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Hypopituitarism
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Hypopituitarism

(Pituitary Insufficiency)

Pronounced: Hi-po-pi-TUI-tar-ism

En Español (Spanish Version)

Definition

The pituitary gland, the master gland, is a pea-sized structure that is located at the base of the brain. It’s primary role is to produce hormones.which control the production of other endocrine glands in the body.

Hypopituitarism is an uncommon disorder characterized by an insufficient production of of one or more hormones. The pituitary gland also produces its own hormones. When it isn’t functioning properly, it can cause the amount of hormones that other glands produce to diminish. This is a potentially serious problem that requires care from your doctor.

The pituitary gland is responsible for many body functions, including the following:

  • Growth
  • Blood pressure
  • Sex organ function
  • Thyroid gland function
  • Breast milk production and other aspects of pregnancy
  • Conversion of food into energy
  • Water balance in the body

Pituitary Gland

Nucleus factsheet image

© 2008 Nucleus Medical Art, Inc.

Causes

There are several factors which may cause this condition:

  • Tumors of the pituitary gland, hypothalamus, or brain
  • Poor blood supply to the pituitary gland
  • Head trauma
  • Radiation to pituitary gland, head, or neck
  • Stroke
  • Infections and inflammatory diseases
  • Uncommon immune system or metabolic diseases
  • A rare complication after pregnancy, called Sheehan’s syndrome
  • Metastatic cancer from lung , colon , prostate , or melanoma

Risk Factors

A risk factor is something that increases your chance of getting a disease or condition. The risk factors for hypopituitarism include the following:

  • History of childhood cancer (Treatment can damage the endocrine system, which controls hormones.)
  • Infections
  • Genetics
  • Type 1 diabetes
  • Sickle cell anemia
  • Reduced blood volume or hypovolemia

Symptoms

Symptoms of hypopituitarism usually begin gradually and may not be recognized for a while. Symptoms depend on which hormone or hormones are low. The following are the hormones produced by the pituitary gland and their associated symptoms due to hormone deficiency:

  • Growth hormone deficiency:
    • Poor overall growth
    • Short stature
    • Increased blood pressure
    • Central obesity
    • Muscle weakness
    • Small heart
  • Thyroid-stimulating hormone deficiency:
    • Sensitivity to cold
    • Weight gain
    • Constipation
    • Hair that is brittle and coarse
    • Heart rate slowed
    • Dry skin
    • Muscle weakness or fatigue
  • Adrenocorticotropic hormone (ACTH) deficiency:
    • Fatigue and weakness
    • Low blood pressure
    • Weight loss
    • Increase in skin pigmentation
    • Amenorrhea
  • Follicle-stimulating hormone and luteinizing hormone deficiency:
    • Infertility in men and women
    • Vaginal dryness
    • Loss of some gender-specific sexual characteristics (Women may lose hair from their underarms, body, and pubic area.)
    • Reduced libido
    • Amenorrhea
    • Erectile dysfunction
    • Muscle weakness
    • Small testes
    • Breast enlargement in men

Diagnosis

Your doctor will ask about your symptoms and medical history, and perform a physical exam. If necessary, your doctor will refer you to an endocrinologist, a doctor who specializes in treating hormone disorders.

Tests to determine hypopituitarism include taking a blood sample to do the following:

  • Measure the levels of hormones produced by the pituitary gland
  • Measure the levels of hormones produced by target endocrine glands, which are influenced by the pituitary gland

Provocative tests of pituitary function may also be done. These may include:

  • Growth hormone-releasing hormone (GHRH) test
  • Arginine stimulation test
  • L-dopa
  • Clonidine stimulation test
  • Insulin tolerance test
  • Adrenocorticotropic hormone (ACTH) stimulation test

Once the diagnosis of hypopituitarism is confirmed, lateral skull x-ray imaging tests (eg, an MRI ) are done on the pituitary gland to identify problems such as abnormal tissue and growth or shrinkage of the pituitary gland.

Treatment

Talk with your doctor about the best treatment plan for you. Hypopituitarism is permanent and will likely need to be treated for life. Treatment options include the following:

Medications

If the condition is caused by a tumor, it is first treated with medications (bromocriptine, cabergoline, or quinagolide), which can successfully shrink the tumor in up to 90% of cases.

Surgery

Surgery is required in cases where treatment with medication has failed.

Often, hormone replacement therapy is needed after surgery.

Hormone Replacement Therapy

When the target hormone levels are inadequate, they must be replaced. In most cases, therapy does not replace the hormones that the pituitary gland produces. Instead, the hormones of the other target glands that it stimulates are replaced. Examples include:

  • Thyroid hormone
  • Corticosteroids
  • Testosterone (male)
  • Estrogen and progesterone (female)
  • Growth hormone
  • Antidiuretic hormone

Radiation Therapy

Treatment with radiation is used after drug or surgical treatment.

Prevention

In general, this condition is not preventable. However, being aware of the risks and symptoms will make early diagnosis and treatment possible.

RESOURCES:

Pituitary Disorders Education and Support
http://www.pituitarydisorder.net

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

The Pituitary Society
http://www.pituitarysociety.org

CANADIAN RESOURCES:

BC Health Guide
http://www.bchealthguide.org/

Thyroid Foundation of Canada
http://www.thyroid.ca

References:

Beers MH, Fletcher AJ, Jones TV, et al. The Merck Manual of Medical Information: Second Home Edition . Whitehouse Station, NJ: Merck Research Laboratories; 2003.

Hypopituitarism. Medline Plus website. Available at: http://www.nlm.nih.gov/medlineplus/ency/article/000343.htm . Accessed on July 22, 2005.

Schneider HJ, Aimaretti G , Kreitschmann-Andermahr I, et al. Hypopituitarism. Lancet. 2007;369:1461-1470.

Tomlinson JW, et al. Association between premature mortality and hypopituitarism. West Midlands Prospective Hypopituitary Study Group. Lancet . 2001; 357:425.



Last reviewed March 2008 by David Juan, MD

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.


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