Hypopituitarism

Last reviewed: April 2018

Last updated: February 2016

Summary

Deficiency of one or more pituitary hormones.

Variable presentation depending on cause.

Symptoms include headaches, amenorrhea, galactorrhea, and visual field defects.

Treatment depends on correction of the underlying cause. Where causes are not correctable, treatment focuses on replacing the target hormones.

Patients who require cortisol for ACTH deficiency require increased dosage in times of stress (such as infection, trauma, and surgery).

Definition

Hypopituitarism refers to the partial or complete deficiency of one or more pituitary hormones. It may arise as a congenital defect during the development of the pituitary gland or as a result of acquired diseases of the pituitary gland, the parasellar structures, or the hypothalamus.

History and exam

Key diagnostic factors

hx of pituitary or hypothalamic disease
hx of traumatic brain injury
headaches
failure to thrive or short stature
infertility
hypoglycemia
amenorrhea/oligomenorrhea
galactorrhea
delayed puberty
FHx of pituitary hormone deficiencies
hypotension
visual field defects
ophthalmoplegia

Full details

Other diagnostic factors

cardiovascular events
cold intolerance
weight gain
erectile dysfunction and reduced libido
nausea
vomiting
fatigue
weakness
dizziness
constipation
dry skin
delayed relaxation of reflexes
hypoactive sexual desire
hot flashes
nocturia and polyuria
breast atrophy
reduced bone and muscle mass
loss of axillary and pubic hair

Full details

Risk factors

pituitary tumor
pituitary apoplexy
pituitary surgery
cranial radiation
traumatic brain injury
genetic defects
inflammatory disorders
hypothalamic disease
severe postpartum hemorrhage (Sheehan syndrome)
empty sella syndrome
tuberculous meningitis
syphilis

Full details

Diagnostic investigations

1st investigations to order

serum electrolytes
8 a.m. cortisol and ACTH
TFT
8 a.m. testosterone, FSH, and LH in men
estradiol, FSH, and LH in women
prolactin
insulin-like growth factor-1 (IGF-1)
cosyntropin/tetracosactide stimulation test

Full details

Investigations to consider

insulin tolerance test (ITT)
water deprivation and desmopressin response test
MRI pituitary
CT pituitary
metyrapone testing of the adrenal axis

Full details

Treatment algorithm

INITIAL

pituitary apoplexy

ONGOING