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Hyperprolactinaemia: diagnosis and management – GP online

Raised prolactin levels and their management, including clinical presentations, recent research on dopamine agonists and when surgery may be indicated.

Coloured CR scan showing a side view of a tumour (orange) of the pituitary gland (Picture: Science Photo Library)

Hyperprolactinaemia is a raised level of prolactin in the blood. This hormone stimulates breast epithelial cell proliferation and induces milk production. However, excessive production of prolactin can lead to infertility and gonadal dysfunction.1

Prolactin suppresses gonadotrophin-releasing hormone (GnRH), resulting in suppression of ovulation in females and reduced testosterone levels and hypogonadism in males.

Prolactin levels are normally high during pregnancy and lactation. Levels also increase after meals, after exercise and during stress, as well as during sleep.

Abnormally high levels of prolactin may be caused by a prolactin-secreting pituitary tumour (prolactinoma), or by a non-secreting pituitary tumour that prevents dopamine (a prolactin release-inhibiting hormone) from reaching normal prolactin-producing cells.

Common and rarer causes

Prolactinomas are the most common cause of hyperprolactinaemia, although it has many different causes. They are benign tumours that account for 40% of pituitary tumours and are the most common type of pituitary adenomas. More than 90% are intrasellar microprolactinomas (

Primary hypothyroidism may lead to hyperprolactinaemia as a consequence of increased synthesis of thyrotropin-releasing hormone, which stimulates prolactin production.

Severe liver disease and chronic renal failure can also be causes. Head injuries, brain surgery and cranial radiotherapy can also cause hyperprolactinaemia.

Drugs

The commonest medications to cause hyperprolactinaemia are antipsychotic drugs. Antidepressants, opiates, verapamil and oestrogens can also lead to hyperprolactinaemia.

Mildly increased prolactin levels (400-600mu/L) may be physiological and asymptomatic but higher levels are usually pathological. Very elevated levels (above 5,000mu/L) usually imply a prolactin-secreting pituitary tumour. Most patients with a prolactinoma are women.

The clinical presentation in women is more obvious and so occurs earlier than in men. Women present most commonly with galactorrhoea (up to 90% of cases), menstrual disturbance, reduced fertility and libido. Men present with galactorrhoea (10-20% of men), loss of libido, erectile dysfunction and occasionally, reduced fertility and gynaecomastia.

In both sexes, a macroadenoma (>10 mm in diameter) can cause mass effects, which may result in visual-field defects or headache.

In both sexes, long-standing hyperprolactinaemia can lead to low bone mineral density with an increased risk of developing osteoporosis.

A single measurement of prolactin level is usually adequate to diagnose hyperprolactinaemia. However, when the result is borderline, the test should be repeated. The pain/stress of venepuncture can actually elevate prolactin levels. Obviously, pregnancy must be excluded, if relevant. Renal and thyroid function tests should also be performed.

When other causes of hyperprolactinaemia have been excluded, the diagnosis of a prolactinoma is usually confirmed by a pituitary MRI scan.

Patients with macroadenomas that extend beyond the sella should undergo testing to exclude visual field defects, and also dynamic testing of the anterior pituitary function to exclude hypopituitarism.

Treatment of hyperprolactinaemia will vary according to the cause – for example, a drug review may be required where it is drug-related. The aim of treatment is to improve symptoms and avoid the long-term effects of oestrogen deficiency in women or testosterone deficiency in men.

Dopamine agonists suppress prolactin in most patients, normalise gonadal function and stop galactorrhoea. In patients with prolactinomas, they reduce the size of the tumour.2

Cabergoline and bromocriptine are both ergot-based dopamine receptor agonists. Cabergoline is the first-line treatment for prolactinomas as it has greater efficacy in suppressing prolactin secretion. It is better tolerated and has a more convenient dosing regimen when compared with bromocriptine.

The MHRA issued a warning in the past about the safety of dopamine agonists for treating hyperprolactinaemia, due to concerns about an association with chronic pleuropulmonary, pericardial and retroperitoneal fibrosis, and particularly fibrotic valvular heart disease.3

However, recent studies have not shown a clinically significant association between the use of ergot-derived dopamine agonist drugs for the treatment of hyperprolactinaemia and valvulopathy.4,5

In some patients with microprolactinomas, withdrawal of treatment can be tried after three years, as microprolactinomas can spontaneously resolve, especially after the menopause or pregnancy. Transsphenoidal surgery is an option in infertile patients who cannot tolerate or are resistant to dopamine agonists. It may also be performed if a macroadenoma does not shrink with drug treatment.

Definitive treatment depends on the size of the tumour and the patient’s wishes (including future fertility).

Over 90% of microadenomas remain stable or gradually reduce their secretion of prolactin. One third of patients with idiopathic hyperprolactinaemia improve without treatment. This is more common in women around their menopause.

However, recurrence rates of hyperprolactinaemia are as high as 80 per cent, and therefore the majority of patients require long-term medical treatment.

