Hypopituitarism

Keywords: Panhypopituitarism, Pituitary hormone deficiency

Causes

Appropriate Tests

 

Diagnosis and evaluation may involve assay of pituitary or target gland hormones.

Dynamic stimulation tests may assist to evaluate hormone reserves: Insulin hypoglycaemia stimulation test is usually sufficient; rarely, stimulation tests using gonadotrophin releasing hormones are occasionally of value - consult pathologist.

Panhypopituitarism

Patients may have clinical or radiological evidence of a space occupying lesion in the pituitary fossa.

They may present initially with deficiency of a single hormone: Prolactin, Testosterone (in males), Luteinising hormone, Follicle stimulating hormone (in post-menopausal females), Thyroid stimulating hormone, Free T4, Cortisol, Growth hormone.

Non-functioning tumours

  • Adenoma
  • Craniopharyngioma
  • Meningioma
  • Germinoma
  • Metastatic carcinoma

 

Functioning tumours

  • Prolactinoma
  • Gonadotroph adenoma

 


Alpha subunit - this may be the main secretory product of the tumour.

Hypothalamic disorders

  • Tumour
  • Birth asphyxia
  • Histiocytosis

See also Pituitary/hypothalamic disorders

Vascular disorders

  • Post-partum necrosis (Sheehan's syndrome)

 

Post-traumatic

 

Post-hypophysectomy

 

Post-irradiation

 

Septo-optic dysplasia

 

Granulomas

  • Sarcoidosis
  • Tuberculosis

 

Empty sella syndrome

 

Genetic

 

Single hormone deficiency

May be the presenting feature of any cause of panhypopituitarism, however single hormone deficiency can occur and is usually genetic.

Growth hormone

Growth hormone stimulation test.

See Short stature

  • Idiopathic

 

  • Genetic

 

  • Psychosocial dwarfism

 

  • Laron dwarfism

IGF-1.

Growth hormone resistance, rather than deficiency; growth hormone levels are usually high.

Thyroid stimulating hormone

See also Hypothyroidism.

  • Genetic

 

Luteinising hormone, Follicle stimulating hormone

See also Infertility (male and female) and Testicular failure.
  • Kallmann syndrome

 

  • Genetic

 

ACTH

See also Adrenocortical insufficiency.

  • Genetic