Description

Hypopituitarism is a rare condition in which the pituitary gland does not make one or more hormones or doesn't make enough hormones.

The pituitary gland is a kidney-bean-sized gland at the base of the brain. It is part of the body's system of glands that produce hormones, called the endocrine system. The pituitary gland produces several hormones. Operating in almost every part of the body.

Hypopituitarism is when there's not enough of one or more of the pituitary hormones. This lack of hormones, called a deficiency, it can affect how the body functions in many ways. These include the growth, blood pressure, and the ability to have children, among others. The symptoms depend on the hormones that are missing.

People who have hypopituitarism in general have to take medications for the rest of their lives. These medications replace the missing hormone, which helps control the symptoms.

Symptoms

The symptoms of hypopituitarism usually start slowly and get worse over time. It could not be noticed for months or even years. But for some people, the symptoms start suddenly.

The symptoms of hypopituitarism vary from person to person. The symptoms depend on which are the hormones that are missing, and what little of the hormone is being made. There may be more of a hormone that is low. A second deficiency of the hormone can increase the symptoms of the first. Or, sometimes, you may hide the symptoms.

The growth hormone (GH)

In children, GH deficiency can cause problems of growth and stature. The majority of adults with GH deficiency have no symptoms. But some adults have:

  • Fatigue.
  • The muscle weakness.
  • Changes in body fat.
  • Loss of interest in activities.
  • The lack of social contacts.

Luteinizing hormone (LH) and follicle-stimulating hormone (FSH) deficiency

The lack of these hormones called gonadotropins, affects the reproductive system.

The lack of hormones maintains the ovaries from producing enough eggs and estrogen. Keeps the testes doing enough sperm and testosterone. This can decrease sexual desire and cause tiredness. You can also make it difficult or impossible to have children — a condition called infertility. In children, the physical changes in the body of an adult, known as puberty, may not occur or can be late.

Some people may have symptoms such as:

  • Hot flashes.
  • Irregular periods or absence of periods.
  • Loss of pubic hair.
  • Not be able to produce milk for breastfeeding.
  • Not being able to get or keep an erection, known as erectile dysfunction.
  • Decreased facial or body hair.
  • Changes of mood.
  • Fatigue.

Thyroid-stimulating hormone (TSH) deficiency

This hormone controls the thyroid gland. Too little TSH leads to low levels of thyroid hormones. This condition is known as hypothyroidism. It causes symptoms such as:

  • Fatigue.
  • The increase of weight.
  • Dry skin.
  • The constipation.
  • Sensitivity to cold or difficulty staying warm.

The adrenocorticotropic hormone (ACTH) deficiency

This hormone helps the adrenal glands are working properly. It also helps the body react to stress. The symptoms of adrenal insufficiency include:

  • Fatigue.
  • The low blood pressure.
  • Many and duration of infections.
  • Nausea, vomiting, or abdominal pain.
  • Confusion.

Antidiuretic hormone (ADH) deficiency

This hormone, which is also called vasopressin, helps the body to balance your fluid levels. ADH deficiency can lead to a disease called diabetes insipidus, which can cause:

  • Urinating more than usual.
  • Extreme thirst.
  • Imbalances in minerals such as sodium and potassium, which are known as electrolytes.

The deficiency of prolactin

Prolactin is the hormone that tells the body when to start the production of breast milk. Low levels of prolactin can cause problems with the production of milk for breastfeeding.

When to see a doctor

Consult your health care provider if you experience any of the symptoms of hypopituitarism.

Contact your health-care provider immediately if symptoms of hypopituitarism start suddenly or come up with a strong headache, changes in vision, confusion, or a drop in blood pressure. These could be symptoms of a sudden damage to the pituitary gland tissues. This condition is known as pituitary apoplexy.

The bleeding within the pituitary gland can cause the pituitary apoplexy. Pituitary apoplexy is a medical emergency and requires medical attention quickly.

Causes

Hypopituitarism has a number of causes. A common cause is a tumor of the pituitary gland. As a tumor of the pituitary gland grows, it can press on and damage to the pituitary tissue. This alters the pituitary gland, the ability to produce hormones. A tumor also may press on the optic nerve, causing vision problems.

Other possible causes of damage to the pituitary gland, which can lead to hypopituitarism include:

  • The lack of blood flow to the brain or the pituitary gland, known as a cerebrovascular accident, or bleeding, called a hemorrhage in the brain or the pituitary gland.
  • Certain medications, such as narcotics, high-dose steroids or certain anti-cancer drugs called checkpoint inhibitors.
  • Swelling, known as inflammation of the pituitary gland caused by an unusual response of the immune system, called hypophysitis.
  • Infections of the brain, such as meningitis, or infections that may spread to the brain, such as tuberculosis or syphilis.
  • Significant blood loss during childbirth, which can cause damage to the anterior part of the pituitary gland. This condition is known as Sheehan's syndrome or postpartum pituitary necrosis.

In some cases, a change in a gene that causes hypopituitarism. That change is the inheritance, which means that it runs in families. The genetic change that affects the pituitary gland, the ability to perform one or more of its hormones. This often starts at birth or in early childhood.

Tumors or diseases of one part of the brain just above the pituitary gland, called the hypothalamus, also can cause hypopituitarism. The hypothalamus produces hormones that affect how the pituitary gland works.

Sometimes, the cause of hypopituitarism is not known.