This is an updated version of an article that was first published in September 2009.

Useful website: Pituitary Foundation -www.pituitary.org.uk

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Hyperprolactinaemia: diagnosis and management – GP online

Yeovil Hospital sorry for charges of over 400 wrongly sent to stressed mum of disabled girl – Somerset Live

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Imagine you’re a busy mother-of-three with a daughter who has profound disabilities.

You have to visit Yeovil Hospital quite often on more than one occasion every week – you have a blue badge, your car registration is registered with the hospital.

And yet you keep getting issued with parking charges.

That’s what’s happened to Nicky Fordon from Ash six times in the last couple of months – the charges she has faced total more than 400.

On each occasion the ticket has been cancelled – but after she’s had to make yet another journey there to deal with it in person.

“It’s stressful, time-consuming and completely unnecessary,” said Mrs Fordon, 52.

“When I had the first one I was really worried – I couldn’t work out what I’d done.”

The hospital has admitted there is a problem with the system and apologised, but Mrs Fordon says she’s worried about vulnerable and elderly people who may be shelling out unnecessarily.

MORE: Yeovil Hospital’s new multi-storey car park opening is delayed for another two months

She was shocked to get the first ticket and studying it closely she realised that somehow the camera monitoring the entrance to the hospital had registered her as parking there and not in a disabled parking bay.

“It showed my car and registration and it said I’d stopped there for an hour and a half – but it could only have been for a few seconds while I waited for a parking bay to be free or to let someone out.

“I mean I was in the car and the brake lights were on!”

Mrs Fordon has to regularly visit the hospital with her daughter Rebecca who has learning disablities and suffers from a rare condition called diabetes insipidus and hypopituitarism.

It means she has to have regular appointments at Yeovil hospital to make sure her sodium levels are sufficient because she can’t retain liquids.

If they’re too low this can be dangerous and mean a trip to the Bristol Royal Infirmary.

MORE: New Boots branch to open in Yeovil Hospital later this month

“I feel like I spend my life at the hospital so it’s a real pain to have to go back with the tickets – there’s no number you can phone to talk to anyone, I’ve got to go in person.

“I think there must be loads of elderly people who just pay without questioning it.

“What’s going to happen when they open the new car park? Is it going to get any better?”

A Yeovil Hospital spokeswoman said: “We would like to apologise for the inconvenience caused to this lady who has received these fines in error.

“The spaces out of the front of the hospital are controlled by ParkingEye who use number-plate recognition cameras. We have assisted with dealing with each ticket on an individual basis but this issue will now be escalated to ParkingEye for them to investigate.

“This is an unusual case and we would encourage this lady to get back into contact with us so we can address her concerns.”

READ NEXT: Tributes to ‘an amazing’ Yeovil Town supporter, 103, who had soft spot for Terry Skiverton’s legs

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Yeovil Hospital sorry for charges of over 400 wrongly sent to stressed mum of disabled girl – Somerset Live

Evaluation of ICD-10 algorithms to identify hypopituitary patients in the Danish National Patient Registry – Dove Medical Press

Agnethe Berglund,1 Morten Olsen,2 Marianne Andersen,3 Eigil Husted Nielsen,4 Ulla Feldt-Rasmussen,5 Caroline Kistorp,6 Claus Hjbjerg Gravholt,1,7 Kirstine Stochhholm1,8

1Department of Endocrinology and Internal Medicine, 2Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, 3Department of Endocrinology, Odense University Hospital, Odense, 4Department of Endocrinology, Aalborg University Hospital, Aalborg, 5Department of Endocrinology, Rigshospitalet, Copenhagen University,Copenhagen, 6Department of Endocrinology, Herlev Hospital, Herlev, 7Department of Molecular Medicine, 8Department of Pediatrics, Center of Rare Diseases, Aarhus University Hospital, Aarhus, Denmark

Objective: Routinely collected health data may be valuable sources for conducting research. This study aimed to evaluate the validity of algorithms detecting hypopituitary patients in the Danish National Patient Registry (DNPR) using medical records as reference standard. Study design and setting: Patients with International Classification of Diseases (10th edition [ICD-10]) diagnoses of hypopituitarism, or other diagnoses of pituitary disorders assumed to be associated with an increased risk of hypopituitarism, recorded in the DNPR during 20002012 were identified. Medical records were reviewed to confirm or disprove hypopituitarism. Results: Hypopituitarism was confirmed in 911 patients. In a candidate population of 1,661, this yielded an overall positive predictive value (PPV) of 54.8% (95% confidence interval [CI]: 52.457.3). Using algorithms searching for patients recorded at least one, three or five times with a diagnosis of hypopituitarism (E23.0x) and/or at least once with a diagnosis of postprocedural hypopituitarism (E89.3x), PPVs gradually increased from 73.3% (95% CI: 70.675.8) to 83.3% (95% CI: 80.785.7). Completeness for the same algorithms, however, decreased from 90.8% (95% CI: 88.792.6) to 82.9% (95% CI: 80.385.3) respectively. Including data of hormone replacement in the same algorithms PPVs increased from 73.2% (95% CI: 70.675.7) to 82.6% (95% CI: 80.184.9) and completeness decreased from 94.3% (95% CI: 92.695.7) to 89.7% (95% CI: 87.591.6) with increasing records of E23.0x. Conclusion: The DNPR is a valuable data source to identify hypopituitary patients using a search criteria of at least five records of E23.0x and/or at least one record of E89.3x. Completeness is increased when including hormone replacement data in the algorithm. The consequences of misclassification must, however, always be considered.

