GH deficiency masks central hypothyroidism in a significant proportion of hypopituitary patients and this is exposed after GH replacement. We recommend that hypopituitary patients with GH deficiency and low normal serum T4 concentration should be considered for T4 replacement prior to commencement of GH in order to provide a robust baseline from which to judge the clinical effects of GH replacement.

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Context: Patients with panhypopituitarism have impaired quality of life (QoL) despite GH replacement. They are profoundly androgen deficient, and dehydroepiandrosterone (DHEA) has been shown to have a beneficial effect on well-being and mood in patients with adrenal failure and possibly in hypopituitarism. Objective: Our objective was to determine the effect of DHEA administration on mood in hypopituitary adults on established GH replacement with a constant serum IGF-I. Design: A double-blind, placebo-controlled trial was conducted over an initial 6 months followed by an open phase of 6 months of DHEA. Setting: The study was conducted at a tertiary referral endocrinology unit. Patients: Thirty female and 21 male hypopituitary patients enrolled. Data from 26 females and 18 males were analyzed after patient withdrawal. Interventions: DHEA (50 mg) was added to maintenance replacement including GH. Main Outcome Measures: The primary outcome objective was the effect on QoL and libido assessed by QoL assessment in GH deficiency in adults, Short Form 36, General Health Questionnaire, EuroQol, and sexual self-efficacy scale. Results: Patients had impaired QoL at baseline compared with the age-matched British population. Females showed improvement in QoL assessment in GH deficiency in adults score (−2.9 ± 2.8 DHEA vs.−0.53 ± 3 placebo; P < 0.05), in Short Form 36 social functioning (14.6 ± 23.1 DHEA vs.−4.7 ± 25 placebo; P = 0.047), and general health perception (9.6 ± 14.2 DHEA vs.−1.2 ± 11.6 placebo; P = 0.036) after 6 months of DHEA. Men showed improvement in self-esteem (−1.3 ± 1.7 DHEA vs. 0.5 ± 1.5 placebo; P = 0.03) and depression (−1.6 ± 2.2 DHEA vs. 1.2 ± 2.4 placebo, P = 0.02) domains of the General Health Questionnaire after 6 months of DHEA. Conclusions: DHEA replacement leads to modest improvement in psychological well-being in female and minor psychological improvement in male hypopituitary patients on GH replacement.