Panhypopituitarism

(PHP; Underactive Pituitary Gland)

Definition

The pituitary gland is found at the base of the brain. It produces several important hormones that control the production of other hormones made by glands in the body. In panhypopituitarism, the gland produces an insufficient amount of hormones.
Pituitary Gland
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Causes

This condition is most often caused by damage to the gland. In adults, it is usually a result of pituitary surgery. In children, damage to the pituitary gland may be caused by:
  • Infection
  • Stroke
  • Genetic factors
  • Tumor on or near the pituitary gland
  • Cancer that has spread
  • Injury
In some cases, the cause may be unknown.

Risk Factors

Factors that may increase your chance of panhypopituitarism include:

Symptoms

Compression of the Tumor

Compression of the tumor on local structures, especially the nerves of the eyes, can cause:
  • Blurred vision
  • Loss of visual field
  • Poor temperature control

Insufficient Hormones

  • Insufficient levels of gonadotropins can cause:
    • In premenopausal women—missed menstrual cycles, infertility , osteoporosis , vaginal dryness, loss or reduction in female characteristics
    • In men—impotence, reduced size of testes, decreased production of sperm, infertility , breast enlargement, reduced muscle mass, loss or reduction in male characteristics like beard growth
  • Insufficient levels of growth hormone can cause:
    • In children—stunted growth or dwarfism
    • In adults—weakness, obesity , reduced cardiac output, low blood sugar levels, and reduced exercise tolerance
  • Insufficient levels of thyroid-stimulating hormones can lead to:
    • Underactive thyroid , which causes confusion, hair loss, weakness, slow heart rate, muscle stiffness, intolerance to cold, constipation , weight gain, and dry skin.
  • Insufficient corticotrophic levels can lead to:
    • Underactive adrenal gland, which causes low blood pressure, low blood sugar , fatigue, weight loss, vomiting, and low stress tolerance (this can be life-threatening).
  • Excessive prolactin levels can cause:
    • In women—missed periods, infertility, and milk secretion
    • In men—reduced facial and body hair, small testes
  • Insufficient antidiuretic hormone (rare) can cause:
    • Excessive thirst and frequent urination
    • Night-time urination

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Diagnosis

Your doctor will ask about your symptoms and medical history. A physical exam will be done.Tests may include the following:
  • Blood tests—to measure pituitary, as well as target gland hormone levels
  • Stimulation tests—to test the maximum capacity of the endocrine glands, usually of the pituitary gland
  • Semen analysis—in males suspected of infertility
  • MRI scan—imaging test used to assess internal structures

Treatment

Talk with your doctor about the best plan for you. Treatment depends on the cause of the condition. The goal of treatment is to restore normal blood hormone levels of thyroid, adrenal, estrogen or testosterone, and sometimes growth hormone.Treatment options include:
  • Hormone replacement therapy—based on what types of hormones are missing
  • Tumor removal—done if the cause of the damage is a tumor
  • Radiation therapy—done if the cause of the damage is a cancer or tumor

Prevention

In most cases, the causes of panhypopituitarism are not preventable.

RESOURCES

Hormone Health Network—Endocrine Society
http://www.hormone.org

The Pituitary Network Association
http://www.pituitary.org

CANADIAN RESOURCES

About Kids Health—The Hospital for Sick Children
http://www.aboutkidshealth.ca

Health Canada
http://www.hc-sc.gc.ca

References

Bhasin S, Cunningham GR, et al. Testosterone therapy in adult men with androgen deficiency syndromes: an endocrine society clinical practice guideline. J Clin Endocrinol Metab. 2006;91:1995-2010.

Hypopituitarism in children. Lucile Packard Children's Hospital website. Available at: http://www.lpch.org/DiseaseHealthInfo/HealthLibrary/diabetes/hypop.html.Accessed February 6, 2015.

Randeva HS, Schoebel J, et al. Classical pituitary apoplexy: clinical features, management and outcome. Clin Endocrinol (Oxf). 1999;51:181-188.

Schneider HJ, Aimaretti G, et al. Hypopituitarism. Lancet. 2007;269:1461-1470.

Toogood AA, Stewart PM. Hypopituitarism: clinical features, diagnosis, and management. Endocrinol Metab Clin North Am. 1998;37:235-261

What is a growth disorder? Nemours Kids Health website. Available at: http://kidshealth.org/parent/medical/endocrine/growth%5Fdisorder.html.Updated July 2014. Accessed February 6, 2015.

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