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Hypopituitarism is a general term that refers to any under-performance of the pituitary gland. This is a clinical definition used by endocrinologists and is interpreted to mean that one or more functions of the pituitary are deficient. The term may refer to both anterior and posterior pituitary gland failure.
Below is a list of the hormones secreted by the pituitary and their functions: - growth hormone (stimulates cell division and bone growth)
- thyroid stimulating hormone (stimulates the thyroid gland to secrete hormones that affect body metabolism)
- adrenocorticotropic hormone (stimulates the adrenal gland to secrete hormones that affect metabolism)
- prolactin (stimulates female breast development and milk production)
- luteinizing hormone (controls sexual function in males and females)
- follicle stimulating hormone (controls sexual function in males and females)
- melanocyte stimulating hormone (controls pigmentation of the skin)
- antidiuretic hormone (controls water loss by the kidneys)
- oxytocin, (stimulates contraction of the uterus during labor and milk release from the breasts).
Growth hormone is necessary in children for growth, but also appears necessary in adults to maintain normal body composition (muscle and bone mass). It may also be helpful for maintaining an adequate energy level, optimal cardiovascular status and some mental functions.
Incidence; Causes & Development; Risk Factors
The incidence is 1 out of 10,000 people.
In cases of hypopituitarism, single or multiple hormone deficiencies are present. The deficiencies affect the target organ activity or secretion (the thyroid; the adrenals; or the gonads, which includes both female and male sexual development and function). Causes of hypopituitarism are tumors or lesions of various origins, congenital defects, trauma, radiation, surgery, encephalitis, hemochromatosis, and stroke. In children, the condition results in slowed growth and development and is known as dwarfism. The cause may also be unknown.
Deficient pituitary gland function can result from damage to either the pituitary or the area just above the pituitary, namely the hypothalamus. The hypothalamus contains releasing and inhibitory hormones that control the pituitary. Since these hormones are necessary for normal pituitary function, damage to the hypothalamus can also result in deficient pituitary gland function. Injury to the pituitary can occur from a variety of insults, including damage from an enlarging pituitary tumor, irradiation of the pituitary gland, limited blood supply (as experienced in a stroke), trauma or abnormal iron storage (hemochromatosis). There appears to be a predictable loss of hormonal function with increasing damage. The progression from most vulnerable to least vulnerable is usually as follows:- Growth hormone (GH)
- Gonadotropins (LH and FSH which control sexual/reproductive function)
- TSH (which control thyroid hormone release)
- ACTH (which controls adrenal function)
Risk factors are related to the cause and may include previous history of diabetes insipidus, previous history of adrenal insufficiency, previous history of a pituitary tumor, cessation of menses in a premenopausal woman, and short stature.
Signs & Symptoms
Symptoms of growth hormone deficiency in adults include:- fatigue
- poor exercise performance
- social isolation
- weakness
- sensitivity to cold
- decreased appetite
- weight loss
- abdominal pain
- low blood pressure
- headache
- visual disturbances
- short stature (< 5 feet) if onset is during a growth period
- loss of armpit or pubic hair
- in women: cessation of menses, infertility, or failure to lactate
- in men: decreased sexual interest, loss of body or facial hair
- in children: slowed growth and sexual development
Note: Symptoms may develop slowly and may vary greatly depending upon the severity of the disorder and the number of deficient hormones and their target organs.
Additional symptoms that may be associated with this disease: - weight gain (unintentional)
- joint stiffness
- hoarseness or changing voice
- hair loss
- facial swelling
Gonadotropin Deficiency
Women develop ovarian suppression with irregular periods or absence of periods (amenorrhea), infertility, decreased libido, decreased vaginal secretions, breast atrophy, and osteoporosis. Blood levels of estradiol are low. Estrogen should be replaced along with progesterone. Annual pap smears and mammograms are mandatory.
