Hypopituitarism

What is hypopituitarism ?

Hypopituitarism otherwise called as pituitary insufficiency refers to the low levels of circulating pituitary hormones.

What causes hypopituitarism?

  • Pituitary tumors
  • Parapituitary rumors
    • Craniopharyngiomas
    • Meningiomas
  • Radiotherapy (pituitary, cranial, nasopharyngeal)
  • Infarction (apoplexy), Shehan’s syndrome
  • Infiltration of the pituitary gland ( Sarcoidosis, Lymphocytic hypophysistis, haemochromatosis)
  • Empty sella syndrome

What are the symptoms?

Hormone def Clinical Features
GH · Reduced exercise capacity
· Reduced lean body mass
· Impaired psychological well being
· Increased Cardiovascular risk
LH/FSH · In women
. Anovulatory cycles
. Period problems
. Loss of libido
. Loss of secondary sexual hair
· In males
. Erectile dysfunction
. Testicular atrophy
. Loss of libido
. Loss of secondary sexual hair
ACTH · Anorexia/ weight losstiredness/ fatigue
· Dizziness/ postural hypotension
· Nausea, vomiting, abdominal pain
· Arthralgia/ myalgia
· Symptomatic hypoglycaemia
TSH · Fatigue, cramps
· Constipation
· Cold intolerance
· Weight gain
· Slowing of intellectual & motor activities
· Dry skin, hoarse voice
PRL · Failure of lactation
ADH · Excess thirst and urination

What are the necessary investigations?

  1. Basal hormone levels
    • Both basal concentrations of the pituitary hormones and the, target hormone levels are to be measured, as the pituitary hormones may remain within the target range despite low target hormone levels.
      • LH, FSH, Oestradiol, Testosterone
      • TSH and free T4
      • 8 am cortisol
      • Prolactin
  2. Dynamic testing
    • Insulin tolerance test
    • Short synacthen test
  3. Imaging
    • Pituitary imaging – MRI

pituitary-9

Empty sella (sagittal view)

What is the treatment?

  • Adequate and appropriate replacement of the deficient pituitary hormones – At present we can replace all the hormones and life-style can be put back to normal.
  • Treatment of the cause
  • Hypopituitarism is usually permanent and requires life-long treatment.

This article is prepared along with Dr Menaka