Clinical Practice Guideline

Hormone Replacement in Hypopituitarism Guideline Resources

October 01, 2016

Full Guideline: Hormonal Replacement in Hypopituitarism in Adults
JCEM | October 2016

Maria Fleseriu (Chair), Ibrahim A. Hashim, Niki Karavitaki, Shlomo Melmed, M. Hassan Murad, Roberto Salvatori, and Mary H. Samuels

The 2016 guideline addresses:

  • Diagnosis and evaluation of multiple pituitary hormonal deficiency (hypopituitarism)
  • Treating a variety of hormone deficiencies
  • Managing interactions between replacement hormones and limiting the risks of over-replacement
  • Special circumstances, such as peri- and postoperative care and pregnancy


Hormonal Replacement in Hypopituitarism: An Endocrine Society Clinical Practice Guideline | ENDO 2016



Essential Points

The guideline addresses special circumstances that may affect the treatment of patients with hypopituitarism, including pregnancy care, post-surgical care following pituitary or other operations, treatment in combination with anti-epilepsy medication, and care following pituitary apoplexy—a serious condition that occurs when there is bleeding into the gland or blood flow to it is blocked.

Recommendations from the guideline include:

  • Measurements of both free thyroxine and thyroid-stimulating hormone are needed to evaluate central hypothyroidism, a condition where the thyroid gland does not produce enough hormones because it isn’t stimulated by the pituitary gland.
  • People who have central hypothyroidism should be treated with levothyroxine in doses sufficient to raise levels of the thyroid hormone free thyroxine to the upper half of the reference range.
  • Growth hormone stimulation testing should be used to diagnose patients with suspected growth hormone deficiency.
  • People who have proven cases of growth hormone deficiency and no contraindications should be offered growth hormone replacement as a treatment option.
  • Premenopausal women who have central hypogonadism, a condition where the sex glands produce minimal amounts or no hormones, can undergo hormone treatment, provided there are no contraindications.
  • People producing abnormally large volumes of dilute urine should be tested for central diabetes insipidus—a rare condition that leads to frequent urination—by analyzing the concentration of their blood and urine.
  • For patients who have low levels of glucocorticoid hormones, hydrocortisone can be given in a daily single or divided dose.
  • All hypopituitarism patients should be instructed to obtain an emergency card, bracelet or necklace warning about the possibility of adrenal insufficiency.
  • Patients who are suspected of having an adrenal crisis due to secondary adrenal insufficiency should receive an immediate injection of 50 to 100 milligrams of hydrocortisone.
  • People who have central adrenal insufficiency should receive the lowest tolerable dose of hydrocortisone replacement on a long-term basis to reduce the risk of metabolic and cardiovascular disease.
  • Accurate and reliable measurements are central to diagnose hypopituitarism and monitoring therapies.

Recommendations

+ 1.0 Diagnosis of hypopituitarism

+ 2.0 Treatment

+ 3.0 Special circumstances

CME

Certified Medical Minute

Watch this expert CME/CE-certified presentation highlighting expert recommendations on the variety of continuous glucose monitoring devices for optimizing management of individual patients with type 1 and type 2 diabetes

Comparison of Available and Emerging CGM Technology

Watch this expert CME/CE-certified presentation highlighting expert recommendations on the variety of continuous glucose monitoring devices for optimizing management of individual patients with type 1 and type 2 diabetes

On the Go

Guideline Pocket Cards

Pocket Guides
Practical quick-reference tools to help you make accurate clinical decisions at the point of care.

Practical quick-reference tools to help you make accurate clinical decisions at the point of care.

Membership

Community Connect

Community Connect is Endocrine Society’s exclusive online community where you can network, talk to experts, join a conversation with people who share your interests, and find what you need throughout your membership journey. Learn, share ideas, and be heard on Community Connect now!

Community Connect is Endocrine Society’s exclusive online community where you can network, talk to experts, join a conversation with people who share your interests, and find what you need throughout your membership journey. Learn, share ideas, and be heard on Community Connect now!

Back to top
Short on time?

We'll come to you...

Get updates on the latest breakthroughs, clinical practice guidelines, and career development opportunities, straight to your inbox

Then take the next step: Set up your free website account and get exclusive access to even more great tools & content!