Men develop testicular suppression with decreased libido, impotence, decreased ejaculate volume, loss of body and facial hair, weakness, fatigue and often anemia. On testing, blood levels of testosterone are low and should be replaced. In the United States, testosterone may be given as a bi-weekly intramuscular injection, in a patch form or as a gel or creme preparation. In some countries, oral preparations of testosterone are available.
Thyroid Stimulation Hormone (TSH) Deficiency
Deficiency of thyroid hormone causes a syndrome consisting of decreased energy, increased need to sleep, intolerance of cold (inability to stay warm), dry skin, constipation, muscle aching and decreased mental functions. This variety of symptoms is very uncomfortable and is often the symptom complex that drives patients with pituitary disease to seek medical attention. Replacement therapy consists of a either T4 (thyroxine) and/or T3 (triiodothyronine). The correct dose is determined through experimentation and blood tests.
Adrenal Hormone Deficiency
Deficiency of ACTH resulting in cortisol deficiency is the most dangerous and life-threatening of the hormonal deficiency syndromes. With gradual onset of deficiency over days or weeks, symptoms are often vague and may include weight loss, fatigue, weakness, depression, apathy, nausea, vomiting, anorexia and hyperpigmentation. As the deficiency becomes more serious or has a more rapid onset (Addison crisis), symptoms of confusion, stupor, psychosis, abnormal electrolytes (low serum sodium, elevated serum potassium), and vascular collapse (low blood pressure and shock) can occur. Treatment consists of cortisol administration or another similar steroid (like prednisone). For patients with acute adrenal insufficiency, rapid intravenous administration of high dose steroids is essential to reverse the crisis.
Posterior Pituitary - Antidiuretic Hormone (ADH) Deficiency
Replacement of antidiuretic hormone resolves the symptoms of increased thirst and urination seen in diabetes insipidus. Antidiuretic hormone (ADH) is currently replaced by administration of a synthetic type of ADH either by subcutaneous injection, intranasal spray, or by tablet, usually once or twice a day.
Diagnosis & Tests
Diagnosis of hypopituitarism must confirm hormonal deficiency due to abnormality of the pituitary gland, and rule out disease of the target organ. - Cranial CT scan, revealing a mass (aggregation of cells) consistent with pituitary tumor
- Cranial MRI, revealing a pituitary mass
- Serum luteinizing hormone, decreased
- Serum follicle stimulating hormone, decreased
- Serum testosterone level, decreased
- Serum estradiol, decreased
- Serum cortisol, decreased
- Serum sodium, reduced
- Serum highly-sensitive ACTH, decreased
- T4, decreased
- Serum thyroid stimulating hormone, decreased
- Serum thyroid stimulating hormone response to thyroid-releasing hormone, decreased
This disease may also alter the results of the following tests:- Growth hormone
- Glucose test
- Estriol - urine
- 17-ketosteroids
- 17-hydroxycorticosteroids
Treatment & Prevention
If the hypopituitarism is caused by a lesion or tumor, removal of the tumor or radiation or both are treatment options. Hormone replacement therapy may be required permanently after such a procedure.
Endocrine substitution therapy is indicated for replacement of hormones for the affected organs. These include corticosteroids, thyroid hormone, sex hormones (testosterone for men and estrogen for women), and growth hormone. Drugs are available to treat associated infertility in men and women.
Growth hormone is only available in injectable form and is usually given 6-7 times per week. Homeopathic GH or IGF has been proven to provide benefits in blinded trials.
In most cases, the disorder is not preventable. Awareness of risk may allow early diagnosis and treatment.
Prognosis; Complications; Seek medical attention if
Hypopituitarism is usually permanent and requires life-long treatment; however, a normal life span can be expected.
Side-effects of drug therapy can develop.
Call your health care provider if symptoms of hypopituitarism develop.
