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Hypopituitarism

more about Hypopituitarism


  • The pituitary gland is a small gland located behind the place in the brain where the optic (eye) nerves cross.
  • This gland secretes multiple hormones that are needed for normal body function, such as thyroid stimulating hormone (TSH), which controls the thyroid gland; Luteinizing hormone (LH), and Follicle stimulating hormone (FSH), involved in sexual development and function (they maintain the menstrual cycle in women and sexual functions in both men and women); Adrenocorticotrophic Hormone (ACTH), which controls Cortisol secretion in the adrenal glands; and GH (growth hormone).
  • Any condition that affects the pituitary function will result in a decrease or deficiency of one or more of these hormones.

  • All symptoms and signs depend on the hormone affected.  One, more than one, or all may be affected.
  • LH/FSH deficiency:
    1. Puberty does not occur
    2. Decreased sex drive in men and women
    3. Women do not get menstrual periods (amenorrhea)
    4. Men have decreased erections
    5. Infertility in both men and women
    6. Decreased hair in armpits, pubic area, and body hair.  In men, it may cause decreased beards.
  • TSH deficiency -- symptoms of Hypothyroidism, e.g., fatigue, weight gain, weakness, hair loss, cold intolerance (see section of Hypothyroidism for a more extensive list)
  • ACTH deficiency -- fatigue, weakness, weight loss, Low Blood Pressure
  • GH deficiency may occur in children of short stature.
  • In adults, obesity or mild generalized weakness can be seen.
  • Pan-Hypopituitarism (complete malfunction of the entire pituitary gland) -- all the symptoms of the above hormone deficiencies, plus dry, pale skin, coupled with fine wrinkles in the face.
  • Visual field defects can be a sign of pituitary tumor.

  • Pituitary adenomas (benign tumors)
  • Congenital
  • Idiopathic (unknown)
  • Autoimmune disease
  • Brain Tumors
  • Brain Aneurysms
  • Pituitary Stroke
  • Metastatic Cancer
  • Granulomas
  • Pituitary Abscess
  • Multifocal Langerhans cell granulomatosis
  • Trauma
  • Radiation
  • Surgery
  • Encephalitis
  • Hemochromatosis
  • Sheehan's syndrome (pituitary destruction after pregnancy)

  • Laboratory:
    1. Low fasting blood sugar
    2. Sodium level may be low
    3. Low T4 level without elevation of TSH
    4. Cosyntropin stimulation test shows subnormal Cortisol response
    5. Testosterone and Estradiol levels are low or below normal
    6. Prolactin levels may be elevated
  • Imaging:

- MRI of pituitary gland


  • If a pituitary tumor is present, surgical removal and/or radiation treatment may be necessary
  • Replacement hormone therapy (lifetime):
    1. Corticosteroids -- usually Hydrocortisone 15mg in the AM, and 10mg in the PM
    2. Prednisone: 5mg in the AM and 2.5 mg in the PM.  Note: additional "stress doses" of corticosteroids must be prescribed for any stresses on the body, including minor illness, infection, trauma, or surgery.  The "stress dose" is determined by your physician.  If this is not done, severe illness and death may occur.
    3. Thyroid hormones -- Levothyroxine in a maintenance-sized dose. Note: most individuals need corticosteroids with thyroid replacement for this condition, or intense Shock may occur.  The final decision in this matter usually rests with your physician or an endocrinologist.
    4. Sex hormones -- testosterone replacement in males and estrogen/progesterone replacement in females.  For male fertility -- chorionic gonadotropin injections and/or leuprolide injections.  For Female Infertility-clomiphene.  If these fail, menitropins and chorionic gonadotropin may be considered.
    5. Growth hormone -- adults feel better if replaced, but it is not often done since it is very expensive.
    6. If hyperprolactinomas are present, bromocriptine may be used to suppress Prolactin production.

  • Anorexia nervosa may have similar symptoms.




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