2021) Hypopituitarism, in StatPearls, Treasure Island, accessed 3/28/2022
- https://www.ncbi.nlm.nih.gov/books/NBK470414/
- Kim (2015) Endocrinol Metab 30:443-55 [PubMed]