Image of gland in human head responsible for hypopituitarism.
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Hypopituitarism

January 23, 2022

Hypopituitarism (also called pituitary insufficiency) is a rare condition in which the pituitary gland doesn't make enough of certain hormones. Hypopituitarism can develop suddenly after surgery, injury, or bleeding, or very slowly, over several months or even over several years. 

Endocrine Connection 

Hormones produced in the pituitary gland control the function of other glands in your body, including the thyroid gland (TSH), adrenal glands (ACTH), ovaries, and testes (LH and FSH). The body can't work properly when important glands, such as your thyroid gland and adrenal gland, don't get the hormones they need from your pituitary gland. Also, the pituitary gland makes growth hormone that helps children grow. The gland can also affect the well-being of adults. The pituitary gland produces anti-diuretic hormone (ADH), and lack of ADH causes thirst and increased urination.

Hypopituitarism can be caused by: 

  • Tumors in or near the pituitary gland (which are usually benign, meaning not cancerous) 
  • Radiation treatment, which can destroy pituitary gland tissue 
  • Pituitary surgery 
  • Bleeding in a pituitary tumor (pituitary apoplexy) 
  • Traumatic brain injury, such as with a head injury from an accident 
  • Severe blood loss during childbirth 
  • Certain infections such as tuberculosis or meningitis 
  • Certain conditions present at birth 
  • Hypophysitis (inflammation of the pituitary gland) 
  • Conditions that can infiltrate the pituitary gland (example, histiocytosis, lymphoma, hemochromatosis) 

Sometimes, the cause is unknown (called idiopathic).

Your doctor will conduct a series of tests to first determine if you suffer from hypopituitarism and if you do, discover its cause including: 

Physical Examination: Your doctor will do a careful physical examination that will include checking your blood pressure laying down, sitting and standing up, skin and overall appearance 
 
Blood Tests: Your doctor will order blood tests to check hormone levels. These could include: 

  • Morning blood test to check your cortisol. Cortisol is stimulated by the pituitary hormone ACTH and is highest in the morning 
  • Thyroid hormone levels 
  • Morning blood test for testosterone in men 
  • IGF-1; this reflects your GH levels 
  • Pituitary hormone levels such as LH, FSH, prolactin 

Stimulation Test: Additional stimulation tests might be needed. These usually involve injection of medications that will increase your pituitary hormones in the blood.  

  • An ACTH stimulation test checks your cortisol level 
  • An insulin tolerance test involves insulin being injected to lower blood glucose; this in turn increases cortisol and GH levels 
  • GHRH and/or arginine test to check GH level 

The tests you have may be different depending on where you live. Your doctor will look at the following to determine the results:

  • Low morning cortisol level and not good enough cortisol increase after ACTH stimulation or insulin test would indicate that the pituitary does not make enough ACTH. 
  • Low free T4 (thyroid hormone) level without high TSH would indicate the pituitary does not make enough TSH 
  • Low testosterone with normal or low LH or FSH shows that the pituitary is not making enough LH and FSH 
  • Low IGF-1 or poor response of GH to stimulation test show that the pituitary is not making enough GH. 

Magnetic Resonance Imaging (MRI): Your doctor will also order an MRI scan to look at the pituitary gland and other structures around it. The MRI will show the size of your pituitary gland and whether there is a tumor, a cyst (fluid collection) or inflammation that affects your pituitary function. Pituitary tumors are usually benign (not cancer) 

Large pituitary tumors or cysts can affect your vision and your doctor may order additional tests for your vision such as visual field testing 

Symptoms can include one or more of the following: 

  • Stomach pain, decreased appetite, nausea and vomiting, constipation 
  • Excessive thirst and urination 
  • Fatigue and/or weakness 
  • Anemia (not having enough red blood cells) 
  • Headache and dizziness 
  • Sensitivity to cold 
  • Weight loss or weight gain 
  • Muscles aches  
  • In women: loss of armpit or pubic hair, decreased sex drive, infertility, problems with breast feeding, irregular or no menstrual periods 
  • In men: loss of hair (on the face, or in the armpits or pubic area), decreased sex drive, infertility, erectile dysfunction  
  • In children, problems with growth (including height) and sexual development 

Treatment of the underlying cause of hypopituitarism is important. Endocrine treatment includes giving back the hormones missing, such as thyroid hormone, cortisol, testosterone in men and estrogen in women, DDAVP (synthetic ADH) and sometime sometimes growth hormone. Many times, hormones need to be given for life. If needed, your doctor also will teach you what to do when you are sick or under stress. If a tumor is causing your hypopituitarism, you might need surgery to remove it and/or possibly radiation therapy. Sometimes, surgery to remove a tumor might help improve the pituitary gland function.  

You will need to get regular check-ups. It's wise to wear medical identification, such as a bracelet or pendant, which provides information about your condition in case of an emergency. 

You can expect a normal life span, as long as you regularly take the medications recommended by your doctor. However, many patients with hypopituitarism do not feel completely well even when they take the recommended hormone therapy. Your doctor will help you adjust your hormone therapy to feel as well as possible.   

  • What tests do I need to find out what's wrong with my pituitary? 
  • Will my pituitary ever start working again? 
  • What medicines do I need to take? 
  • Do I need other types of treatment? 
  • How long will I need treatment? 
  • How often will I need check-ups and blood tests? 
  • If I get sick or have an emergency, how should I adjust the dose of medicine I take? 

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