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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
Resources
- Educational Slide Deck (PowerPoint) | Endocrine Society
- App and point of care tools | Endocrine Society
- Clinical Education | ENDO 2016
- Patient Resources | Hormone Health Network
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.