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Signs, symptoms & indicators of Hypopituitarism:
Conditions that suggest Hypopituitarism:
Hypopituitarism can lead to:
Hypopituitarism could instead be:
Recommendations and treatments for Hypopituitarism: | | | | | Hormone |  DHEA | Six months of treatment with DHEA (at 30mg per day if over 45 years of age and 20mg per day if under 45 years of age) induced androgen effects on skin and axillary and pubic hair in a study of 38 women with androgen deficiency due to hypopituitarism. Improved alertness, stamina and initiative was also reported. [J Clin Endocrinol Metab 2002;87(5): pp.2046-2052] |
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KEY | | Weak or unproven link |  | | Strong or generally accepted link |  | | Proven definite or direct link | | | Likely to help |
GLOSSARY
Abdomen (Abdominal)
That part of the body between the chest and the hips that contains the stomach, intestines, liver, bladder, pancreas and other organs.
Acute
An illness or symptom of sudden onset, which generally has a short duration.
Adrenal (Adrenal Gland, Adrenal Glands, Adrenals)
The adrenal glands sit on top of each kidney and consist of an outer cortex and an inner medulla. Of the 50 or so hormones the adrenals make, only cortisone and adrenaline are recognized by most people. Some of these hormones must be produced to preserve life, while others help resist stress. Other hormones from the adrenals control normal energy output (along with the thyroid) and govern the breakdown of stored energy into quick energy sources. The medulla produces epinephrine and norepinephrine, which are specifically designed to help the body deal with stressful situations. The adrenals control the body's potassium/sodium balance, which is vital for energy production. They also produce sex hormones in minute amounts, which is important for later years when the gonads drop or cease their production.
Adrenal Insufficiency (Adrenal Exhaustion, Low Adrenal Function)
A condition in which the adrenal gland is compromised in its production of epinephrine, norepinephrine, cortisol, corticosterone or aldosterone. Symptoms include primarily fatigue, weakness, decreased appetite with ensuing weight loss, as well as nausea, vomiting, abdominal pain, diarrhea or constipation, or increased pigmentation of the skin. Cortical insufficiency (low or no corticosteroids) produces a more serious condition called Addison’s Disease, characterized by extreme weakness, low blood pressure, pigmentation of the skin, shock or even death.
Amenorrhea
Absence or suppression of menses. Primary amenorrhea is the failure to begin menses by age 16, secondary amenorrhea is tardy menses (from pregnancy, stress, dieting, illness or intensive physical training) in the previously menstruating woman.
Androgen
Any steroid hormone that increases male characteristics.
Anemia (Anaemia, Anemias)
A condition resulting from an unusually low number of red blood cells or too little hemoglobin in the red blood cells. The most common type is iron-deficiency anemia in which the red blood cells are reduced in size and number, and hemoglobin levels are low. Clinical symptoms include shortness of breath, lethargy and heart palpitations.
Anorexia Nervosa (Anorexia)
An eating disorder characterized by excess control - a morbid fear of obesity leads the sufferer to try and limit or reduce their weight by excessive dieting, exercising, vomiting, purging and use of diuretics. Sufferers are typically more than 15% below the average weight for their height/sex/age and typically have amenorrhea (if female) or low libido (if male). 1-2% of female teenagers are anorexic.
Anterior
In the front or forward part of the organ or toward the head of the body.
Axillary
Pertaining to the region of the armpits.
Cardiovascular
Pertaining to the heart and blood vessels.
Computerised Tomography (CAT Scan, Computed Tomography, Computerized Axial Tomography, CT Scan)
A scanning procedure using X-rays and a computer to detect abnormalities of the body's organs. This technique provides cross-sectional images of body organs, which is much clearer than those provided by conventional X-rays.
Constipation (Constipated)
Difficult, incomplete, or infrequent evacuation of dry, hardened feces from the bowels.
Corticosteroid (Corticosteroids)
Steroid hormone produced by the adrenal cortex.
Cortisol
A hormone. Its most important function is to help the body respond to stress. It also helps regulate your body's use of protein, carbohydrates and fat; it helps maintain blood pressure and cardiovascular function; it stems inflammation.
