Hypopituitarism is a rare disorder involving underproduction of hormones by the pituitary gland. The pituitary, deep in the brain, is the most important gland in the body’s endocrine, or hormonal, system.
One of the six hormones produced by the anterior portion of the pituitary is human growth hormone (HGH). In children, HGH deficiency may lead to impaired growth, or dwarfism. Early diagnosis and administration of HGH can correct this hormonal deficiency and result in normal or near-normal height.
Deficiencies in other pituitary hormones produce a wide variety of symptoms; in panhypopituitarism, deficiencies occur in all pituitary hormones. Because pituitary hormones stimulate hormone production in other glands, hypopituitarism may have a snowball effect, resulting in deficiencies of adrenal, thyroid, and sex hormones
What Causes Hypopituitarism?
- A tumor located in or near the pituitary gland is the most common cause of hypopituitarism.
- Pituitary surgery or radiation is a potential cause.
- Hypopituitarism may develop in the postpartum period (Sheehan’s syndrome) because of necrosis (tissue death) in the pituitary as it outgrows its blood supply during pregnancy.
- Inflammatory processes such as those that occur with tuberculosis are a possible cause.
- Infiltration of the pituitary by a starchy protein (amyloidosis) or iron (hemochromatosis) may result in hypopituitarism.
Symptoms of Hypopituitarism
- Growth retardation (children and adolescents)
- Partial or total sexual maturation impairment
- Weakness; dizziness or lightheadedness
- Nausea and vomiting; hoarseness
- Sensitivity to cold or difficulty staying warm
- Slow heartbeat; intolerance to cold
- Slowed or impaired thinking
- Abdominal discomfort
- Facial puffiness
- Extreme thirst combined with excessive urination (due to diabetes insipidus), dehydration, and constipation
- Fine wrinkles next to the eyes and mouth, dry skin, depigmentation of the skin, loss of axillary and pubic hair
- In women: cessation of menstruation (amenorrhea), breast atrophy, vaginal dryness, absence of milk production in new mothers (Sheehan’s syndrome)
- In men: loss of libido and potency, reduced muscular strength, shrinking and softening of the testes, decreased secondary hair growth
- Patient history and physical examination.
- Blood tests to measure levels of pituitary, gonadal, thyroid, and adrenal hormones.
- X-rays, MRI (magnetic resonance imaging), or CT (computed tomography) scans to detect a tumor.
- Provocative tests of pituitary function may also be done, such as growth hormone-releasing hormone (GHRH) test, arginine stimulation test, L-dopa, clonidine stimulation test, insulin tolerance test or adrenocorticotropic hormone (ACTH) stimulation test.
How Hypopituitarism Is Treated
- Lifelong hormonal replacement therapy is necessary. The specific hormones needed will depend on the nature of the deficiency. To treat adult panhypopituitarism, it is necessary to replace thyroid, adrenal, and gonadal hormones.
- HGH replacement therapy is necessary for children and adolescents to obtain normal growth. HGH is also recommended for adults to maintain normal metabolism.
- In some cases, doses of corticosteroids (such as hydrocortisone or prednisone) must be increased during periods of stress, illness, infection, or surgery.
- It may be necessary to reduce insulin dosage in people with diabetes who develop hypopituitarism.
- If a tumor causes hypopituitarism, surgery or radiation therapy may be warranted.
When to Call a Doctor
- Call a doctor if you or your child develop any of the symptoms of hypopituitarism.
- EMERGENCY Nausea, vomiting, extreme weakness, dehydration, and fever suggest adrenal insufficiency that may require emergency medical care.
Johns Hopkins Symptoms and Remedies: The Complete Home Medical Reference
Simeon Margolis, M.D., Ph.D., Medical Editor
Prepared by the Editors of The Johns Hopkins Medical Letter: Health After 50
Updated by Remedy Health Media