HYPOPITUITARISM
PRESENTED BY:
Dr. Md. Najibulla Rahaman
INTERN
DEPARTMENT OF MEDICINE
NMCTH Hospital

INTRODUCTION
• Deficient production of anterior pituitary hormones leads to features
of hypopituitarism.
• It is a clinical syndrome of deficiency in pituitary hormone production
and secretion.
• Panhypopituitarism refers to involvement of all pituitary hormones;
however, it is rare.
• It may result from disorders involving the pituitary gland,
hypothalamus or surrounding structures.

CLINICAL FEATURES
• Mass lesions-
- Space occupying lesions result in headache, visual disturbances and
rarely, personality changes, temporal lobe epilepsy, and CSF
rhinorrhoea.
-Actively secreting tumors can produce a complex
picture of combined hormonal excess and deficiency
• Growth hormone
-Reduced energy and vitality
-Reduced muscle mass and strength
-Increased central adiposity
-Decreased sweating and impaired thermogenesis
-Reduced bone mineral density (BMD)

CLINICAL FEATURES
• Adrenocorticotrophic hormone
-Fatigue, weakness, anorexia, weight loss, nausea, vomiting, abdominal
pain, hypoglycaemia, circulatory collapse; loss of axillary/pubic hair in
women
• Gonadotrophins
-Men: erectile dysfunction, reduced muscle mass, erythropoiesis,
reduced energy and vitality
-Women: oligomenorrhoea/amenorrhoea, dyspareunia, breast
atrophy
-Both: loss of libido, flushes, infertility, regression of sexual
characteristics, reduced BMD.

CLINICAL FEATURES
• Thyroid stimulating hormone
-Fatigue, apathy, cold intolerance, constipation, weight gain, dry skin, psychomotor
retardation.
• Antidiuretic hormone
-Polyuria, polydipsia, nocturia.
• Prolactin
-Lactational failure
•Excessive mortality rates due to cardiovascular disease

PITUITARY APOPLEXY
• Hemorrhagic infarction of a pituitary adenoma/tumor
• Considered a neurosurgical emergency
• Presentation:
-Hypoglycemia
-Hypotension and shock
-CNS hemorrhage
-Severe headache
-Visual changes
-Opthalmoplegia

PITUITARY APOPLEXY
• Risk factors:
-Diabetes
-Radiation treatment
-Warfarin use
• Symptoms may occur immediately or may develop over 1-2 days
• Diagnose with CT/MRI
• Treatment:
-Surgical - Trans-sphenoid decompression
-Medical therapy - if symptoms are mild Corticosteroids

KALLMANN SYNDROME
• Kallmann syndrome is a genetic disorder that prevents a person from
starting or fully completing puberty.
• It results from defective hypothlamic gonadotropin-releasing
hormone synthesis.
• Symptoms include absent or delayed puberty,infertility,inability to
smell.
• Hormone replacement therapy is the major form of treatment with
the aim to replace the missing testosterone or oestrogen and
progesterone.

PRADER-WILLI SYNDROME
• Prader-willi syndrome is a genetic disorder due to loss of function of
specific genes.
• This is a contiguous gene syndrome that results from deletion of the
paternal copies of the imprinted SNRPN gene, the NECDIN gene, and
possibly other genes on chromosome15q.
• Prader-Willi syndrome is associated with hypogonadotropic
hypogonadism.
• In newborns symptoms include weak muscles,poor feeding and slow
development,Beginning in childhood person becomes constantly
hungry which often leads to obesity and type 2 diabetes mellitus.

SHEEHAN'S SYNDROME
• Ischemic pituitary necrosis after substantial blood loss during childbirth
• No correlation between severity of hemorrhage
and symptoms
• Recognised days to weeks post-partum
- Secondary hypothyroidism
- Lactational Failure
- Secondary Adrenal insufficiency - Lethargy, anorexia, weight loss
- Typically long interval between obstetric event and diagnosis

EMPTY SELLA SYNDROME
• Usually have normal pituitary function
- Implying that the surrounding rim of pituitary tissue is fully functional
• Hypopituitarism may develop insidiously when >90% tissue is compressed.
• Primary empty sella may develop as a consequence of congenital weakness of
the diaphragm
• Pituitary masses may undergo clinically silent infarction with secondary
development of a partial or totally empty sella by cerebrospinal fluid (CSF) filling
the dural herniation.
• Rarely, functional pituitary adenomas may arise within the rim of pituitary
tissue, and these are not always visible on MRI

DIAGNOSIS
• Thorough clinical examination including visual field charting is essential
• Simultaneous measurements of basal anterior pituitary and target organ hormone
levels
• Dynamic/provocative tests are necessary to assess GH secretory reserve and
ACTH-adrenal axis

TEST OF PITUITARY SUFFICIENCY

TREATMENT
• Hormone replacement therapy
• It should mimic physiological hormone production
• Those with glucocorticoid replacement require dose adjustments during stressful
events like acute illness, pregnancy, surgery, dental procedures, trauma, and acute
hospitalization

TSH DEFICIENCY
• Thyroxine is the treatment of choice.
• ACTH deficiency should be treated if present before initiating thyroxine replacement.
• TSH monitoring is unhelpful
• Long term over treatment may result in AF & reduction in bone mineral density

GONADOTROPHIN DEFICIENCY
MEN
•Testosterone replacement has beneficial effects on body composition, sexual function,
mood, behavior & BMD.
•Treatment is contraindicated in patients with prostate cancer and male breast cancer
WOMEN
• Oestrogen replacement alleviates symptoms of deficiency and is bone protective.
• It is often given with cyclical/continuous progesterone.

GH DEFICIENCY
• Human GH 0.2-0.3 mg s.c. is given daily,titrating the dose every 4-6 weeks
• Side effects include headache, arthralgia,myalgia, fluid retention.
• Absolute contraindications are active malignancy, benign intracranial hypertension and
proliferative diabetic retinopathy

VASOPRESSIN DEFICIENCY
• In mild Diabetes Insipidus, (urine output <41/day), adequate oral fluid intake is
sufficient
• In severe forms desmopressin is the treatment of choice
• Hyponatremia is a common side effect
ACTH DEFICIENCY
• Hydrocortisone is the preferred agent
• 2 to 3-fold increase in glucocorticoid dose is needed temporarily during
intercurrent illness, surgery, etc.

Hormone Replacement Therapy For Adult Hypopituitarism

References :
• Davidson’s Principles and Practice of Medicine
• Harrison's Principles of Internal Medicine

THANK YOU