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Hypopituitarism

Differential Diagnosis and Treatment

  • Chapter
Book cover Diseases of the Pituitary

Part of the book series: Contemporary Endocrinology ((COE,volume 3))

Abstract

Hypopituitarism refers to the congenital absence or acquired loss of pituitary hormone secretion, which may be an isolated deficiency or multiple hormone deficiencies. The diagnosis of pituitary hormone deficiency can usually be made in the outpatient setting with a combination of the clinical assessment and hormone measurements. Hypopituitarism is most commonly acquired, and occurs most often with pituitary disease, usually a benign adenoma. Pituitary failure may also result from treatment of the adenoma (surgery, radiation). Causes of pituitary hormone deficiency are listed in Table 1 (1–23). The loss of pituitary function has numerous effects, depending on which hormone or hormones is/are deficient. Table 2 lists the hypothalamic and pituitary hormones and target organs. It is apparent from this list that some deficiencies can be life threatening, i.e., adrenocorticotropin (ACTH) deficiency results in adrenal insufficiency, thyrotropin (TSH) deficiency results in hypothyroidism. Loss of the gonadotropins, luteinizing hormone (LH), and follicle-stimulating hormone (FSH) produce hypogonadism and infertility. If the posterior pituitary is compromised, diabetes insipidus (DI) results in polyuria and polydipsia; if the patient does not ingest adequate fluid, the resultant volume depletion and hypernatremia can be severe.

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References

  1. Percy AK, Elveback LR, Okazaki H, Kurland LT. Neoplasms of the central nervous system: epidemiologic considerations. Neurology 1972; 22:40–48.

    PubMed  CAS  Google Scholar 

  2. Kurland LT. The frequency of intracranial and intraspinal neoplasms in the resident population of Rochester, Minnesota. J Neurosurg 1958; 15:627–641.

    Article  PubMed  CAS  Google Scholar 

  3. Sandler LM, Richards NT, Carr DH, Mashiter K, Joplin GF. Long term follow-up of patients with Cushing’s disease treated by interstitial irradiation. J Clin Endocrinol Metab 1987; 65:441–447.

    Article  PubMed  CAS  Google Scholar 

  4. Lam KSL, Tse VKC, Wang C, Yeung RTT, Ma JTC, Ho JHC. Early effects of cranial irradiation on hypo-thalamic-pituitary function. J Clin Endocrinol Metab 1987; 64:418–424.

    Article  PubMed  CAS  Google Scholar 

  5. Samaan NA, Vieto R. Schultz PN, et al. Hypothalamic, pituitary and thyroid dysfunction after radiotherapy to the head and neck. J Rad Onc Biol Phys 1982; 8:1857–1867.

    Article  CAS  Google Scholar 

  6. Wakai S. Fukushima T. Teramoto A, Sano K. Pituitary apoplexy: its incidence and clinical significance. J Neurosurg 1981; 55:187–193.

    Article  PubMed  CAS  Google Scholar 

  7. Cardoso ER, Peterson EW. Pituitary apoplexy: a review. Neurosurgery 1984; 14:363–373.

    Article  PubMed  CAS  Google Scholar 

  8. Veldhuis JD, Hammond JM. Endocrine function after spontaneous infarction of the human pituitary: report, review, and reappraisal. Endocr Rev 1980; 1:100–107.

    Article  PubMed  CAS  Google Scholar 

  9. Barkan AL. Case report: pituitary atrophy in patients with Sheehan’s syndrome. Am J Med Sei 1989; 1:38–40.

    Article  Google Scholar 

  10. Sherif IH, Vanderley CM, Beshayah S, Bosairi S. Sella size and contents in Sheehan’s syndrome. Clin Endocrinol 1989; 30:613–618.

    Article  CAS  Google Scholar 

  11. Ishikawa SE, Furuse M, Saito T, Okada K, Kuzuya T. Empty sella in control subjects and patients with hypopituitarism. Endocrinol Japon 1988; 35:665–674.

    CAS  Google Scholar 

  12. Nakagawa YK, Matsumoto TF, Takase K. Exploration of the pituitary stalk and gland by high-resolution computed tomography: comparative study of normal subjects and cases with microadenoma. Neuroradiology 1984; 26:473–478.

    Article  PubMed  CAS  Google Scholar 

  13. Pocecco M, de Campo C, Marinoni S. et al. High frequency of empty sella syndrome in children with growth hormone deficiency. H’elv Paediat Acta 1988; 43:295–301.

    Google Scholar 

  14. Edwards OM, Clark JDA. Post-traulnatilc hypopituitarism. Medicine 1986; 65:281–290.

    Article  PubMed  CAS  Google Scholar 

  15. Asa SL, Bilbao JM, Kovacs K, Josser RG, Kreines K. Lymphocytic hypophysitis of pregnancy resulting in hypopituitarism: a distinct clinicopathologic entity. Ann Intern Med 1981; 95:166–171.

    PubMed  CAS  Google Scholar 

  16. Miura M, Ushio Y, Kuratsu JI, Ikeda JI, Kai Y,. Yamashiro S. Lymphocytic adenohypophysitis: report of two cases. Surg Neurol 1989; 32:463–470.