Keywords: ICD-10 algorithms, registry health data, hypopituitarism

This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License. By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms.

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Evaluation of ICD-10 algorithms to identify hypopituitary patients in the Danish National Patient Registry – Dove Medical Press

Hypopituitarism in Children Causes, Symptoms, Treatment …

Hypopituitarism in Children (cont.) Hypopituitarism Treatment

Treatment primarily involves hormone replacement therapy.

Drugs used to treat hypopituitarism replace the deficient hormone.

Surgery may be performed if a tumor is present within or near the pituitary gland, depending on the type and location of the tumor, and depending on the symptoms being experienced.

The doctor or health care practitioner may schedule routine checkups every three months to monitor growth and development.

Frequent checkups for children on growth hormone replacement therapy may be scheduled to monitor progress and side effects.

A doctor who specializes in studying hormones (a pediatric endocrinologist) should supervise the treatment of children with hypopituitarism.

With appropriate treatment, the prognosis is very good.

The Magic Foundation

The Hormone Foundation

John A. Seibel, MD; Board Certified Internal Medicine with a subspecialty in Endocrinology & Metabolism

REFERENCE:

“Causes and clinical manifestations of central adrenal insufficiency in children” UpToDate.com

Medically Reviewed by a Doctor on 12/24/2015

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Hypopituitarism in Children Causes, Symptoms, Treatment …

What is Hypopituitarism, Pituitary Insufficiency | Hormone.org

What Is Hypopituitarism?

The pituitary gland is one of the smallest parts of the endocrine system, yet it is also one of the most important. Without this tiny gland functioning as it should, your body is not going to function well either. Hypopituitarism, also known as pituitary insufficiency, is one condition that affects this important gland and can impact the health and well-being of your entire body.

The pituitary gland is a small gland that sits at the base of the brain, right behind the nose and between the ears. This gland may be small, but its powerful hormones affect almost every area of the body. In fact, the gland is so important to the overall function of the body that it is sometimes called the “master gland.” The pituitary gland signals other glands in the body to produce their own hormones, and as such has a role to play in almost every bodily function. A deficiency in these hormones can affect many different functions, including reproduction, sexual health, growth and blood pressure.

Hypopituitarism is a condition that occurs when the pituitary gland does not produce enough of its important hormones. Because the hormones are lacking, the condition is sometimes called pituitary insufficiency. It can occur for a variety of reasons and cause a wide range of symptoms because of the far-reaching effects of the pituitary gland.

Hypopituitarism has a wide range of causes. Sometimes, tumors, also known as adenomas, in the pituitary gland can interfere with the production of pituitary hormones. While these tumors are rarely cancerous, they can have far-reaching effects.

Some patients who have undergone radiation treatment to remove pituitary gland tumors may notice a poor function of the gland. This occurs because the pituitary gland tissue is destroyed during the radiation treatment. Similarly, chemotherapy can destroy the tissue and leave the pituitary gland without proper function.

Patients who have had brain surgery or a traumatic brain injury may have a pituitary insufficiency. Severe bleeding on the brain or loss of blood, especially if it occurs during childbirth, can also have this impact. Patients who have had meningitis or tuberculosis may have damaged pituitary glands. In a small portion of patients, the cause is never found.

Pituitary insufficiency is a rare condition, but for those who have it, this disease can be life changing. While it can be controlled with medication, it must be dealt with consistently to ensure that the patient suffers no ill effects from the hormonal insufficiencies.

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What is Hypopituitarism, Pituitary Insufficiency | Hormone.org

Hypopituitarism-Panhypopituitarism

The pituitary gland produces a number of hormones, which are released into the blood to control other glands in the body (thyroid, adrenal, ovary or testicles). If the pituitary is not producing one or more of these hormones, the condition is called hypopituitarism. If all the hormones produced by the anterior pituitary are decreased, the condition is called panhypopituitarism. Hypopituitarism is most often caused by large benign tumors of the pituitary gland, or of the brain in the region of the hypothalamus. Pituitary underactivity may be caused by the direct pressure of the tumor mass on the normal pituitary or by the effects of surgery or radiotherapy used to treat the pituitary tumors.

