Hypopituitarism

What is hypopituitarism?

Hypopituitarism (also called pituitary insufficiency) is a rare condition in which your pituitary gland doesn't make enough of certain hormones. Hormones coming from the pituitary gland control the function of other glands in your body: thyroid gland, adrenal glands, ovaries, and testes. Your 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 but can also affect the well-being of adults, and anti-diuretic hormone (ADH); lack of ADH causes thirst and increased urination. Hypopituitarism can develop suddenly after surgery, injury or bleeding, or very slowly, over several months or even over several years.

What can cause hypopituitarism?

Hypopituitarism can be caused by:

• Tumors in or near the pituitary gland (which are usually benign, meaning not cancer)
• 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)

Sometimes, the cause is unknown.

What are the symptoms of hypopituitarism?

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

How is hypopituitarism diagnosed?

Your doctor will check your hormone levels with blood tests. You may have other tests, such as an MRI of your pituitary gland, to help find the cause of your hypopituitarism.

What is the treatment for hypopituitarism?

Treatment of the underlying cause of hypopituitarism is important. Endocrine treatment includes taking the hormones you're 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.

What is the long-term outlook for me with hypopituitarism?

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. 

Questions to ask your doctor

• 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?