    Article  PubMed  CAS  Google Scholar 

  17. Kelly TM, Edwards CQ, Meikle AW, Kushner JP Hypogonadism in hemochromatosis: reversal with iron depletion. Ann Intern Med 1984; 101:629–632.

    PubMed  CAS  Google Scholar 

  18. Ooi TC, Russell NA. Hypopituitarism resulting from an intrasellar carotid aneurysm. Canad J Neurol Sci 1986; 13:70–71.

    PubMed  CAS  Google Scholar 

  19. Shone GR, Richards SH, Hourihan MD, Hall R. Thomazs JP, Scanion MR Non-secretory adenomas of the pituitary treated by trans-ethmoidal sellotomy. J R Soc Med 1991; 84: 140–143.

    PubMed  CAS  Google Scholar 

  20. Constine LS, Woolf PD, Cann D, et al. Hypothalamic-pituitary dysfunction after radiation for brain tumors. N Engl J Med 1993; 328:87–94.

    Article  PubMed  CAS  Google Scholar 

  21. Snyder PJ, Fowble BF, Schatz NJ, Savino PJ, Gennarelli TA. Hypopituitarism following radiation therapy of pituitary adenomas. Am J Med 1986; 81:457–462.

    Article  PubMed  CAS  Google Scholar 

  22. Littley MD, Shalet SM, Beardwell CG, Ahmed SR, Applegate G, Sutton ML. Hypopituitarism following external radiotherapy for pituitary tumors in adults. Quart J Med 1989; 70:145–160.

    PubMed  CAS  Google Scholar 

  23. Thapar K, Laws ER. Parasellar lesions other than pituitary adenomas. In: Management of Pituitary Tumours: A Handbook. M Powell, SL Lightman, eds. Churchill Livingston, London, 1996, pp. 175–222.

    Google Scholar 

  24. Rosén T. Bengtsson BA. Premature mortality due to cardiovascular disease in hypopituitarism. Lancet 1990; 336:285–288.

    Article  PubMed  Google Scholar 

  25. McGauley GA. Quality of life assessment before and after growth hormone treatment in adults with growth hormone deficiency. Acta Pediatr Scand [Suppl] 1989; 356:70–72.

    Article  CAS  Google Scholar 

  26. Hall WA, Luciano MG, Doppman JL, Patronas NJ, Oldrileld EH. Pituitary magnetic resonance imaging in normal human volunteers: Occult adenomas in the general population. Ann Intern Med 1994; 120:817–820.

    PubMed  CAS  Google Scholar 

  27. Elster AD. Modern imaging of the pituitary. Radiology 1993; 187:1–14.

    PubMed  CAS  Google Scholar 

  28. Vance ML, Lipper M, Klibanski A, Biller BMK, Samaan NA, Molitch ME. Treatment of prolactin-secreting pituitary macroadenomas with the long-acting non-ergot dopamine agonist CV 205–502. Ann Intern Med 1990; 112:668–673.

    PubMed  CAS  Google Scholar 

  29. Stevenaert A, Beckers A, Vandalem JL, Henen G. Early normalization of luteinizing hormone pulsatility after successful transsphenoidal surgery in women with microprolactinomas. J Clin Endocrinol Metab 1986; 62:1044–1047.

    Article  PubMed  CAS  Google Scholar 

  30. Sauder SE, Frager M, Case GD, Kelch RP, Marshall JC. Abnormal patterns of pulsatile luteinizing hormone secretion in women with hyperprolactinemia and amenorrhea: responses to bromocriptine. J Clin Endocrinol Metab 1984; 59:941–948.

    Article  PubMed  CAS  Google Scholar 

  31. Ebersold MJ, Quast LM, Laws ER Jr, et al. Long-term results in transsphenoidal removal of nonfunctioning pituitary adenomas. J Neurosurg 1986; 64:713–719.

    Article  PubMed  CAS  Google Scholar 

  32. Nelson PB, Goodman ML, Flickenger JC, Richardson DW, Robinson AG. Endocrine function in patients with large pituitary tumors treated with operative decompression and radiation therapy. Neurosurgery 1989; 24:398–400.

    Article  PubMed  CAS  Google Scholar 

  33. Arafah BM, Harrington JF, Madhoun ZT, Selman WR. Improvement of pituitary function after surgical decompression for pituitary tumor apoplexy. J Clin Endocrinol Metab 1990; 71:323–328.

    Article  PubMed  CAS  Google Scholar 

  34. van Lindert EJ, Grotenhuis JA, Meijer E. Results of follow-up after removal of nonfunctioning pituitary adenomas by transcranial surgery. Br J Neurosurg 1991; 5:129–133.

    Article  PubMed  Google Scholar 

  35. Molitch ME, Elton RL, Blackwell RE, et al. Bromocriptine as primary therapy for prolactin-secreting macroadenomas: results of a prospective multicenter study. J Clin Endocrinol Metab 1985; 60:698–705.