Less frequently, hypopituitarism can be caused by infections in or around the brain (such as meningitis) or by severe blood loss, by head injury, or by other rare diseases. Some of the clinical features that may be associated with hypopituitarism include excessive tiredness and decreased energy, irregular periods (oligomenorrhea) or loss of normal menstrual function (amenorrhea), impotence (in men), infertility, increased sensitivity to cold, constipation, dry skin, low blood pressure and lightheadedness upon standing (postural hypotension). Treatment of hypopituitarism consists of long-term hormone replacement therapy, since pituitary hormone deficits are rarely reversed after tumor removal.

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Hypopituitarism-Panhypopituitarism

Hypopituitarism (Panhypopituitarism): Background …

Causes of pituitary insufficiency include pituitary adenomas or other intrasellar and parasellar tumors, inflammatory and infectious destruction, surgical removal, radiation-induced destruction of pituitary tissue, traumatic brain injury (TBI), subarachnoid hemorrhage, and postpartum pituitary necrosis (Sheehan syndrome). Similar diseases originating in the hypothalamus or pituitary stalk may also result in pituitary insufficiency.

Pituitary tumors, or adenomas, are the most common cause of hypopituitarism in adults, although traumatic brain injury as a cause is being more frequently recognized.

Hypopituitarism resulting from pituitary adenomas is due to impaired blood flow to the normal tissue, compression of normal tissue, or interference with the delivery of hypothalamic hormones via the hypothalamus-hypophysial portal system.

In primary pituitary destruction, the anterior pituitary is destroyed, causing a deficiency in some or all pituitary hormones, including prolactin. Disease involving the hypothalamus or pituitary stalk may cause pituitary hormone deficiency with an elevated serum prolactin. Pituitary tumors, or adenomas, can be secretory or nonsecretory. Approximately 30% of all macroadenomas larger than 10 mm produce at least 1 hormone.

Hypothalamic disease involves destruction of the hypothalamus. This causes a deficiency or loss of hypothalamic regulatory hormone input to the pituitary, which leads to the loss of anterior pituitary hormone secretion, with an elevated serum prolactin level. Loss of antidiuretic hormone (ADH) may have concomitant diabetes insipidus.

Hypersecretion of the secretory pituitary tumor hormone is suggestive of an adenoma. Another indication of a pituitary adenoma is a deficiency in some pituitary hormones with concomitant hyperprolactinemia. Normally, dopamine, produced in the hypothalamus, inhibits prolactin secretion by the anterior pituitary. Compressing the pituitary stalk decreases the inhibitory effect of dopamine and increases prolactin levels.

Longstanding target gland disease may result in hyperplasia of the relevant pituitary cell secreting the tropic hormone, the level of which would be elevated, with an enlarged pituitary gland simulating a mass. Although uncommon, this may appear to be a pituitary adenoma, but the target gland is not hyperfunctioning.

Another common intracranial tumor is craniopharyngioma, a squamous cell tumor that arises from remnants of the Rathke pouch. One third of these tumors extend into the sella, while approximately two thirds remain suprasellar.

Sheehan syndrome occurs with a large volume of postpartum hemorrhage. During pregnancy, the pituitary gland enlarges due to hyperplasia and hypertrophy of the lactotroph cells, which produce prolactin. The hypophyseal vessels, which supply the pituitary, constrict in response to decreasing blood volume, and subsequent vasospasm occurs, causing necrosis of the pituitary gland. The degree of necrosis correlates with the severity of the hemorrhage.

As many as 30% of women experiencing postpartum hemorrhage with hemodynamic instability may develop some degree of hypopituitarism. These patients can develop adrenal insufficiency, hypothyroidism, amenorrhea, diabetes insipidus, and an inability to breastfeed (an early symptom). Lymphocytic hypophysitis occurs most commonly in the postpartum state and may appear as Sheehan syndrome with postpartum hypopituitarism.

Pituitary apoplexy denotes the sudden destruction of the pituitary tissue resulting from infarction or hemorrhage into the pituitary. The most likely cause of the apoplexy is brain trauma; however, it can occur in patients with diabetes mellitus, pregnancy, sickle cell anemia, blood dyscrasias or anticoagulation, or increased intracranial pressure. Apoplexy usually spares the posterior pituitary and solely affects the anterior pituitary. In patients with such underlying diseases, Sheehan syndrome can occur with lesser degrees of postpartum hemorrhage or hypotension.

Head trauma from a motor vehicle accident, a fall, or a projectile can cause hypopituitarism by direct damage to the pituitary or by injuring the pituitary stalk or the hypothalamus. Hypopituitarism may occur immediately, or it may develop months or years later. Recovery is uncommon. Many studies show an incidence of 15-40%, [2] but a study by Kokshoorn et al found the incidence of posttraumatic hypopituitarism to be low. [3]

Other causes of hypopituitarism include empty sella syndrome and infiltrative diseases. Empty sella syndrome occurs when the arachnoid herniates into the sella turcica through an incompetent sellar diaphragm and flattens the pituitary against bone, but resulting pituitary insufficiency is uncommon. Infiltrative diseases, such as Wegener granulomatosis and sarcoidosis, can cause destruction of the anterior pituitary. Lymphocytic hypophysitis is an autoimmune destructive disease that may be directed towards the pituitary or its stalk.

