Hypopituitarism is a condition where the pituitary gland fails to produce or secrete one or more hormones. This can result from defects in pituitary development, genetic conditions, tumors, trauma, or other causes. Deficiencies in specific pituitary hormones lead to distinct clinical effects, such as short stature from growth hormone deficiency, infertility from gonadotropin deficiency, or weight gain and fatigue from TSH deficiency. The document provides details on the causes, clinical presentations, and hormone deficiencies associated with hypopituitarism.

1. HYPOPITUITARISM
Dr.Aadhar harshana
JR-2 GEN. MEDICINE
IMS, BHU VARANASI ,INDIA

2. Pituitary gland introduction
• Situated within the bony sella tursica&overlain by dural diaphrgma
sella,through stalk connects to median eminence of hypothalamus.
• 600mg, pregnancy upto 1g.
• Pituitary together with hypothalamus orchestrates the structural
integrity & function of endocrine glands- Thyroid ,Adrenal
gland,Gonads & target tissue-cartilage,breast.
• Preservation of hypothalamo-pituitary unit is critical for integretion
of anterior pituitary control of sexual function,fertility,linear &organ
growth,lactation,stress responses,energy,appetite& temprature
regulation.
• Posterior pituitary gland-directly innervated by supraoptic
hypophyseal & tuberohypophyseal nerve tract of posterior stalk.

3. Anterior pituitary
Cells type Hormone synthesis
Acidophillic cells
1. Somatotrophs Growth hormone
2.Lactotrophs Prolactin
Basophilic cells
1.Corticotrophs POMC,ACTH ,MSH
,endorphins,lipotropin
2.Thyrotrophs TSH
3.Gonadotrophs FSH,LH

4. Pituitary regulated hormones

5. Hormone-secretary cells in ant.pituitary

6. HYP0THALMO-PITUITARY- TARGET ORGAN
AXES REGULATION

7. HYPOPITUITARISM DEFINATION
•Failure of one or more pituitary hormones to be produced or secreted
from the ant. or post. Pituitary.
•Failure can be the result of any step in production, stimulation,
secretion, regulation.

8. Hormone m/c clinical feature of deficiency
GH Child-growth retardation
Adult –decrease muscle bulk,
tendency to hypoglycemia
PROLACTIN Lactation failure
GONADOTROPINS Child-delayed puberty
Female-oligomenorrhea , infertility ,breast atropy , loss of libido
Male –impotency,azoospermia , testicular atropy , loss of libido.
ACTH Weight loss ,hypotension,hypoglycemia,skin pigmentation,
Decrease skin pigmentation,nausea&vomiting
TSH Weight gain,cold intolerance ,fatigue,hair loss,constipation, dry
skin,hoarseness of voice,bradycardia ,fatigue
VASOPRESSIN Thirst ,polyuria
 Clinical manifestation of hypopituitarism-
depend on which hormones are lost

9. Causes----

11. Development & genetic cause of
hypopituitarism
 PITUITARY DYSPLASIA-
• Congenital –
– May due to aplastic /hypoplastic or ectopic gland development,
because pituitary development followed midline cell migration from
nasopharangeal Rathke’s pouch.
• Aquired – occure in newborn baby
-birth trauma (cranial hemorrhage ,asphyxia,&breech delivery).

12. Septo-optic dysplasia
Hypothalamic dysfunction & hypopituitarism –due to
dysgenesis of the septum pellucid or corpus callosum
Affected children have mutation in the HESX1gene
Children exhibit variable feature of –
•Cleft palat
•Syndactyly
•Ear deformity
•Optic atropy
•Micropenis
•Anosmia
Pituitary dysfunction-
•Diabetes insipidus
•GH deficiency & short stature
•Occasionally TSH deficiency

13.  Pradder willi syndrome

14. Kallman’s syndrome –

15. Clinical feature of kallman syndrome

16. Laurence –Moon-Bardet-Biedl syndrome
•AR disorder
•Charecterised by mental retardation,renal
abnormality,,obesity,hexadactyly/bradactyly,
syndactyly.
•GnRH deficiency occure in 75% of male &
half of affected females.
•Retinal degeneration begin in early
childhood,most patient are blind by age.

