Hormone Replacement in Hypopituitarism Guideline Resources

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.


+ 1.0 Diagnosis of hypopituitarism

+ 2.0 Treatment

+ 3.0 Special circumstances