Physiologic or psychological states can influence the hypothalamus by impairing synthesis and secretion of regulating hormones. For example, poor nutrition may impair the hypothalamic secretion of gonadotropin-releasing hormone (GnRH), resulting in reversible pituitary gonadotropin deficiency. Medications may affect measured hormone levels, such as opioids decreasing serum LH and testosterone.

The degree of hormone deficiency varies greatly and depends on the extent of the process and its location. Some functional causes include emotional disorders, changes in body weight, habitual exercise, anorexia, bulimia, congestive heart failure (CHF), renal failure, and certain medications.

Hypopituitarism occurs in adult patients after cranial radiotherapy performed to treat nonpituitary tumors. Thus, patients who undergo cranial radiotherapy should be periodically assessed for pituitary functions. [4]

Additional causes of hypopituitarism include the following:

With regard to item 9 above, in a study of 435 patients, Fatemi et al found evidence that the likelihood of hypopituitarism development after transsphenoidal adenoma removal is higher when the tumor is larger than 20 mm. [6] In contrast, some with hypopituitarism prior to adenomectomy may have improved pituitary function following surgery, if the cause of the hypopituitarism was increased suprasellar pressure resulting from the mass itself.

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Hypopituitarism (Panhypopituitarism): Background …

Suzy’s story – hypopituitarism | The Pituitary Foundation

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When I was between five and six, I attended balletclasses. One day the ballet teacher was observing myarm positions and could not understand why my rightarm did not look the correct shape in certain positions.

The ballet teacher decided to ask my mum if I had anyproblems with it i.e. had I broken it at any time? My mumwas not aware of any problems and had not noticed it.

My mum and dad took me to our local GP, who afterlooking at my arm, decided to refer me to a bonespecialist at the Royal National Orthopaedic Hospital inLondon. I remember thinking it was fun, as I got to goon a train, a few x-rays were taken and afterwards Iwas diagnosed with Ollier disease (discondroplasia ofthe bone) this was managed by a yearly appointment tocheck things had not changed.

At around age of 11 to 12, they found that I also had itin my left ankle. We were told if they did not correct thetwisted ankle it would cause problems when I got olderwith walking.I went into hospital when I was 13 years old. This was ahard thing to deal with but luckily the hospital I went intoStanmore RNOH, Edgware was brilliant. My mum wasable to stay with me as there were parents housing onsite but it was hard on my sisters as my mum was awayfrom home a lot.

I was in hospital for nearly four months, as I caught amajor infection in the wound following surgery. It tookhold quickly. The plaster cast that they put on in theatresuddenly turned yellow; they took me into the treatmentroom, my dad came in and when they took the plaster offthey undone the stitches and the wound spilled infectioneverywhere; I remember my dad saying he could seethe bone beneath – it was bad!

I was put on IV antibiotics, but my veins kept collapsingwhich was very painful, and it would always happen lateat night. I had a fantastic friend; she sat with me everytime they needed to change the needle and she wassuch a wonderful person; she had gone through herown trauma by losing her leg due to cancer, but shewas such a strong person.

The nurses, doctors and domestic staff made my timein there enjoyable I made some good friends who I wishI had stayed in touch with but I was young and thoughtit did not matter.About a year or so after that surgery, I was back inhospital having my leg lengthened as the first surgeryhad left me with a 2 inch limp, so that I would notdevelop a back problem; they made the decision to lengthenit.

I went into surgery and had an external fixate attachedto my right tibia. I stayed in hospital for 3 months.Again, it was made fun but this time I was studying formy GCSEs so I had to do a lot more schooling, but itpassed the time as we had a giggle. We had some roughtimes too, but because most of the kids in there werenot poorly and as it was corrective surgery, we were allable bodied, so we would all take our wheelchairs downto the hospital shop; some would be on crutches, but wewere allowed our own space.

I saw a lot in my time in that hospital but it made methe person I am, because when you witness somebodyelses pain and it is greater than your own, you realisethat there is always someone worse off than yourself.I came home with the fixator still attached and went backto school; they were very supportive and my friendsthere were great, but I got a lot of attention as kids hadnot seen this device before, so they were curious butnever cruel.I lengthened it millimetre by millimetre, so it took alongtime, but once it was done I had no limp and things wereback to normal.

Once all that was finished with I then got on with myschooling; passed my GCSEs and left school. I thenmet my husband; I was age 16 and he lived in Harlow,Essex and I commuted to Harlow every weekend;during the week I worked in a bakery and went to nightcollege to learn cake decorating.

