Hypopituitarism

Last reviewed: March 2019

Last updated: December 2018

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 adrenocorticotropic hormone 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

history of pituitary or hypothalamic disease
history of traumatic brain injury
headaches
failure to thrive or short stature
infertility
hypoglycemia
amenorrhea/oligomenorrhea
galactorrhea
delayed puberty
family history 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

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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
serum and urine osmolarity
8 a.m. cortisol and adrenocorticotropic hormone
thyroid function tests
8 a.m. testosterone, follicle-stimulating hormone, and luteinizing hormone in men
estradiol, follicle-stimulating hormone, and luteinizing hormone in women
prolactin
insulin-like growth factor-1
cosyntropin/tetracosactide stimulation test

Full details

Investigations to consider

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

Full details

Treatment algorithm

INITIAL

pituitary apoplexy

ONGOING