Hypopituitarism
Pituitary insufficiency; PanhypopituitarismHypopituitarism is a condition in which the pituitary gland does not produce normal amounts of some or all of its hormones.
Causes
The pituitary gland is a small structure that is located just below the brain. It is attached by a stalk to the hypothalamus. The hypothalamus is the area of the brain that controls the pituitary gland's function.
Hypothalamus
The hypothalamus is an area of the brain that produces hormones that control:Body temperatureHeart rateHungerMoodRelease of hormones from many glands...
Read Article Now Book Mark ArticleThe hormones released by the pituitary gland (and their functions) are:
- Adrenocorticotropic hormone (ACTH) -- stimulates the adrenal gland to release cortisol; cortisol helps to maintain blood pressure and blood sugar
- Antidiuretic hormone (ADH) -- controls water loss by the kidneys
- Follicle-stimulating hormone (FSH) -- controls sexual function and fertility in males and females
- Growth hormone (GH) -- stimulates growth of tissues and bone
- Luteinizing hormone (LH) -- controls sexual function and fertility in males and females
- Oxytocin -- stimulates the uterus to contract during labor and the breasts to release milk
- Prolactin -- stimulates female breast development and milk production
- Thyroid-stimulating hormone (TSH) -- stimulates the thyroid gland to release hormones that affect the body's metabolism
Metabolism
Metabolism refers to all the physical and chemical processes in the body that convert or use energy, such as:BreathingCirculating bloodControlling bo...
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In hypopituitarism, there is a lack of one or more pituitary hormones. Lack of a hormone leads to loss of function in the gland or organ the hormone controls. For example, lack of TSH leads to loss of normal function of the thyroid gland.
Hypopituitarism may be caused by:
- Brain surgery
Brain surgery
Brain surgery is an operation to treat problems in the brain and surrounding structures.
Read Article Now Book Mark Article - Brain tumor
- Head trauma (traumatic brain injury)
- Infections or inflammation of the brain and the tissues that support the brain
- Death of an area of tissue in the pituitary gland (pituitary apoplexy)
Pituitary apoplexy
Pituitary apoplexy is a rare, but serious condition of the pituitary gland.
Read Article Now Book Mark Article - Radiation therapy to the brain
- Stroke (rare)
- Subarachnoid hemorrhage (from a burst aneurysm)
Subarachnoid hemorrhage
Subarachnoid hemorrhage is bleeding in the area between the brain and the thin tissues that cover the brain. This area is called the subarachnoid sp...
Read Article Now Book Mark Article - Tumors of the pituitary gland or hypothalamus
Sometimes, hypopituitarism is due to uncommon immune system or metabolic diseases, such as:
- Too much iron in the body (hemochromatosis)
Hemochromatosis
Hemochromatosis is a condition in which there is too much iron in the body. It is also called iron overload.
Read Article Now Book Mark Article - Abnormal increase in immune cells called histiocytes (histiocytoses)
Histiocytoses
Histiocytosis is a general name for a group of disorders or "syndromes" that involve an abnormal increase in the number of specialized white blood ce...
Read Article Now Book Mark Article - Autoimmune condition that causes inflammation of the pituitary (lymphocytic hypophysitis)
Autoimmune condition
An autoimmune disorder occurs when the body's immune system attacks and destroys healthy body tissue by mistake. There are more than 80 autoimmune d...
Read Article Now Book Mark Article - Sarcoidosis, a condition that causes inflammation of various tissues and organs
Sarcoidosis
Sarcoidosis is a disease in which inflammation occurs in the lymph nodes, lungs, liver, eyes, skin, and/or other tissues.
Read Article Now Book Mark Article - Infections of the pituitary, such as primary pituitary tuberculosis
Hypopituitarism is also a rare complication caused by severe bleeding during pregnancy. The loss of blood leads to tissue death in the pituitary gland. This condition is called Sheehan syndrome.
Sheehan syndrome
Sheehan syndrome is a condition that can occur in a woman who bleeds severely during childbirth. Sheehan syndrome is a type of hypopituitarism....
Read Article Now Book Mark ArticleCertain medicines can also suppress pituitary function. The most common medicines are glucocorticoids (such as prednisone and dexamethasone), which are taken for inflammatory and immune conditions. Medicines used to treat prostate cancer can also lead to low pituitary function.
Symptoms
Symptoms of hypopituitarism include any of the following (multiple symptoms are common):
- Abdominal pain
Abdominal pain
Abdominal pain is pain that you feel anywhere between your chest and groin. This is often referred to as the stomach region or belly.
Read Article Now Book Mark Article - Decreased appetite
Decreased appetite
A decreased appetite is when your desire to eat is reduced. The medical term for a loss of appetite is anorexia.
Read Article Now Book Mark Article - Lack of sex drive (libido) in men or women
- Dizziness or fainting
Fainting
Fainting is a brief loss of consciousness due to a drop in blood flow to the brain. The episode most often lasts less than a couple of minutes and y...
