About Your Diagnosis

Hypopituitarism literally means an underactive pituitary gland. The pituitary gland, sometimes called the master gland, is a small gland that sits beneath the brain and regulates normal thyroid, adrenal, and gonadal function. It is important for regulating water balance, blood pressure, sexual function, stress response, and basic metabolism. One or more of these hormone systems may be dysfunctional in a patient with hypopituitarism. There are many causes of hypopituitarism such as pituitary or hypothalamic tumors or infections, hemorrhage of the pituitary, trauma, pituitary surgery, stroke, congenital malformations, familial syndromes, or radiation therapy for malignant disease. Some degree of hypopituitarism is common in individuals with predisposing conditions as outlined above. However, in the general population it is relatively uncommon. Hypopituitarism is detected by performing a complete medical history and physical examination, followed by blood tests. Tests are now readily available to check anterior pituitary control of thyroid function (thyroid-stimulating hormone [TSH]), gonadal function (follicle-stimulating hormone [FSH] and luteinizing hormone [LH]), adrenal function (adrenocorticotropin hormone [ACTH]), and growth (growth hormone [GH]). Lack of posterior pituitary vasopressin, or antidiuretic hormone (ADH), is detected by excess water excretion (diabetes insipidus) and low ADH levels. Tumors of the hypothalamus and pituitary that cause compression may be removed by surgery. This may relieve some symptoms of hypopituitarism, although permanent deficits may remain. Replacement of each missing hormone is currently possible, which can alleviate symptoms and prevent complications.

Living With Your Diagnosis
Some individuals may have no symptoms whatsoever until in a stressful situation. Others may have a sudden onset of headache, pain, blurry vision, and increased light sensitivity with neck stiffness. Most, however, have symptoms related to the specific hormonal disorders. Patients with abnormal thyroid function will notice weakness, tiredness, constipation, bloating, and weight gain. Women with abnormal gonadal function will notice a change in their menstrual periods, whereas men will have impotence. Women may also notice vaginal dryness and painful intercourse. Abnormal ACTH levels lead to weakness, especially under conditions of exertion or stress, dizziness upon standing, nausea, and increased abdominal pain. Absent growth hormone leads to poor growth in childhood.

Treatment
Treatment is based on treating the underlying tumor or process causing the hypopituitarism, followed by hormone replacement. Patients with underactive thyroids are treated with levothyroxine. Such hormone replacement may result in palpitations or unmasking of underlying coronary artery disease. Patients with gonadal dysfunction can receive exogenous testosterone or estrogen. Patients with underactive ACTH production will receive cortisol. Excess cortisol replacement may result in the Cushing’s syndrome, leading to weight gain, easy bruising, high blood pressure, or diabetes. Patients with low ACTH levels must learn to use Solu-Cortef for injection in the case of emergency. Family members should also be trained. Children with short stature caused by growth hormone deficiency may be treated with growth hormone injections. Improper treatment may result in early fusion of bones, resulting in a decrease in final height.

The DOs
• Check the entire pituitary if there is one system that is malfunctioning. Often these malfunctions travel in groups.
• Take extra hydrocortisone if you are sick, injured, or stressed. The dose should be doubled or tripled for minor illnesses. Injection of Solu- Cortef should be taken for severe trauma or lifethreatening emergencies.
• Wear a Medic Alert bracelet indicating that you have hypopituitarism.
• Take your medicines as prescribed and have regular blood work performed to ensure that hormone levels are optimal.
The DON’Ts
• Don’t skip your medicines, especially when you are sick.
• Don’t take growth hormone except under the direction of a board-certified pediatric endocrinologist or other specialist.
• Don’t leave home without your emergency treatment kit.

When to Call Your Doctor
• You are scheduled for surgery.
• You have a fever, nausea, or vomiting.
• You feel weak or dizzy.