Journal Article

Hypopituitarism

Higham, Claire E, Johannsson, Gudmundur, Shalet, Stephen M

2016

Overview

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.

• Publisher: Elsevier Ltd,Elsevier Limited
• Subject: Acute Disease / Adenoma - blood / Adenoma - radiotherapy / Adenoma - surgery / Adenoma - therapy / adrenal insufficiency / Adrenocorticotropic Hormone - administration & dosage / Adrenocorticotropic Hormone - deficiency / Chronic Disease / Deamino Arginine Vasopressin - administration & dosage / Disease / Endocrinology and Diabetes / Endokrinologi och diabetes / Epidemiology / Gonadal Steroid Hormones - administration & dosage / Gonadal Steroid Hormones - deficiency / Gonadotropins, Pituitary - administration & dosage / Gonadotropins, Pituitary - deficiency / Growth hormones / Hormone Replacement Therapy - methods / Hormones / Human Growth Hormone - administration & dosage / Human Growth Hormone - deficiency / Humans / Hydrocortisone - administration & dosage / Hydrocortisone - deficiency / Hypophysectomy - adverse effects / hypopituitarism / Hypopituitarism - blood / Hypopituitarism - diagnosis / Hypopituitarism - drug therapy / Hypopituitarism - etiology / Internal Medicine / Pituitary gland / Pituitary Gland - secretion / Pituitary Hormones, Anterior - administration & dosage / Pituitary Hormones, Anterior - deficiency / Pituitary Irradiation - adverse effects / Pituitary Neoplasms - blood / Pituitary Neoplasms - radiotherapy / Pituitary Neoplasms - surgery / Pituitary Neoplasms - therapy / pituitary tumour / Prolactin - administration & dosage / Prolactin - deficiency / Radiotherapy - adverse effects / Risk factors / Thyroid / Thyroid gland / Thyrotropin - administration & dosage / Thyrotropin - deficiency / Thyroxine - administration & dosage / Thyroxine - deficiency / Vasopressins - administration & dosage / Vasopressins - deficiency