Hypopituitarism: Symptoms, Diagnosis and Treatment

A small gland called the pituitary is present as an extension from the base of the brain. This gland is secretes substances in the blood which act on farway organs; the substance is called a Hormone. The hormones secreted by the pituitary help the brain in influencing the functioning of different organs and maintaining balance of different functions. The hormones produced by the pituitary gland are

• Growth hormone: responsible for controlling growth during childhood
• Adreno corticotrophic hormone: responsible for secretion of cortisol, a hormone which is realised in response to stress
• Gonadotrophic hormone: consists of two hormone Luetenising hormone and Follicle Stimulating Hormone, they are necessary for your reproductive health
• Prolactin: secreted in pregnant mother to stimulate milk production
• Vasopressin: secreted to conserve water by reabsorbing it from the kidney
• Thyroid stimulating hormone: stimulate secretion of thyroid hormone from the thyroid gland.

A deficiency in either one or a group or all these hormones results in a condition called Hypopituitarism.

Symptoms of Hypopituitarism

The symptoms of hypopituitarism depend on the hormones which are deficient and age. They are:

• Weakness and fatigue
• Reduced sex drive
• Irregular menstruation
• Cold insensitivity
• Weight loss
• Inability to produce milk in pregnant women
• Infertility
• Reduced growth rate in children
• Increase urination and thirst

Causes of Hypopituitarism

Hypopituitarism is caused due to variety of causes:

• Benign or cancerous mass of pituitary gland
• After a surgery or radiation exposure to pituitary gland
• Following a traumatic injury to the brain
• Diseases like sarcoidosis and tuberculosis
• Immunological
• Following severe blood loss during childbirth (Sheehan syndrome)
• Genetic

Diagnosis of Hypopituitarism

Your doctor would like to obtain a thorough history followed by a physical examination to suspect hypopituitarism. To confirm the diagnosis your doctor might order a few tests.

• Blood test: to measure the level of pituitary hormones in the blood
• Stimulation or dynamic testing: the level of hormone in your blood will be checked after you have been administered a stimulant, depending upon the hormone.
• Visual testing: a pituitary mass can affect the vision by compressing the nerve that goes from your eye to the brain. This test is meant to determine the extent of the effect of the effect of the pituitary mass on the vision.
• CT scan: to rule out the presence of a pituitary mass.

Treatment of Hypopituitarism

Treatment for hypopituitarism involves replacement of the deficient hormone, this may be lifelong. If the hypopituitarism is because of a mass of the pituitary gland a surgery to remove it might be suggested; an alternative to surgery would be radiation therapy.

• Levothyroxine: a replacement for thyroid hormone in individuals with TSH deficiency. This drug can be taken orally.
• Corticosteroids: they replace the adrenal steroids that are secreted because of ACTH. They can be taken by mouth.
• Sex hormones: prescribed for individuals with a deficiency of gonadotrophic hormone. For women this medicine is a combination of estrogen and progesterone. The medicine is available in the form of gel, patch, and pill. For men testosterone is replaced by administration through skin in the form of a gel, patch or injection.
• Growth hormone: this hormone is replaced by administration through the skin with the help of an injection. Although the benefits are more visible in children, adults may also benefit from this replacement. The increase in height is seen only in children.

Resources:

• American Association of Clinical Endocrinologists.
• Hypopituitarism by Claire E Higham, DPhil Prof Gudmundur Johannsson, MD Prof Stephen M Shalet, MD; lancet 2016.