17. Pituitary Apoplexy
•Acute intrapituitary hemorrhagic vascular events can cause substantial
damaged to the pituitary & surrounding sellar structure.
•May occure spontaneously in preexiting pit adenoma, postpartum
(sheehan syndrome) ,in a/c diabetes,hypertension,sickle cell anemia
,acute shock.
It’s an endocrine emergency may be presented with –
•Severe hypoglycemia
•Hypotension , shock
•CNS hemorhhage
•Death
Acute symptoms –
•Variable onset of headache, nausea & vomiting,
•Meningeal irritation ,vertigo ,visual defect
•Altered sensorium

18. Sheehan syndrome
• Infarction of pituitary after substantial blood loss during
childbirth.
• No correletion b/w severity of hemorrhage & symptoms.
• Severe recognised months to years postpartum period—
- lethargy,anorexia,weight loss,unable to breast feeding .
• 50% permanent amenorrhea,rest had scanty amenorrhea,
mostly lactation was poor to absent

19. Lymphophysitis hypophysitis-
• This happened most often in postpartum women.
• It usually present with hyperpractinemia & MRI
evidence of pituitary mass (adenoma).
• Pituitary failure causes by diffuse lymphocytic
infiltration.
• Isolated pituitary hormone deficiency s/o selective
autoimmune process target to specific cell types.
• Clinically – progressive mass effect with headache &
visual disturbance.

20. Empty sella syndrome-

21. GROWTH HORMONE
• at night triggered by the onset of slow-wave sleep (70% 1st episode
of slow-wave sleep cycle).
• The ultradian rhythm of GH secretion is generated by coordinated
interaction of many factors. “Jet lag” transiently increases GH peak
amplitude, resulting in a transient increase of 24-hour GH secretion.
• Exercise and physical stress, including trauma with hypovolemic
shock and sepsis, increase GH levels.
• Emotional deprivation and endogenous depression suppresses GH
secretion.
• Nutrition plays a major role in GH regulation. Malnutrition increases
GH secretion, whereas obesity decreases GH secretion.

23. Growth hormone Deficiency
children Adult
Short stature Reduced lean body mass
Micropenis Increase fat mass with selective deposition of intra-
abdominal visceral fat
Increase fat Increased waist-to-hip ratio
High pitch voice Hyperlipidemia
Propensity to
hypoglycemia
Left venticular dysfunction
Hypertension
Increase plasma fibrinogen level
BMD decrease
Impaired quality of life
Reduced exercise capacity
Poorconcentration , social isolation.

25. Adrenocorticotropic hormone ACTH
• HPA axis is the major system subserving stress and survival.
• POMC precursor of ACTH, which acts on the adrenal glands to induce
synthesis and secretion of adrenal steroids.
• aimed at providing adequate amounts of glucocorticoids, which exert
vital pleotrophic effects on energy supply, fuel metabolism, immunity,
and cardiovascular function.
• Earliest detectable human fetal pituitary cell 8th wk GA.
 ACTH DEFICIENCY – 2ndy adrenal deficiency occure as a result of
pituitary deficiency, chatrecterised by--- hypocortisonism-
• Fatigue ,malaise
• Weakness,weight loss
• Anorexia
• Nausea & vomiting
• Occasional hypoglycemia,hyponatremia,hyperkalemia.

26. Hypogonadotropin -hypopituitarism
 Congenital causes include- gene mutations
governing the processes of development and migration of GnRH neurons,
the control of GnRH secretion, the development of the gonadotroph, the
regulation of LH and FSH secretion.
 AcquiredFunctional causes are frequently encountered & include-
• stress, malnutrition, chronic illness,
• depression, excessive exercise, and low body weight.
• Several centrally acting drugs including- opiates, glucocorticoids,sex
steroids, GnRH agonists and antagonists, tranquilizers,antidepressants, and
antipsychotic medications suppress gonadotropin secretion,
• either directly or indirectly via induction of hyperprolactinemia.
 Organic causes include-
• malignant disease, developmental disorders, tumors, infiltrative
disease, trauma, and hypothalamic or pituitary.
• damage from surgery or radiotherapy.

