Hypopituitarism (the term “hypo” means “less amount” and “pituitarism” refers to a “disorder of pituitary gland functioning” This article is about a condition known as hypopituitarism. To begin knowing and understanding – The pituitary gland is a tiny, pea-sized structure located near the base of the brain. It is referred to as the “master gland” because it produces hormones that travel throughout our bodies and stimulates and controls hormone production by other endocrine glands such as the thyroid gland, adrenal gland, ovaries (in females), testes (in males), parathyroid gland, and pineal gland.
Pituitary hormones and their functions
The following are the various pituitary hormones and their functions:
Growth Hormone: Facilitates growth of bone and other body tissues.
Prolactin: Stimulates milk production in breastfeeding women.
Adrenocorticotropin (ACTH): Prompts the adrenal glands to produce cortisol, essential for blood pressure and blood glucose regulation.
Antidiuretic Hormone (ADH): Regulates water balance and urine production in the kidneys; deficiency may lead to diabetes insipidus.
Thyroid Stimulating Hormone (TSH): Acts on the thyroid gland to produce hormones vital for metabolism, nervous system function, energy, and growth.
Luteinizing Hormone (LH): In men, regulates testosterone production; in women, helps in estrogen production.
Follicle Stimulating Hormone (FSH): Stimulates sperm production in men and ovulation in women.
Oxytocin: Induces contraction and relaxation of the uterus during labour.
Melanocyte-Stimulating Hormone: Controls skin pigmentation.
About Hypopituitarism
Hypopituitarism is a condition in which the body does not produce enough pituitary hormones. When the pituitary gland fails to produce even one of its hormones, the body’s regular function suffers. The consequence of hypopituitarism is determined by which hormone is insufficiently or no longer produced by the pituitary gland. Hypopituitarism can have abrupt or slow and significant effects.
Causes
The primary cause often involves pituitary tumours that compress and damage the gland, potentially leading to visual impairments due to optic nerve pressure.
Other causes of hypopituitarism include:
- Tumour in the brain
- Brain surgery
- Meningitis infection
- Injury in the head region
- Radiation treatment
- Inadequate blood supply to pituitary gland
- Tuberculosis
- Surgical removal of pituitary tissues
- Stroke
- Hemochromatosis (excess absorption of iron from the GIT)
- Histiocytosis ( increases in immune cells)
- Disease of the hypothalamus (a small part of the brain just above the pituitary, that controls the pituitary function)
- Sarcoidosis (inflammation in the various body tissues)
- In many the cause of hypopituitarism is unknown
Symptoms
Symptoms of hypopituitarism can develop either gradually or suddenly. A few symptoms of hypopituitarism are
- Constipation
- Abdominal discomfort
- Weakness/fatigue
- Nausea
- Muscle weakness
- Puffed face
- Hoarse voice
- Headache
- Reduced blood pressure
- No appetite
- Weight gain or weight loss
- Loss of underarm and pubic hair
- Sensitive to cold/difficulty staying warm
- Joint stiffness
- Feeling thirsty and excess urination
- Visual difficulties
- Erectile dysfunction in men
- Lack of facial and body hair in men
- Loss of sexual interest in men
- Infertility in women
- Inability to produce breast milk
- Irregular or no menstrual bleeding
- Shout stature in children
- Development of sexual characters is slowed
If a patient develops unexpected symptoms such as a headache, vision problems, disorientation, or low blood pressure, a doctor should be seen right away, since this might be a warning sign of pituitary apoplexy (pituitary haemorrhage).
Diagnosis
When a patient’s symptoms, medical history, and thorough examination suggest a deficiency in pituitary hormones, doctors may conduct various tests. Blood tests are employed to assess hormone levels, revealing potential inadequacies in pituitary hormone production. An endocrinologist, specializing in the endocrine system and hormones, may administer stimulation tests, observing hormone secretion after the patient receives stimulating medications. Imaging techniques such as computed tomography (CT) and magnetic resonance imaging (MRI) visualize the brain for damage, injury, or structural abnormalities within the pituitary gland. Vision tests determine the presence and impact of pituitary tumours on eyesight. In paediatric cases, X-ray studies assess the normal growth of hand and leg bones. These diagnostic measures collectively contribute to a comprehensive understanding of pituitary hormone deficiencies, guiding physicians in formulating tailored treatment plans.
Treatment
The treatment of hypopituitarism commences by addressing the underlying cause, particularly if it originates from a tumour. Surgical removal or radiation therapy may be pursued to eliminate the tumour. When the condition persists despite addressing the root cause, hormone replacement therapy becomes a pivotal approach. For those with ACTH deficiency, corticosteroids like prednisone and hydrocortisone are prescribed to compensate for the lack of cortisol hormone. Desmopressin is utilized for anti-diuretic hormone deficiency, aiding in water balance and curbing excessive urination. Growth hormone medications foster growth in children with growth hormone deficiency. Levothyroxine steps in to replace missing thyroid hormone in TSH-deficient patients. Certain hormone medications are used to replace testosterone (in men), estrogen (in women), or a combination of estrogen and progesterone (in women with LH and FSH deficiency). The efficacy of hormone replacement therapy relies on regular monitoring of hormone levels to ensure effectiveness. Any reported side effects, such as illness, weight gain, or stressful situations, necessitate prompt communication with the doctor, as dosage adjustments may be required. Most importantly, adjustments are essential if the patient becomes pregnant. Monitoring and adapting the treatment plan are integral aspects of managing hypopituitarism effectively.
Outlook
Hypopituitarism has no cure, however, effective treatment of the underlying conditions is crucial. Precise diagnosis of the specific hormone deficiency causing hypopituitarism is essential. Active involvement, awareness of treatment choices, cooperation, adherence to treatment procedures, and regular follow-ups empower individuals with hypopituitarism to lead normal, productive lives.