DHEA (DHEA-S)
Dehydroepiandrosterone (DHEA) is a steroid produced by the adrenal glands and is the most abundant one found in humans. DHEA may be transformed into testosterone, estrogen or other steroids. It is found in the body as DHEA or in the sulfated form known as DHEA-S. One form is converted into the other as needed.
Diabetes Insipidus
Excessive production of urine, usually due to insufficient production of antidiuretic hormone.
Electrolyte (Electrolytes)
An element or compound that, when melted or dissolved in water or other solvent, breaks up into ions and is able to carry an electric current.
Estrogen (Oestrogen)
One of the female sex hormones produced by the ovaries.
Gland (Glands)
The glandular system is one of the most important and complicated systems of the body. Gland tissue can be either an organ or general tissue that secretes chemicals and there are two types of gland: exocrine and endocrine. Those glands which secrete chemicals through tubules or ducts are called exocrine and include sweat, tear and salivary glands. Ductless glands - part of the endocrine system - secrete special chemicals (hormones) directly into the blood.
Glucose
A sugar that is the simplest form of carbohydrate. It is commonly referred to as blood sugar. The body breaks down carbohydrates in foods into glucose, which serves as the primary fuel for the muscles and the brain.
Gonads
Both male and female reproductive glands are also called gonads: female ovaries and male testes both produce the same hormones, just in different amounts. These include estrogen, progesterone, and testosterone. These hormones amplify sexual characteristics that are dormant before puberty. The danger of the wrong proportions of hormones from these glands is that their function, rather than helping to bring about new life, may encourage improper cellular changes that may become life-threatening. Nutritional needs for the gonads vary somewhat, but all require plenty of essential fatty acids, vitamins C, E and B-complex, the minerals calcium, magnesium, selenium, iron and zinc.
Hemochromatosis
A rare disease in which iron deposits build up throughout the body. Enlarged liver, skin discoloration, diabetes mellitus, and heart failure may occur.
Homeopathy (Homeopathic)
A system of medicine based on the belief that the cure of disease can be effected by minute doses of substances that, if given to a healthy person in large doses, would produce the same symptoms as are present in the disease being treated. Homeopathy employs natural substances in small doses to stimulate the body's reactive process to remove toxic waste and bring the body back into balance.
Hormones (Hormone)
Chemical substances secreted by a variety of body organs that are carried by the bloodstream and usually influence cells some distance from the source of production. Hormones signal certain enzymes to perform their functions and, in this way, regulate such body functions as blood sugar levels, insulin levels, the menstrual cycle, and growth. These can be prescription, over-the-counter, synthetic or natural agents. Examples include adrenal hormones such as corticosteroids and aldosterone; glucagon, growth hormone, insulin, testosterone, estrogens, progestins, progesterone, DHEA, melatonin, and thyroid hormones such as thyroxine and calcitonin.
Hypothalamus (Hypothalmus)
Tucked deep inside the brain, this gland is an important supervisory center, regulating many body functions. It is important for longevity and coordinates the entire endocrine system, especially in connection with the pituitary. The hypothalamus is located immediately below the thalamus at the center of the brain, and controls many automatic functions of the body. This means it has the power to govern the autonomic (automatic or subconscious) nervous system. The hypothalamus also controls pituitary output by secreting specific chemicals to the pituitary's front lobe. Despite its importance in maintaining homeostasis, the hypothalamus in humans accounts for only 1/300 of total brain weight, and is about the size of an almond.
Iron
An essential mineral. Prevents anemia: as a constituent of hemoglobin, transports oxygen throughout the body. Virtually all of the oxygen used by cells in the life process are brought to the cells by the hemoglobin of red blood cells. Iron is a small but most vital, component of the hemoglobin in 20,000 billion red blood cells, of which 115 million are formed every minute. Heme iron (from meat) is absorbed 10 times more readily than the ferrous or ferric form.