27. Gonadotropin deficiency
•Hypogonadism is the most common feature of
adult hypopituitarism.
•even when other pituitary hormones are also
deficient.
• In hypogonadism female -Diminished ovarian
function leading to oligomenorrhea/
amenorrhea ,Infertility ,decrease vaginal
secretion ,decrease libido&breast atrophy .
•In hypogonadal adult men - 2ndry testicular
failure is a/c decrease libido, potency, infertility,
decrease muscle mass with weakness,reduced
beard &body hair growth,Soft testes &
charecteristic fine facial wrinkles.
•Osteoporosis occure in both untreated
hypogonadal women & men.

28. Symptoms of gonadotropin deficiency

30. TSH
REGULATION OF THYROID HORMONE AXES
• classic example of an endocrine feedback loop.
•Hypothalamic TRH stimulates pituitary production of
TSH,which in turn,stimulates thyroid hormone
synthesis and secretion.
• Thyroid hormones act via negative feedback
predominantly through THR ß2 (TRß2) to inhibit TRH
and TSH production .
•The "set-point" in this axis is established byTSH&TRH.
•TSH is the major positive regulator of TSH synthesis nd
secretion.
Causes ----Hypopituitarism –
•tumor ,surgery,irradiation,
•infiltrative disorders,sheehan’s,syndrome,Trauma
genetic form of combined pituitary hormones
deficiencies.
•Isolated TSH deficiency /inactivity
•Bexarotene treatment
--hypothalamic disease----
•Tumor, trauma,infiltrative disorder,idiopathic

32. Prolactin deficiency
•Inability to lactate during postpartum period.
•Often 1st manifestation of sheehan syndrom.
•Isolated PRL deficiency is rare.
•Prevelence of hypoprolactinemia parallel the
prevelence of hypopituitarism.

33. THANK YOU

36. Pituitary control
HYPOTHALAMUS
CNS
PITUITARY
TARGET GLAND

38. Congenital hypotyroidism
• If mother has TSH-R blocking Ab , received antithyroid drugs.
• Neonatal hypothroidism is due to –
Thyroid gland dysgenesis (80-85%),
inborn error of thyroid hormone synthesis(10-15%),
TSH-R Ab (5%)
• Clinical feature – majority infant appear normal at birth ,<
10% diagnosed based on clinically ---
prolonged jaundice,feeding problems,hypotonia,enlarged
tongue, delayed bone maturation,umbilical hernia
TSH & fT4 play important role in diagnosis of
hypothyroidism.

39. Hormone m/c clinical feature of deficiency
GH Child-growth retardation
Adult –decrease muscle bulk,tendency to hypoglycemia
PROLACTIN Lactation failure
GONADOTROPINS Child-delayed puberty
Female-oligomenorrhea,infertility ,breast atropy, loss of libido
Male –impotency,azoospermia,testicular atropy,loss of libido.
ACTH Weight loss ,hypotension,hypoglycemia,skin pigmentation,
Decrease skin pigmentation,nausea&vomiting
TSH Weight gain,cold intolerance ,fatigue,hair loss,constipation, dry
skin,hoarseness of voice,bradycardia ,fatigue
VASOPRESSIN Thirst ,polyuria

41. Thyroid stimulating hormone
• HPT system plays a critical role in development, growth, and cellular
metabolism with thyroid hormone availability and action controlled by
complex mechanisms at the tissue level.
• develops frm floor of the primitive pharynx 3rd wk GA, developing
gland migrates along the thyroglossal duct to reach its final location in
the neck.
• Neural crest derivatives from the ultimobranchial body give rise to
thyroid medullary C cells& produce calcitonin,a calcium-
loweringhormone.

43. Pituitary ACTH Deficiency
2ndy adrenal insufficiency
Presented with –
• Fatigue,weakness,anorexia,nausea,vomiting&occsn hypoglycemia.
• ACTH deficient may be present failure to thrive.
• In the adult, there is slowly progressive weight and appetite loss,
generalized fatigue mimicking a wasting syndrome.