My consultant decided to lengthen my ulna bone as it wasshort. So once again I was in Stanmore hospital havinga fixator attached to my arm; once the lengthening wascomplete I had an op to take bone from my hip, as newbone had not grown between the gap; this was painfulas the removal of bone from the hip has to be chiselled.

Then, in early 1999 I was at work and my face suddenlystarted to tingle and went very red and numb in thespace of a couple of hours. I stayed at work and thoughtit was just an infection of some sort but as the daywent on I decided to go to my GP where by he gaveme antibiotics and said it could be the trigeminal nerve,I took them but the problem continued over the nextcouple of weeks and I was back and forward to my GP.When I was pregnant with my son (1997) I had to havea grommet fitted in my ear as it blocked up.

As the GP doc could not think what could be causingthe numbness, he sent me back to Dr OMalley at MiltonKeynes hospital; I went for the appointment and thedoctor decided to order an MRI scan. I had the scanand then went back to see Dr OMalley; I took my dadwith me and we were stunned by what we were beingshown – a tumour growing from the base of my skull thesize of an orange. It had grown up and into the opticnerve and damaged the nerves surrounding the rightside of my face; that is why I had numbness, rednessand a few painful headaches.

I was then referred from there to Oxford hospital where Isaw a Dr Kerr; they did not want to do a biopsy but theybrought in a specialist on tumours connected to Ollierdisease – a Dr Cadu Hudson. I was diagnosed witha chondrosarcoma, which is the rare form of maffuccisyndrome; these two diseases run side by side but itsrare to have both.

They talked us through the steps of how they weregoing to go about sorting the problem as the tumourwas very close to the carotid artery, so it was going tobe difficult to remove.The doctors thought it had been growing for about tenyears; as they are slow growing tumours they did not wantto rush in.

I had a Robbie Williams concert to go to in the September,Neil had brought me the tickets for Christmas; I loveRobbie and really wanted to go, so Dr Kerr said wewould hold off until after then as he knew the op wouldbe difficult – he implied I was to do and experience asmuch as I could. The only trouble was that the tumourwas not going to hold off, so in the May, I was rushed intoOxford hospital with a major headache. I was in over theweekend and Neil had gone home for the weekend asit was my mums 50th party and their 25th anniversary.It was hard for Neil and my family to celebrate it withoutme with them.

Over the weekend the headache got worse. ComeMonday morning, I had had a really bad night and theteam thought the tumour could have been bleeding!! Nopainkiller was working and I was given IV morphine. Iwas in so much pain in the morning, Dr Cadu Hudsonhad to come in as Dr Kerr was on holiday and theywanted to do surgery early that morning; Neil wascalled and he was on his way. They told me the risksthat were involved but I would not let them take medown to surgery until Neil arrived. My mum and dadwere not told how bad it was due to them being away,so I wanted him there to help me make some important decisions. I was so scared and confused; the consultantwas phoning Neil to find out how far away he was as itwas getting harder to hold off.

When Neil arrived, I then felt I could have the surgeryas I could relay things to him and say what I needed tosay to him and Ryan. I had the surgery; it went well butthe damage was already done to my eye, eye lid andface and I was in intensive care for three days – thesedays I dont remember. It took only ten days after that torecover and I went home to recover further.Once again, I had very good help and treatment atOxford from the nurses and doctors and I think theworld of Dr Cadu Hudson and Dr Kerr; they are veryclever people and special surgeons.I made it to the Robbie concert, three months aftersurgery and it was fantastic.I was kept a very close eye on at the clinic but theydecided a course of radiation would be needed to makesure that the tumour had stopped growing; but thething was, the radiation could not be done with normal radiation, I had to go to Paris for Proton and Photontherapy, at the IGR hospital Paris. The governmentwould pay for treatment but we had to fund the eightweek stay so family, friends, work friends and the localpaper helped find the money by fund raising, so I couldbe comfortable out there and that our son could belooked after while Neil was with me.

It was a hard time as we were away from our four yearold son, in a foreign country trying to communicate ourproblems when I did not speak French; Neil knew somebut only the kind of stuff for holiday visits, not hospitaltranslation. We had help from a lovely multilingual manin the hospital but it was very hard having radiation andnot being able to understand the instructions.Again the treatment and care we received was fantastic;we had two hospitals to visit- one that gave me theProton therapy at the IGR, and then we moved to thesecond hotel so I could have the second part of theradiation Photon therapy.