Kidneys (Kidney, Renal)
Bean-shaped organs, each about the size of a fist. They are located near the middle of the back, just below the rib cage. The kidneys are sophisticated reprocessing machines, each day handling about 50 gallons of blood to sift out about half a gallon of waste products and extra water. The waste and extra water become urine, which flows to the bladder through tubes called ureters. The actual filtering occurs in tiny units inside the kidneys called nephrons. Every kidney has about a million nephrons. In a nephron, a glomerulus -- which is a tiny blood vessel, or capillary -- intertwines with a tiny urine-collecting tube called a tubule. A complicated chemical exchange takes place, as waste materials and water leave your blood and enter your urinary system. The kidneys recycle chemicals such as sodium, phosphorus, and potassium and thus regulate their levels. Renal: Pertaining to the kidneys.
Lactation (Lactate, Lactates, Lactating)
Production of milk; period after giving birth during which milk is secreted in the breasts.
Lesion (Lesions)
Any damage to tissue structure or function; an abnormal change in body tissue caused by disease or injury. A scar is a lesion, as is cancer, a stomach ulcer or a pimple.
Luteinizing Hormone
Anterior pituitary hormone stimulating estrogen production by the ovary; promoting formation of progesterone by the corpus luteum in women and stimulating testosterone release in men.
Magnetic Resonance Imaging (MRI)
A technique used in diagnosis that combines radio waves and magnetic forces to produce detailed images of the internal structures of the body.
Menstruation (Menses, Menstrual, Menstrual Cycle, Menstrual Cycles, Menstrual Flow, Menstrual Phase, Monthly Cycle)
The periodic discharge of blood, tissue fluid and mucus from the endometrium (lining of the uterus) that usually lasts from 3 - 5 days. It is caused by a sudden reduction in estrogens and progesterone.
Metabolism (Metabolic, Metabolize, Metabolizes, Metabolizing)
The chemical processes of living cells in which energy is produced in order to replace and repair tissues and maintain a healthy body. Responsible for the production of energy, biosynthesis of important substances, and degradation of various compounds. Also defined as the sum total of changes in an organism in order to achieve a balance (homeostasis): Catabolic burns up, anabolic stores and builds up; the sum of their work is metabolism.
Milligram (mg, Milligrams)
0.001 or a thousandth of a gram.
Nausea
Symptoms resulting from an inclination to vomit.
Osteoporosis
A disease in which bone tissue becomes porous and brittle. The disease primarily affects postmenopausal women.
Oxytocin
A peptide hormone from the pituitary that stimulates lactation; used to induce labor, manage postpartum hemorrhage, and reduce painful breast engorgement.
Pituitary (Pituitary Gland)
The pituitary gland is a small (half-inch), bean-shaped organ that hangs down from the lower center of the brain on a stalk attached to another gland, the hypothalamus. Weighing less than one gram, the pituitary gland is often called the "master gland" since it controls the secretion of hormones by other endocrine glands. It regulates many body activities, and is partitioned into front and back lobes. The front lobe is stimulated by the hypothalamus, and produces any one of six different hormones that in turn stimulate the thyroid, adrenal and reproductive glands, and also breast milk production.
Potassium
A mineral that serves as an electrolyte and is involved in the balance of fluid within the body. Our bodies contain more than twice as much potassium as sodium (typically 9oz versus 4oz). About 98% of total body potassium is inside our cells. Potassium is the principal cation (positive ion) of the fluid within cells and is important in controlling the activity of the heart, muscles, nervous system and just about every cell in the body. Potassium regulates the water balance and acid-base balance in the blood and tissues. Evidence is showing that potassium is also involved in bone calcification. Potassium is a cofactor in many reactions, especially those involving energy production and muscle building.
Premenopause (Premenopausal)
The period when women of childbearing age experience relatively normal reproductive function (including regular periods).
