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OVERVIEW

What is hypopituitarism?

Hypopituitarism is a disorder in which your body doesn’t make enough pituitary hormones. The pituitary gland is a small, bean-shaped gland at the base of your brain. It plays a role in controlling your body’s endocrine system, a group of glands that produce and secrete hormones to regulate your body’s processes.

In hypopituitarism, the pituitary gland fails to produce or doesn’t produce enough of one or more of its hormones. When your pituitary gland doesn’t produce enough hormones, your body functions are affected.

The pituitary gland is responsible for releasing:

• Adrenocoricotropic hormone (ACTH), which stimulates the adrenal glands to produce cortisol and other hormones to help your body deal with stress.
• Anti-diuretic hormone, which controls urine production.
• Follicle-stimulating hormone, which works with luteinizing hormone to stimulate sperm production in men and egg development and ovulation in women.
• Growth hormone, which controls bone and tissue growth. It also maintains the balance of fat and muscle tissue in the body.
• Luteinizing hormone, which controls testosterone production in men and estrogen in women.
• Prolactin, which controls the development of breasts and the production of breast milk in women.
• Thyroid-stimulating hormone, which stimulates your thyroid gland to make other hormones that regulate your body’s metabolism.

SYMPTOMS

What are the symptoms of hypopituitarism?

The symptoms of hypopituitarism usually develop gradually, although it is possible for them to appear suddenly. Because the symptoms tend to progress over time, they are often overlooked for months or years.

Possible symptoms include:

• Abdominal discomfort
• Constipation
• Facial puffiness
• Fatigue
• Headaches
• Hoarse voice
• Low blood pressure
• Loss of appetite
• Loss of underarm and pubic hair
• Muscle weakness
• Nausea
• Sensitivity to cold or difficulty staying warm
• Stiffness in the joints
• Thirst and excessive urination
• Unintended weight loss or gain
• Vision problems

Men may also experience:

• Erectile dysfunction
• Decrease in facial or body hair
• Loss of interest in sexual activity

Women may also experience:

• Inability to produce milk for breast-feeding
• Infertility
• Irregular or stopped menstrual periods

Children may also experience:

• Stunted growth, which may result in short stature
• Slowed sexual development

If certain symptoms of hypopituitarism develop suddenly, such as a severe headache, visual problems, confusion, or a drop in blood pressure, you should contact a healthcare provider immediately. These symptoms could be a sign of sudden bleeding into the pituitary (called pituitary apoplexy), which is a serious condition.

CAUSES & RISK FACTORS

What causes hypopituitarism?

Hypopituitarism is commonly caused by a tumor in the pituitary gland. A tumor can squeeze the pituitary gland as it grows, which can cause damage. A pituitary tumor can also put pressure on the optic nerves in the eyes and cause visual problems.

Other causes of hypopituitarism are:

• Brain tumor
• Brain surgery
• Head injuries
• Infections of the brain, such as meningitis
• Radiation treatment
• Stroke
• Tuberculosis
• Uncommon diseases, such as sarcoidosis and histiocytosis X

Hypopituitarism can also be caused by diseases of the hypothalamus, a portion of the brain located just above the pituitary gland. The hypothalamus is responsible for producing hormones that help the pituitary gland function normally.

In other cases, the cause of hypopituitarism may be unknown.

DIAGNOSIS & TESTS

How will my healthcare provider know I have hypopituitarism?

If you have symptoms of hypopituitarism, your healthcare provider may order blood tests to detect the levels of pituitary hormones in your blood. A computerized tomography (CT) scan or a magnetic resonance imaging (MRI) scan of your brain can check for pituitary tumors or defects. Your healthcare provider may do several vision tests to see if your sight is being affected. In children, X-rays can measure whether bones are growing normally.

Your healthcare provider may also want you to see an endocrinologist or go to a special endocrine clinic for other tests. An endocrinologist is a healthcare provider who studies the endocrine system.

TREATMENT

How is hypopituitarism treated?

Your healthcare provider will treat the condition that is the cause of your hypopituitarism first. This can help restore your pituitary gland’s ability to produce hormones.

If a tumor on your pituitary gland is causing your hypopituitarim, your healthcare provider may recommend surgery to remove it or radiation therapy to shrink it.

If your body does not produce enough of one or more pituitary hormones after treating the underlying condition, your healthcare provider may prescribe a hormone replacement medicine to add to your body’s hormone production.  Hormone replacement medicines include:

• Corticosteroids (such as prednisone and hydrocortisone) to replace hormones missing because of an adrenocorticotropic hormone deficiency.
• Desmopressin (DDAVP) to replace adrenocoricotropic hormone missing because of an anti-diuretic hormone deficiency. This medicine also helps reduce your body’s loss of water through frequent urination.
• Growth hormone (also called somatropin) to promote growth in children and to benefit adults who have a growth hormone deficiency.
• Levothyroxine to replace thyroid hormones missing because of a thyroid-stimulating hormone deficiency.
• Sex hormones to replace testosterone (in men), estrogen (in women) or an estrogen/progesterone combination (in women) missing because of a pituitary problem. If you are taking hormone replacement medicine, your healthcare provider may want to monitor the levels of hormones in your blood to make sure you’re getting the right amount of replacement hormones.

If you become very sick (such as with the flu) or go through a stressful time, your healthcare provider may adjust the dose of replacement hormone you take to act the way a normally functioning pituitary gland would act in response to these situations. You might also need a dose adjustment if you become pregnant or have a significant change in weight.

You should carry a medical alert card and bracelet at all times so that emergency medical workers know what kind of care you need in case of emergency.

QUESTIONS TO ASK YOUR HEALTHCARE PROVIDER

• What is the likely cause of my hypopituitarism?
• What are the results of my blood/diagnostic test(s)? What do these results mean?
• What is the best treatment option? Will I need surgery?
• What risks are associated with surgery?
• Will I need to take medicine? For how long?
• Am I at risk of having a medical emergency? Do I need to wear a medical alert bracelet?
• What symptoms would indicate that my condition is getting worse?
• Am I at risk for any long-term health problems?