    Article  PubMed  CAS  Google Scholar 

  36. Vance ML, Cragun JR, Reimnitz C, et al. CV 205502 treatment of hyperprolactinemia. J Clin Endocrinol Metab 1989; 68:336–339.

    Article  PubMed  CAS  Google Scholar 

  37. Kleinberg DL, Boyd AE, III, Wardlow S. et al. Pergolidle for the treatment of pituitary tumors secreting prolactin or growth hormone. N Engl J Med 1983; 309:704–709.

    Article  PubMed  CAS  Google Scholar 

  38. Arafah BM. Reversible hypopituitarism in patients with large nonfunctioning pituitary adenomas. J Clin Endocrinol Metab 1986; 62:1173–1179.

    Article  PubMed  CAS  Google Scholar 

  39. Harris PE, Afshar F. Coates R et al. The effects of transsphenoidal surgery on endocrine function and visual fields in patients with functionless pituitary tumours. Quart J Med 1989; 71:417–427.

    PubMed  CAS  Google Scholar 

  40. Lukert BP, Raisz LG. Glucocorticoid-induced osteoporosis: pathogenesis and management. Ann Intern Med 1990; 112:352–364.

    PubMed  CAS  Google Scholar 

  41. Greenspan SL, Oppenheim DS, Klibanski A. Importance of gonadal steroids to bone mass in men with hy-perprolactinemic hypogonadism. Ann Intern Med 1989; 110:526–531.

    PubMed  CAS  Google Scholar 

  42. Klibanski A, Neer RM, Beitins IZ, Ridgway EC, Zervas NT, McArthur JW. Decreased bone density in hy-perprolactinemic women. N Engl J Med 1980; 303:1511–1514.

    Article  PubMed  CAS  Google Scholar 

  43. Matthews KA, Meilahn E, Kuller LH, Kelsey SF, Caggiula AW, Wing RR. Menopause and risk factors for coronary heart disease. N Engl J Med 1989; 321:641–646.

    Article  PubMed  CAS  Google Scholar 

  44. Findlay AC, Place VA, Snyder PJ. Transdermal delivery of testosterone. J Clin Endocrinol Metab 1987; 64:266–268.

    Article  PubMed  CAS  Google Scholar 

  45. Carey PO, Howards SS, Vance ML. Transdermal testosterone treatment of hypogonadal men. J Urology 1988; 140:76–79.

    CAS  Google Scholar 

  46. Mazer NA et al. Enhanced transdermal delivery of testosterone: a new physiologic approach for androgen replacement in hypogyonadal men. J Ctrl Rel 1992; 19:347–362.

    Article  CAS  Google Scholar 

  47. Meikle AW et al. Enhanced transdermal delivery of testosterone across non-scrotal skin produces physiologic concentrations of testosterone and its metabolites in hypogonadal men. J Clin Endocrinol Metab 1992; 74:623–628.

    Article  PubMed  CAS  Google Scholar 

  48. Jorgensen JOL, Pedersen SA, Thuesen L, et al. Beneficial effects of growth hormone treatment in GH-deficient adults. Lancet 1989; 11:1221-1225.

    Article  Google Scholar 

  49. Salomon F, Cuneo RC, Hesp R, Sonksen PH. The effects of treatment with recombinant human growth hormone on body composition and metabolism in adults with growth hormone deficiency. N Engl J Med 1989; 321:797-803.

    Article  Google Scholar 

  50. Cuneo RC, Salomon F, Wiles CM, Hesp R, Sonksen PH. Growth hormone treatment in growth hormone-deficient adults. I. Effects of muscle mass and strength. J Appl Physiol 1991; 70(2):688-694.

    PubMed  CAS  Google Scholar 

  51. Cuneo RC, Salomon F, Wiles CM, Hesp R. Sonksen Pal. Growth hormone treatment in growth hormone-deficient adults. II. Effects on exercise performance. J Appl Physiol 1991; 70(2): 695-700.

    PubMed  CAS  Google Scholar 

  52. Jorgensen JOL, Pedersen SA, Thuesen AL, et al. Long-term growth hormone treatment in growth hormone deficient adults. Acta Endocrinol (Copenh) 1991; 125:449-453.

    CAS  Google Scholar 

  53. Vance ML. Medical progress: hypopituitarism. New Engl J Med 1994; 330:1651-1662.

    Article  PubMed  CAS  Google Scholar 

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Authors
  1. Mary Lee Vance MD
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Editors and Affiliations

  1. University of Colorado Health Sciences Center, Denver, CO, USA

    Margaret E. Wierman MD

  2. Veterans Affairs Medical Center, Denver, CO, USA

    Margaret E. Wierman MD

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© 1997 Humana Press Inc.

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Vance, M.L. (1997). Hypopituitarism. In: Wierman, M.E. (eds) Diseases of the Pituitary. Contemporary Endocrinology, vol 3. Humana Press. https://doi.org/10.1007/978-1-4612-3954-3_2

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  • DOI: https://doi.org/10.1007/978-1-4612-3954-3_2

  • Publisher Name: Humana Press

  • Print ISBN: 978-1-4612-8438-3

  • Online ISBN: 978-1-4612-3954-3

  • eBook Packages: Springer Book Archive

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