Hypopituitarism: Causes, Symptoms, and Treatment

What Is Hypopituitarism?

Hypopituitarism is a rare condition in which your pituitary gland cannot produce enough hormones. It may not produce sufficient amounts of one or more hormones that are produced by this gland. This gland approximately produces eight different hormones.

Hormones are chemical messengers responsible for the many functions carried out in the body. Pituitary hormones are responsible for functions like growth and development, metabolism, and reproduction.

Hypopituitarism occurs due to a deficiency of hormones produced by the pituitary gland. This may further affect many important body functions. The affected persons may need to be treated for their remaining lifetime.

Types of hypopituitarism:

There are different types of hypopituitarism. These are based on the number of deficient hormones in the pituitary gland.

• Isolated pituitary deficiency:

In this type, only one pituitary hormone is deficient.

• Multiple pituitary hormone deficiency:

In this type, two or more pituitary hormones are affected.

• Panhypopituitarism:

In this type, almost all hormones of the pituitary are affected.

Based on the cause, there are different types of hypopituitarism. These include:

• Primary hypopituitarism:

When there is damage or disorders to the pituitary gland, it causes primary hypopituitarism.

• Secondary hypopituitarism:

When there is damage to or disorders of the hypothalamus, secondary hypopituitarism is caused.

• Idiopathic hypopituitarism:

When no cause is known for hypothyroidism, it is called idiopathic hypothyroidism.

What Is the Anatomy of the Pituitary Gland?

The pituitary gland is a pea-sized gland located in a bony structure called the sella turcica at the base of the brain. It is called a master gland because it controls the functions of many other endocrine glands.

The pituitary is controlled by the hypothalamus. The hypothalamus is a part of the brain. It is situated just above the pituitary gland. The pituitary gland has two parts.

• Front (anterior) lobe.

• Back (posterior) lobe.

The weight of the anterior lobe is almost 80 % of the weight of the pituitary gland. These two lobes are connected to the hypothalamus through a stalk. This stalk has blood vessels and nerve cell projections. The hypothalamus controls hormone production through the blood vessels and the posterior lobe through nerve impulses.

Hormones are not produced continuously but in bursts, from one to three hours. The anterior lobe produces the following hormones:

• Adrenocorticotropic hormone (ACTH):

This hormone is also known as corticotropin. ACTH stimulates the adrenal glands to produce cortisol and other hormones.

• Follicle-stimulating hormone (FSH) and luteinizing hormone (LH) (gonadotropins):

These hormones help stimulate the testes to produce sperm. These are also responsible for producing eggs from the ovaries. They also produce sex hormones (testosterone and estrogen) in sex organs.

• Growth hormone:

This hormone is responsible for growth and development. This hormone has an important effect on body shape. It helps stimulate muscle formation and reduce fat tissue.

• Prolactin:

This hormone has a role in producing milk. It stimulates the mammary glands to produce milk.

Apart from these hormones, the anterior lobe produces other hormones like beta melanocyte-stimulating hormone (causes the skin to darken), hormones that inhibit pain sensations (enkephalins and endorphins), and hormones that control the immune system (endorphins).

Hormones that are produced from the posterior lobe of the pituitary include:

• Vasopressin:

Vasopressin is important for regulating water excretion by the kidneys and helping maintain water balance. It is also called antidiuretic hormone.

• Oxytocin:

This hormone contracts the uterus during childbirth and after delivery to prevent bleeding. It also causes contractions in the milk ducts so that milk moves to the nipples.

What Are the Causes of Hypopituitarism?

Hypopituitarism has many causes. The three main factors that cause hypopituitarism include:

• If something is putting pressure on the pituitary gland or hypothalamus.

• If any damage occurs to the pituitary gland or hypothalamus.

• If any rare condition is present, and if that condition causes hypopituitarism.

Conditions causing pressure on the pituitary gland include:

• Pituitary adenomas:

They are benign tumors that compress the pituitary gland. It can change the way it releases hormones.

• Brain tumors:

Any tumor near the hypothalamus or pituitary gland can affect the pituitary gland's functioning.

Other conditions include lymphocytic hypophysitis (lymphocytes invade the pituitary gland) and sarcoidosis (causes inflammation) of the pituitary or hypothalamus.

Injuries responsible for hypopituitarism:

• Surgery:

If complications occur during or after brain surgery, they can damage the pituitary gland or hypothalamus.

• Radiation therapy:

Radiation therapy used before for pituitary adenoma can cause damage to the pituitary gland.

• Traumatic brain injury:

Incidents such as a vehicle accident, a fall, or a contact sport can cause injuries to the brain.

• Pituitary apoplexy:

When sudden damage occurs to the pituitary gland, it is called pituitary apoplexy.

Some rare conditions that can cause hypopituitarism include:

• Hereditary hemochromatosis:

In this condition, we can observe increased iron in the bloodstream. This can damage the pituitary gland.

• Bacterial meningitis:

Although it was found to be rare, sometimes bacterial meningitis can cause hypopituitarism.

• Genetic disorders:

Some of the genetic disorders can affect the hormone secretions in the pituitary gland.

What Are the Symptoms of Hormone Deficiencies in Hypopituitarism?

