Hypopituitarism

Abstract

Hypopituitarism refers to deficiency of one or more hormones produced by the anterior pituitary or released from the posterior pituitary. Hypopituitarism is associated with excess mortality, a key risk factor being cortisol deficiency due to adrenocorticotropic hormone (ACTH) deficiency. Onset can be acute or insidious, and the most common cause in adulthood is a pituitary adenoma, or treatment with pituitary surgery or radiotherapy. Hypopituitarism is diagnosed based on baseline blood sampling for thyroid stimulating hormone, gonadotropin, and prolactin deficiencies, whereas for ACTH, growth hormone, and antidiuretic hormone deficiency dynamic stimulation tests are usually needed. Repeated pituitary function assessment at regular intervals is needed for diagnosis of the predictable but slowly evolving forms of hypopituitarism. Replacement treatment exists in the form of thyroxine, hydrocortisone, sex steroids, growth hormone, and desmopressin. If onset is acute, cortisol deficiency should be replaced first. Modifications in replacement treatment are needed during the transition from paediatric to adult endocrine care, and during pregnancy.

Multi‐genic pattern found in rare type of hypopituitarism: a whole‐exome sequencing study of Han Chinese with pituitary stalk interruption syndrome

“…Hypopituitarism refers to deficiency of one or more hormones produced by the anterior pituitary or released from the posterior pituitary, the most common cause in adulthood is a pituitary adenoma, or treatment with pituitary surgery or radiotherapy [1]. Pituitary stalk interruption syndrome (PSIS) is a rare type of hypopituitarism due to the blocked transportation for hormones from hypothalamus to pituitary, its estimated incidence of 0.5/ 100,000 births [2,3].…”

Cantú Syndrome with panhypopituitarism

“…Lab evaluation at that time was consistent with panhypopituitarism with TSH 2.46 mIU/mL (0.32 to 5), free thyroxine 0.62 ng/dL (0.71-1.85), luteinizing hormone (LH) 0.2 mIU/mL (0.6-105, depending on menstrual phase), FSH 2.1 mIU/mL (3-26, depending on menstrual phase), IGF-1 11 ng/mL (90-360), estradiol 7 pg/mL (30-400, depending therapy at several weeks of age, suggesting that her hypopituitarism was present at birth and not secondarily acquired later in life. ABCC9 mutations are not a known cause of panhypopituitarism, and the genetic testing our patient underwent did not reveal an additional pathologic or possibly causative mutation [12,13]. Alternative causes of hypopituitarism include ischemia, mass and infiltration, which were not evident on brain MRI and MRA in this case.…”

DIAGNOSIS OF ENDOCRINE DISEASE: Expanding the cause of hypopituitarism

“…Hypopituitarism is an uncommon condition with a prevalence of ~46 per 1 00 000 (1). It is defined as one or more anterior pituitary hormone deficiencies caused by a variety of structural lesions or trauma in the hypothalamic-pituitary region.…”