Read Article Now Book Mark Article - Erection problems
- Excessive urination and thirst (including frequent urination at night)
- Failure to release milk (in women)
- Fatigue, weakness
Fatigue
Fatigue is a feeling of weariness, tiredness, or lack of energy.
Read Article Now Book Mark Article - Headache
- Infertility
Infertility
Infertility means you cannot get pregnant (conceive). There are 2 types of infertility:Primary infertility refers to couples who have not become preg...
Read Article Now Book Mark Article - Irregular or absent menstrual periods
- Loss of armpit or pubic hair
- Loss of the body or facial hair (in men)
- Low blood pressure
- Low blood sugar
- Sensitivity to cold
Sensitivity to cold
Cold intolerance is an abnormal sensitivity to a cold environment or cold temperatures.
Read Article Now Book Mark Article - Short height (less than 5 feet or 1.5 meters) if onset is during the childhood growth period
Short height
A child who has short stature is much shorter than children who are the same age and sex. Your health care provider will go over your child's growth ...
Read Article Now Book Mark Article - Slowed growth and sexual development (in children)
- Vision problems
Vision problems
There are many types of eye problems and vision disturbances, such as: Halos Blurred vision (the loss of sharpness of vision and the inability to see...
Read Article Now Book Mark Article - Weight loss
Weight loss
Unexplained weight loss is a decrease in body weight, when you did not try to lose the weight on your own. Many people gain and lose weight. Uninten...
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Symptoms may develop slowly and may vary greatly, depending upon:
- The number of hormones that are missing and the organs they affect
- The severity of the disorder
Other symptoms that may occur with this condition:
- Face swelling
Face swelling
Facial swelling is the buildup of fluid in the tissues of the face. Swelling may also affect the neck and upper arms.
Read Article Now Book Mark Article - Hair loss
- Hoarseness or changing voice
Hoarseness or changing voice
Hoarseness refers to difficulty making sounds when trying to speak. Vocal sounds may be weak, breathy, scratchy, or husky, and the pitch or quality ...
Read Article Now Book Mark Article - Joint stiffness
- Weight gain
Weight gain
Unintentional weight gain is when you gain weight without trying to do so and you are not eating or drinking more.
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Exams and Tests
To diagnose hypopituitarism, there must be low hormone levels due to a problem with the pituitary gland. The diagnosis must also rule out diseases of the organ that is affected by this hormone.
Tests may include:
- Brain CT scan
Brain CT scan
A head computed tomography (CT) scan uses many x-rays to create pictures of the head, including the skull, brain, eye sockets, and sinuses.
Read Article Now Book Mark Article - Pituitary MRI
Pituitary MRI
A head MRI (magnetic resonance imaging) is an imaging test that uses powerful magnets and radio waves to create pictures of the brain and surrounding...
Read Article Now Book Mark Article - ACTH
ACTH
The ACTH test measures the level of adrenocorticotropic hormone (ACTH) in the blood. ACTH is a hormone released from the pituitary gland at the base...
Read Article Now Book Mark Article - Cortisol
Cortisol
The cortisol blood test measures the level of cortisol in the blood. Cortisol is a steroid (glucocorticoid or corticosteroid) hormone produced by th...
Read Article Now Book Mark Article - Estradiol (estrogen)
Estradiol
An estradiol test measures the amount of a hormone called estradiol in the blood. Estradiol is one of the main types of estrogens.
Read Article Now Book Mark Article - Follicle-stimulating hormone (FSH)
Follicle-stimulating hormone
The follicle stimulating hormone (FSH) blood test measures the level of FSH in blood. FSH is a hormone released by the pituitary gland, located on t...
Read Article Now Book Mark Article - Insulin-like growth factor 1 (IGF-1)
- Luteinizing hormone (LH)
Luteinizing hormone
The LH blood test measures the amount of luteinizing hormone (LH) in blood. LH is a hormone released by the pituitary gland, located on the undersid...
Read Article Now Book Mark Article - Osmolality tests for blood and urine
- Testosterone level
Testosterone
A testosterone test measures the amount of the male hormone, testosterone, in the blood. Both men and women produce this hormone. The test described...
Read Article Now Book Mark Article - Thyroid-stimulating hormone (TSH)
Thyroid-stimulating hormone
A TSH test measures the amount of thyroid stimulating hormone (TSH) in your blood. TSH is produced by the pituitary gland. It prompts the thyroid g...
Read Article Now Book Mark Article - Thyroid hormone (T4)
T4
T4 (thyroxine) is the main hormone produced by the thyroid gland. A laboratory test can be done to measure the amount of free T4 in your blood. Fre...
Read Article Now Book Mark Article - Biopsy of the pituitary
The level of a pituitary hormone may be high in the bloodstream if you have a pituitary tumor that is producing too much of that hormone. The tumor may compress other cells of the pituitary, leading to low levels of other hormones.
Treatment
If hypopituitarism is caused by a tumor, you may need surgery to remove the tumor. Radiation therapy may also be needed.