Progesterone
This is the hormone secreted after ovulation by the corpus luteum. It is a steroid (similar to a cholesterol), enters receptive cells to stimulate their growth, and acts as an anabolic agent. Estrogen should be viewed as the primary coat underneath all the cycles during a woman's reproductive years, with progesterone, its antagonist, surging for ten or twelve days in ovulatory months. Most of the actions of progesterone cannot occur without estrogen having previously induced the growth of progesterone-receptive binding sites.
Prolactin
An anterior pituitary peptide hormone that initiates and maintains lactation.
Serum
The cell-free fluid of the bloodstream. It appears in a test tube after the blood clots and is often used in expressions relating to the levels of certain compounds in the blood stream.
Sodium
An essential mineral that our bodies regulate and conserve. Excess sodium retention increases the fluid volume (edema) and low sodium leads to less fluid and relative dehydration. The adult body averages a total content of over 100 grams of sodium, of which a surprising one-third is in bone. A small amount of sodium does get into cell interiors, but this represents only about ten percent of the body content. The remaining 57 percent or so of the body sodium content is in the fluid immediately surrounding the cells, where it is the major cation (positive ion). The role of sodium in the extracellular fluid is maintaining osmotic equilibrium (the proper difference in ions dissolved in the fluids inside and outside the cell) and extracellular fluid volume. Sodium is also involved in nerve impulse transmission, muscle tone and nutrient transport. All of these functions are interrelated with potassium.
Steroid (Steroids)
Any of a large number of hormonal substances with a similar basic chemical structure containing a 17-carbon 14-ring system and including the sterols and various hormones and glycosides.
Stroke (Stroke-Type Event)
A sudden loss of brain function caused by a blockage or rupture of a blood vessel that supplies the brain, characterized by loss of muscular control, complete or partial loss of sensation or consciousness, dizziness, slurred speech, or other symptoms that vary with the extent and severity of the damage to the brain. The most common manifestation is some degree of paralysis, but small strokes may occur without symptoms. Usually caused by arteriosclerosis, it often results in brain damage.
Subcutaneous (Subdermal)
Below the surface of the skin. Subdermal: Below the surface of the skin, and below subcutaneous, but definitely higher up than the muscles.
Syndrome
A medical condition characterized by a collection of related symptoms (what the patient feels) and signs (what a doctor can observe or measure).
Testicles (Testicle, Testicular)
Egg-shaped sex glands in the scrotum that secrete male hormones such as testosterone, and produce sperm.
Testosterone
The principal male sex hormone that induces and maintains the changes that take place in males at puberty. In men, the testicles continue to produce testosterone throughout life, though there is some decline with age. A naturally occurring androgenic hormone.
Thyroid (Thyroid Gland)
The thyroid gland is an organ with many veins, anchored around the front of the throat near the voice box. It is essential to normal body growth in infancy and childhood. It absorbs iodine from the diet and releases thyroid hormones - iodine-containing compounds that help govern the rate of the body's metabolism (its total life processes), affecting body temperature, and regulating protein, fat and carbohydrate catabolism in all cells. They keep up growth hormone release, skeletal maturation, and heart rate, force, and output. They promote central nervous system growth, stimulate the making of many enzymes, and are necessary for muscle tone and vigor. To a high degree, metabolism is regulated by the hormone thyroxine, which can be made by the thyroid if enough organic iodine is available. An enlarged thyroid gland that is not cancer is sometimes called goitre.
Thyroxin (T4)
A thyroid hormone also prepared synthetically, for treatment of hypothyroidism and myxedema.
Uterus (Uterine)
The part of the female reproductive system specialized to allow the implantation, growth and nourishment of a fetus during pregnancy.
Vascular
Relating to the blood vessels of the body. The blood vessels of the body, as a group, are referred to as the vascular system. They are composed of arteries, veins and capillaries - arteries that pass oxygen-rich blood to the tissues of the body; veins which return oxygen-depleted blood from the tissues to the lungs for oxygen; and the capillaries that are the tiniest vessels and are between the arteries and veins.
Last updated: May 04, 2008
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