Risk factors

The majority of people with hypopituitarism do not have any factors that put them at greater risk of developing the condition. But the following may increase the risk of developing hypopituitarism:

  • A head injury.
  • The brain surgery.
  • Radiation treatment to the head or neck.
  • Diseases that affect more than one part of the body. These include an inflammatory disease that affects various organs, called sarcoidosis, a disease in which abnormal cells cause scarring, called Langerhans cell histiocytosis; and a disease that causes excess iron in the liver and other tissues, called hemochromatosis.

Diagnosis

There are several tests to check the levels of hormones in the body and find the cause of the problems with the way in which the pituitary gland is working. These include:

  • Blood tests. These tests measure the levels of hormones produced by the pituitary gland and those made in the glands, the pituitary controls, such as the thyroid gland. Blood tests can show if low levels of hormones are due to the pituitary does not work as it should.
  • The stimulation or dynamic test. A clinic that specializes in the endocrine system of the conditions to run these tests to measure hormone levels. These tests check of the body's hormone levels before and after taking the drugs that cause the body to produce hormones.
  • The brain images. Magnetic resonance imaging or computed tomography scan of the brain may show a tumor of the pituitary gland or pituitary gland problems.

Treatment

Hypopituitarism is treated with medications that increase levels of the hormone. This is called hormone replacement. The dose is adjusted to the amount of hormones that the body was going to do if you do not have a pituitary problem. In some cases, people with hypopituitarism may need to take this medication for the rest of their lives.

Sometimes, treatment of a condition that causes hypopituitarism can restore the body's ability to produce hormones of the pituitary, either completely or in part.

Drugs

Hormone replacement medications may include:

  • Cortisol replacement. These medications include hydrocortisone (Cortef), or prednisone (Rays). It is taken by mouth, they replace the adrenal hormones due to a lack of adrenocorticotropic hormone (ACTH).
  • Levothyroxine (Levoxyl, Synthroid, others). This medicine treats the low levels of thyroid hormone, known as hypothyroidism, a lack of thyroid stimulating hormone (TSH).
  • The sex hormones. These include testosterone, estrogen, and progesterone. Testosterone is administered by injection, pills, patches or gel. Estrogen and progesterone are usually given in the form of pills, gels or patches.
  • The growth hormone. Also called somatropin (Genotropin, Humatrope, other), the growth hormone is given by an injection under the skin. Promotes the growth, which helps children grow taller. Adults who lack growth hormone can also benefit from the growth hormone, but you're not going to get taller.
  • Fertility hormones. Gonadotropins can be given by a shot to help ovulation and sperm production.

Monitoring of hormone replacement

A specialist in endocrine disorders, called an endocrinologist, you can keep an eye on the symptoms and the levels of the hormone in the blood. This is to ensure that the correct amount of medication.

People who take cortisol replacement need to work with a health care provider to adjust the dosage during times of increased stress. Under stress, the body normally produces more cortisol to help manage the stress.

Have the flu, diarrhea or vomiting, or have surgery or dental work could mean that the dose needs to be changed. The same might be true during pregnancy or with larger changes in the body weight.

Surgery or other procedures

If a tumor in or around the pituitary gland is the cause of hypopituitarism, surgery may be necessary to remove the growth. Some tumors can also be treated with drugs or radiation therapy.

In case of emergency

People with hypopituitarism need to wear a medical alert bracelet or necklace and carry a card to tell others of the condition. This is especially important for the replacement of cortisol by a lack of ACTH .

Preparing for your appointment

It is likely to start by seeing your primary care provider. Sometimes, you may be referred to a specialist in endocrine disorders, known as an endocrinologist.

Here's some information to help you prepare for your appointment.

What you can do

  • Be aware of any pre-appointment restrictions. When you make the appointment, ask if there is something that you need to do to prepare for the exams that you might need.
  • Write down all the symptoms you have, even if they do not appear to be related to one another. Note when you began.
  • Write down key personal information, including any recent life changes or a change in your ability to cope with stress.
  • Make a list of your key medical information, including any recent surgeries, and any other conditions for which it has been treated. Write down the names of all the medications you are taking, including dosage. List of head injuries or problems during delivery.
  • Have a family member or friend along, if possible. Someone who accompanies you can help you remember what your health care provider tells you to.
  • Write questions to ask your care provider.

Create a list of questions before your appointment so that you can make the most of your time with your provider. For hypopituitarism, some basic questions to ask include:

  • What is likely causing my symptoms?
  • What are other possible causes?
  • What tests do I need?
  • Is my condition likely to be short-term or long-term?
  • What treatment do you recommend it?
  • How long will I have to take medication?
  • How to know if the treatment is working?
  • I have other health conditions. How can I best manage them together?
  • There are restrictions that must be followed?
  • Do you have brochures or other printed material I can have? What sites do you recommend?

Be sure to ask all the questions that you have.

What to expect from your doctor

Your health care provider might ask questions such as:

  • How the symptoms changed over time?
  • Has your vision changed?
  • Do you have headaches?
  • Has your weight or the amount of body hair changed? There are other changes in the way they look?
  • Have you lost interest in sex? Has your menstrual cycle changed?
  • Have you recently had a baby?
  • Has had a head injury or neurosurgery?
  • Have you ever had radiation treatment for a head or neck tumor?
  • Has any member of your family has been diagnosed with the pituitary gland or hormonal conditions?
  • What, if anything, seems to improve your symptoms?
  • What, if anything, appears to worsen your symptoms?
Symptoms and treatment of Hypopituitarism