When I got back from Paris I was then referred to the endocrinology unit at the Churchill Radcliffe hospitalwhere I was kept a close eye on, as I was developingsymptoms of pituitary gland failure. They diagnosedhypopituitarism and I was gradually put on the relevanttablets for each part of pituitary shutdown.I am now on thyroxin, hydrocortisone, Premique HRTand growth hormone. I have a neck problem also due tothe radiation, so I am on pregabalin and ranitidine dueto the side effects of the pregabalin.Living with this pituitary problem is harder thandealing with the tumour itself and with my bonedisease put together, I am a different person. When Igot married to Neil six years ago, I was not well, butI weighed 10 stones 3lbs. Now I have no control overmy weight and I am 16 stones and 10lbs. You mightsay (and often I hear people say) But you are alive!!Yes I am, but its easy for them to say that as they are not inmy situation. It is a daily battle to remember to take mydrugs and to stay positive; deep depression, fatigue,keeping up with my son and not being able to get aboutdue to muscle fatigue. As I have low levels of growthhormone, this is being replaced slowly due to thepressure in my brain increasing the first time round.I am not a person to sit around and feel sorry for myself;I have continued to work with the help of my employerand friends, but have just been made redundant soam worried now if any employer will employ me. Mypositivity has come hugely from my husband Neil; hehas had to go through a lot of changes with me and stillhe is here supporting me.

I would like my story to be told as I feel I havebeen through a lot, but I still keep smiling, fundraising, working and generally staying positiveand as I said before There is always someonein more pain than you.If I can bring awareness and support, any research intoall of the diseases I have I will work to do that.

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Suzy’s story – hypopituitarism | The Pituitary Foundation

Hypopituitarism – Wikipedia

Hypopituitarism is the decreased (hypo) secretion of one or more of the eight hormones normally produced by the pituitary gland at the base of the brain.[1][2] If there is decreased secretion of most pituitary hormones, the term panhypopituitarism (pan meaning “all”) is used.[3]

The signs and symptoms of hypopituitarism vary, depending on which hormones are undersecreted and on the underlying cause of the abnormality. The diagnosis of hypopituitarism is made by blood tests, but often specific scans and other investigations are needed to find the underlying cause, such as tumors of the pituitary, and the ideal treatment. Most hormones controlled by the secretions of the pituitary can be replaced by tablets or injections. Hypopituitarism is a rare disease, but may be significantly underdiagnosed in people with previous traumatic brain injury.[1] The first description of the condition was made in 1914 by the German physician Dr Morris Simmonds.[4]

The hormones of the pituitary have different actions in the body, and the symptoms of hypopituitarism therefore depend on which hormone is deficient. The symptoms may be subtle and are often initially attributed to other causes.[1][5] In most of the cases, three or more hormones are deficient.[6] The most common problem is insufficiency of follicle-stimulating hormone (FSH) and/or luteinizing hormone (LH) leading to sex hormone abnormalities. Growth hormone deficiency is more common in people with an underlying tumor than those with other causes.[1][6]

Sometimes, there are additional symptoms that arise from the underlying cause; for instance, if the hypopituitarism is due to a growth hormone-producing tumor, there may be symptoms of acromegaly (enlargement of the hands and feet, coarse facial features), and if the tumor extends to the optic nerve or optic chiasm, there may be visual field defects. Headaches may also accompany pituitary tumors,[1] as well as pituitary apoplexy (infarction or haemorrhage of a pituitary tumor) and lymphocytic hypophysitis (autoimmune inflammation of the pituitary).[7] Apoplexy, in addition to sudden headaches and rapidly worsening visual loss, may also be associated with double vision that results from compression of the nerves in the adjacent cavernous sinus that control the eye muscles.[8]

Pituitary failure results in many changes in the skin, hair and nails as a result of the absence of pituitary hormone action on these sites.[9]

Deficiency of all anterior pituitary hormones is more common than individual hormone deficiency.

Deficiency of luteinizing hormone (LH) and follicle-stimulating hormone (FSH), together referred to as the gonadotropins, leads to different symptoms in men and women. Women experience oligo- or amenorrhea (infrequent/light or absent menstrual periods respectively) and infertility. Men lose facial, scrotal and trunk hair, as well as suffering decreased muscle mass and anemia. Both sexes may experience a decrease in libido and loss of sexual function, and have an increased risk of osteoporosis (bone fragility). Lack of LH/FSH in children is associated with delayed puberty.[1][5]

Growth hormone (GH) deficiency leads to a decrease in muscle mass, central obesity (increase in body fat around the waist) and impaired attention and memory. Children experience growth retardation and short stature.[1][5]

Adrenocorticotropic hormone (ACTH) deficiency leads to adrenal insufficiency, a lack of production of glucocorticoids such as cortisol by the adrenal gland. If the problem is chronic, symptoms consist of fatigue, weight loss, failure to thrive (in children), delayed puberty (in adolescents), hypoglycemia (low blood sugar levels), anemia and hyponatremia (low sodium levels). If the onset is abrupt, collapse, shock and vomiting may occur.[1][5] ACTH deficiency is highly similar to primary Addison’s disease, which is cortisol deficiency as the result of direct damage to the adrenal glands; the latter form, however, often leads to hyperpigmentation of the skin, which does not occur in ACTH deficiency.[10]

