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Hypopituitarism
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Hypopituitarism

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Pituitary insufficiency

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

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  • Causes

    The pituitary gland is a small structure that is located just below the brain. It is attached by a stalk to the hypothalamus. This is the area of the brain that controls the pituitary gland's 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
    • Antidiuretic hormone (ADH) -- controls water loss by the kidneys
    • Follicle stimulating hormone (FSH) -- controls sexual function and fertility in males and females
    • Growth hormone (GH) -- stimulates growth of tissues and bone
    • Luteinizing hormone (LH) -- controls sexual function and fertility in males and females
    • Oxytocin -- stimulates the uterus to contract during labor and the breasts to release milk
    • Prolactin -- stimulates female breast development and milk production
    • Thyroid stimulating hormone (TSH) -- stimulates the thyroid gland to release hormones that affect the body's metabolism
    Pituitary gland

    Pituitary gland

    In hypopituitarism, there is a lack of one or more pituitary hormones. Lack of a hormone leads to loss of function in the gland or organ the hormone controls. For example, lack of TSH leads to loss of normal function of the thyroid gland.

    Hypopituitarism may be caused by:

    • Brain surgery
    • Brain tumor
    • Head trauma
    • Infections or inflammation of the brain and the tissues that support the brain
    • Radiation therapy
    • Stroke
    • Subarachnoid hemorrhage (from a burst aneurysm)
    • Tumors of the pituitary gland or hypothalamus

    Occasionally, hypopituitarism is due to uncommon immune system or metabolic diseases, such as:

    • Hemochromatosis
    • Histiocytosis X
    • Lymphocytic hypophysitis
    • Sarcoidosis

    Hypopituitarism is also a rare complication after pregnancy, a condition called Sheehan's syndrome.

  • Symptoms

    Symptoms of hypopituitarism include any of the following:

    • Abdominal pain
    • Decreased appetite
    • Decreased sexual interest (in men)
    • Dizziness or fainting
    • Excessive urination and thirst
    • Failure to release milk (in women)
    • Fatigue
    • Headache
    • Infertility (in women)
    • Lack of sex drive (in women)
    • Loss of armpit or pubic hair
    • Loss of body or facial hair (in men)
    • Low blood pressure
    • Low blood sugar
    • Sensitivity to cold
    • Short height (less than 5 feet) if onset is during a growth period
    • Slowed growth and sexual development (in children)
    • Stopping of menstrual periods (in women)
    • Vision problems
    • Weakness
    • Weight loss

    Symptoms may develop slowly and may vary greatly, depending upon:

    • The number of hormones that are missing and the organs they affect
    • The severity of the disorder

    Other symptoms that may occur with this disease:

    • Face swelling
    • Hair loss
    • Hoarseness or changing voice
    • Joint stiffness
    • Weight gain (unintentional)
  • Exams and Tests

    To diagnose hypopituitarism, there must be low hormone levels due to a problem with the pituitary gland. The diagnosis must also rule out diseases of the organ that is affected by this hormone.

    Tests may include:

    • Brain CT scan
    • Pituitary MRI
    • Serum ACTH
    • Serum cortisol
    • Serum estradiol (estrogen)
    • Serum follicle stimulating hormone (FSH)
    • Serum insulin-like growth factor 1 (IGF-1)
    • Serum luteinizing hormone (LH)
    • Serum testosterone level
    • Serum thyroid stimulating hormone (TSH)
    • Thyroid hormone (T4)

    Levels of a pituitary hormone may be high in the bloodstream if you have a pituitary tumor that is producing too much of that hormone. The tumor may crush other cells of the pituitary, leading to low levels of other hormones.

  • Treatment

    If hypopituitarism is caused by a tumor, you may need surgery to remove the tumor. Radiation therapy may also be needed. 

    You will need lifelong hormone medicines to replace hormones that are no longer made by organs under the control of the pituitary gland. These may include:

    • Corticosteroids (cortisol)
    • Growth hormone
    • Sex hormones (testosterone for men and estrogen for women)
    • Thyroid hormone

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

  • Outlook (Prognosis)

    Hypopituitarism is usually permanent. It requires lifelong treatment with one or more medicines. But you can expect a normal life span.

  • Possible Complications

    Side effects of medicines can develop. Stopping corticosteroid and thyroid supplementation can be life-threatening.

  • When to Contact a Medical Professional

    Call your health care provider if you develop symptoms of hypopituitarism.

  • Prevention

    In most cases, the disorder is not preventable. Awareness of risk may allow early diagnosis and treatment.

Related Information

  HypothalamusGrowth hormone tes...TSH testMetabolismProlactinLuteinizing hormon...Follicle-stimulati...Antidiuretic hormo...    

References

Melmed S, Kleinberg D, Ho K. Pituitary physiology and diagnostic evaluation. In: Melmed S, Polonsky KS, Larsen PR, Kronenberg HM, eds. Williams Textbook of Endocrinology. 12th ed. Philadelphia, Pa: Elsevier Saunders; 2011:chap 8.

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Review Date: 11/7/2013  

Reviewed By: Brent Wisse, MD, Associate Professor of Medicine, Division of Metabolism, Endocrinology & Nutrition, University of Washington School of Medicine. Also reviewed by David Zieve, MD, MHA, Bethanne Black, and the A.D.A.M. Editorial team.

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