Symptoms of hypopituitarism depend on the deficient hormone produced by the pituitary gland. Symptoms usually begin gradually and go unnoticed for a long time. Sometimes, the symptoms may appear all of a sudden.

Factors that affect the symptoms include:

• Gender.

• The age at which hypopituitarism affects.

• Cause.

Symptoms of hypopituitarism due to a deficiency of growth hormone (GH):

Symptoms that occur in newborns include:

• Low blood sugar.

• Small penis (micropenia)

Symptoms of GH deficiency in children include:

• Slow growth or no growth.

• Short height.

• Missing or delayed sexual development during puberty.

Symptoms among adults due to a lack of GH include:

• Weakness.

• Decreased sense of well-being.

• Reduced sexual interest or function.

• Accumulation of fat, especially around the waist.

• Sensitivity to heat and cold.

• Muscle mass decreases.

• Strength and stamina are lowered during exercise.

Symptoms due to a lack of thyroid-stimulating hormone (TSH):

Symptoms of children and adults are similar. These include:

• Fatigue.

• Dry skin and thinning of your hair.

• Constipation.

• Increased weight.

• Muscle weakness.

• Sensitivity to cold temperature.

• Depression.

• Experience irregular periods or heavier periods.

Symptoms due to lack of FSH and LH:

Symptoms of a lack of FSH and LH among children include:

• Absence of breast development in females.

• Absence of testicular development in males.

• Lack of growth spurt during puberty.

Symptoms of a lack of FSH and LH among men include:

• Loss of interest in sex.

• Weakness.

• Infertility.

• Erectile dysfunction.

• Reduced body hair or facial hair.

Symptoms of a lack of FSH and LH among women include:

• Loss of interest in sex (low libido).

• Fatigue.

• Infertility.

• Hot flashes.

• Irregular periods or no periods (amenorrhea).

• Decreased hair in the pubic region.

• Decreased production of milk after giving birth.

Symptoms due to a lack of adrenocorticotropic hormone (ACTH or corticotropin):

Symptoms in adults and children are the same. These include:

1. Weakness.

2. Weight loss without any reason.

3. Decreased blood pressure.

4. Experience nausea and vomiting.

5. Decreased blood sugar.

6. Feel confused.

Symptoms due to a lack of prolactin:

Decreased production of milk after giving birth is the main symptom due to a deficiency of prolactin.

Symptoms due to a deficiency of oxytocin include:

• Problems in the flow of breast milk after giving birth.

• Difficulty in bonding with your baby.

• Lack of empathy.

• Feel difficulty in interacting with others.

Symptoms due to a deficiency of ADH (antidiuretic):

Symptoms among children include:

• Difficulty in toilet training.

• Bed wetting.

• Easily get tired.

Symptoms due to a deficiency of ADH among adults include:

• Repeated urination.

• Excessive thirst.

• Experience electrolyte imbalance.

How to Diagnose Hypopituitarism?

The tests to be done to know hypopituitarism include:

• Blood tests:

These tests help measure levels of hormones.

• Stimulation and dynamic test:

These tests help measure hormone levels. These tests are done under an endocrinologist’s supervision. These tests are done after giving some medications that stimulate hormones.

• Brain imaging:

Imaging tests such as magnetic resonance imaging (MRI) and computed tomography (CT) scans help determine any issues related to the gland in the brain.

• Vision test:

This test can help identify any pituitary tumor that presses on the optic nerve.

What Are the Treatment Options for Hypopituitarism?

An endocrinologist can manage the condition effectively. As many hormones are affected in hypopituitarism, there is no particular treatment. Hence, the goal in treating this condition is to improve the levels of hormones that are affected. This should not impact the patient's health.

Apart from these, the treatment plan includes:

• Hormone replacement medication.

• Surgery.

• Radiation therapy.

Surgery may be done to remove the tumor if present. Sometimes, radiation therapy may have to be done. The doctor monitors the treatment continuously to know whether it is working correctly. They will adjust the medications according to the needs of the patient if necessary.

How to Live With Hypopituitarism?

If a person is identified with hypopituitarism, they need to be careful and they need lifelong monitoring for the hormones they are lacking. Keep seeing your healthcare provider regularly. This helps to know whether the treatment plan is working. If any new or unusual symptoms appear, contact your healthcare provider immediately.

Life expectancy with hypopituitarism may depend on the hormones affected. It may also depend on the severity of the condition and the overall health of the affected person. However, individuals who strictly follow the treatment plan may not have a lower life expectancy.

Though it is not observed sometimes, sudden severe hypopituitarism may cause emergencies and even cause death. The healthcare provider should be contacted without delay if any symptoms appear.

Conclusion

Hypopituitarism is a rare condition that affects the hormones secreted by the pituitary gland. Many bodily functions are affected by this condition. Hence, it is important to identify the condition and get it treated. If left untreated, it may result in fatality. If timely treatment is given and monitored, the prognosis of the condition is good. The affected person may live healthily.

Key Takeaway From iCliniq

Hypopituitarism is a rare condition related to the pituitary gland. Hormones that are secreted by the pituitary gland are affected. It affects many important functions of the body. If not treated, it may result in fatality. For more information, you can consult an endocrinologist at iCliniq.