You will need lifelong hormone medicines to replace hormones that are no longer made by organs under the control of the pituitary gland. These may include:
- Corticosteroids (cortisol)
- Growth hormone
- Sex hormones (testosterone for men and estrogen for women)
- Thyroid hormone
- Desmopressin
Medicines are also available to treat related infertility in men and women.
Infertility
Infertility means you cannot get pregnant (conceive). There are 2 types of infertility:Primary infertility refers to couples who have not become preg...
Read Article Now Book Mark ArticleIf you take glucocorticoid medicines for pituitary ACTH deficiency, be sure you know when to take a stress dose of your medicine. Discuss this with your health care provider.
Always carry a medical ID (card, bracelet, or necklace) that says you have adrenal insufficiency. The ID should also say the type of medicine and dosage you need in case of an emergency caused by adrenal insufficiency.
Outlook (Prognosis)
Hypopituitarism is usually permanent. It requires lifelong treatment with one or more medicines. But you can expect a normal life span.
In children, hypopituitarism due to a tumor may improve if the tumor is removed by surgery.
Possible Complications
Side effects of medicines to treat hypopituitarism can develop. However, do not stop any medicine on your own without talking with your provider first.
When to Contact a Medical Professional
Contact your provider if you develop symptoms of hypopituitarism.
Prevention
In most cases, the disorder is not preventable. Awareness of risk, such as from taking certain medicines, may allow early diagnosis and treatment.
References
Clemmons DR, Nieman LK. Approach to the patient with endocrine disease. In: Goldman L, Cooney KA, eds. Goldman-Cecil Medicine. 27th ed. Philadelphia, PA: Elsevier; 2024:chap 202.
Fleseriu M, Hashim IA, Karavitaki N, et al. Hormonal replacement in hypopituitarism in adults: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2016;101(11):3888-3921. PMID: 27736313 pubmed.ncbi.nlm.nih.gov/27736313/.
Johannsson G, Ragnarsson O. Hypopituitarism including growth hormone deficiency. In: Robertson RP, ed. DeGroot's Endocrinology. 8th ed. Philadelphia, PA: Elsevier; 2023:chap 5.
Kaiser U, Ho K. Pituitary physiology and diagnostic evaluation. In: Melmed S, Auchus RJ, Goldfine AB, Koenig RJ, Rosen CJ, eds. Williams Textbook of Endocrinology. 14th ed. Philadelphia, PA: Elsevier; 2020:chap 8.
Endocrine glands - illustration
Endocrine glands release hormones (chemical messengers) into the bloodstream to be transported to various organs and tissues throughout the body. For instance, the pancreas secretes insulin, which allows the body to regulate levels of sugar in the blood. The thyroid gets instructions from the pituitary to secrete hormones which determine the rate of metabolism in the body (the more hormone in the bloodstream, the faster the chemical activity; the less hormone, the slower the activity).
Endocrine glands
illustration
The pituitary gland - illustration
The pituitary is a gland attached to the base of the brain. The pituitary secretes hormones that regulate the body's balance of many hormones controlling growth, development, and metabolism of the body.
The pituitary gland
illustration
Gonadotropins - illustration
The pituitary gland controls the release of several hormones, including the gonadotropins FSH (follicle-stimulating hormone) and LH (luteinizing hormone). FSH and LH in turn control the release of sex hormones (testosterone, estrogen, and progesterone). In children, these hormones govern the onset of puberty and sexual development. After puberty and during adulthood, they control reproductive function.
Gonadotropins
illustration
Pituitary and TSH - illustration
The pituitary secretes thyroid stimulating hormone (TSH), which stimulates the thyroid gland to secrete hormones that affect body metabolism.
Pituitary and TSH
illustration
Endocrine glands - illustration
Endocrine glands release hormones (chemical messengers) into the bloodstream to be transported to various organs and tissues throughout the body. For instance, the pancreas secretes insulin, which allows the body to regulate levels of sugar in the blood. The thyroid gets instructions from the pituitary to secrete hormones which determine the rate of metabolism in the body (the more hormone in the bloodstream, the faster the chemical activity; the less hormone, the slower the activity).
Endocrine glands
illustration
The pituitary gland - illustration
The pituitary is a gland attached to the base of the brain. The pituitary secretes hormones that regulate the body's balance of many hormones controlling growth, development, and metabolism of the body.
The pituitary gland
illustration
Gonadotropins - illustration
The pituitary gland controls the release of several hormones, including the gonadotropins FSH (follicle-stimulating hormone) and LH (luteinizing hormone). FSH and LH in turn control the release of sex hormones (testosterone, estrogen, and progesterone). In children, these hormones govern the onset of puberty and sexual development. After puberty and during adulthood, they control reproductive function.
Gonadotropins
illustration
Pituitary and TSH - illustration
The pituitary secretes thyroid stimulating hormone (TSH), which stimulates the thyroid gland to secrete hormones that affect body metabolism.
Pituitary and TSH
illustration
Review Date: 5/12/2023
Reviewed By: Sandeep K. Dhaliwal, MD, board-certified in Diabetes, Endocrinology, and Metabolism, Springfield, VA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.