Thyroid-stimulating hormone (TSH) deficiency leads to hypothyroidism (lack of production of thyroxine (T4) and triiodothyronine (T3) in the thyroid). Typical symptoms are tiredness, intolerance to cold, constipation, weight gain, hair loss and slowed thinking, as well as a slowed heart rate and low blood pressure. In children, hypothyroidism leads to delayed growth and in extreme inborn forms to a syndrome called cretinism.[1][5]

Prolactin (PRL) plays a role in breastfeeding, and inability to breastfeed may point at abnormally low prolactin levels.[7]

Antidiuretic hormone (ADH) deficiency leads to the syndrome of diabetes insipidus (unrelated to diabetes mellitus): inability to concentrate the urine, leading to polyuria (production of large amounts of clear urine) that is low in solutes, dehydration andin compensationextreme thirst and constant need to drink (polydipsia), as well as hypernatremia (high sodium levels in the blood).[11] ADH deficiency may be masked if there is ACTH deficiency, with symptoms only appearing when cortisol has been replaced.[7]

Oxytocin (OXT) deficiency generally causes few symptoms, as it is only required at the time of childbirth and breastfeeding.[1]

Kallmann syndrome causes deficiency of the gonadotropins only. Bardet-Biedl syndrome and Prader-Willi syndrome have been associated with pituitary hormone deficiencies.

The pituitary gland is located at the base of the brain, and intimately connected with the hypothalamus. It consists of two lobes: the posterior pituitary, which consists of nervous tissue branching out of the hypothalamus, and the anterior pituitary, which consists of hormone-producing epithelium. The posterior pituitary secretes antidiuretic hormone, which regulates osmolarity of the blood, and oxytocin, which causes contractions of the uterus in childbirth and participates in breastfeeding.[12]

The pituitary develops in the third week of embryogenesis from interactions between the diencephalon part of the brain and the nasal cavity. The brain cells secrete FGF-8, Wnt5a and BMP-4, and the oral cavity BMP-2. Together, these cellular signals stimulate a group of cells from the oral cavity to form Rathke’s pouch, which becomes independent of the nasal cavity and develops into the anterior pituitary; this process includes the suppression of production of a protein called Sonic hedgehog by the cells of Rathke’s pouch.[14] The cells then differentiate further into the various hormone-producing cells of the pituitary. This requires particular transcription factors that induce the expression of particular genes. Some of these transcription factors have been found to be deficient in some forms of rare combined pituitary hormone deficiencies (CPHD) in childhood. These are HESX1, PROP1, POU1F1, LHX3, LHX4, TBX19, SOX2 and SOX3. Each transcription factor acts in particular groups of cells. Therefore, various genetic mutations are associated with specific hormone deficiencies.[14][15] For instance, POU1F1 (also known as Pit-1) mutations cause specific deficiencies in growth hormone, prolactin and TSH.[12][14][15] In addition to the pituitary, some of the transcription factors are also required for the development of other organs; some of these mutations are therefore also associated with specific birth defects.[14][15]

Most of the hormones in the anterior pituitary are each part of an axis that is regulated by the hypothalamus. The hypothalamus secretes a number of releasing hormones, often according to a circadian rhythm, into blood vessels that supply the anterior pituitary; most of these are stimulatory (thyrotropin-releasing hormone, corticotropin-releasing hormone, gonadotropin-releasing hormone and growth hormone-releasing hormone), apart from dopamine, which suppresses prolactin production.[16] In response to the releasing hormone rate, the anterior pituitary produces its hormones (TSH, ACTH, LH, FSH, GH) which in turn stimulate effector hormone glands in the body, while prolactin (PRL) acts directly on the breast gland. Once the effector glands produce sufficient hormones (thyroxine, cortisol, estradiol or testosterone and IGF-1), both the hypothalamus and the pituitary cells sense their abundance and reduce their secretion of stimulating hormones. The hormones of the posterior pituitary are produced in the hypothalamus and are carried by nerve endings to the posterior lobe; their feedback system is therefore located in the hypothalamus, but damage to the nerve endings would still lead to a deficiency in hormone release.[1]

Unless the pituitary damage is being caused by a tumor that overproduces a particular hormone, it is the lack of pituitary hormones that leads to the symptoms described above, and an excess of a particular hormone would indicate the presence of a tumor. The exception to this rule is prolactin: if a tumor compresses the pituitary stalk, a decreased blood supply means that the lactotrope cells, which produce prolactin, are not receiving dopamine and therefore produce excess prolactin. Hence, mild elevations in prolactin are attributed to stalk compression. Very high prolactin levels, though, point more strongly towards a prolactinoma (prolactin-secreting tumor).[5][17]

The diagnosis of hypopituitarism is made on blood tests. Two types of blood tests are used to confirm the presence of a hormone deficiency: basal levels, where blood samples are takenusually in the morningwithout any form of stimulation, and dynamic tests, where blood tests are taken after the injection of a stimulating substance. Measurement of ACTH and growth hormone usually requires dynamic testing, whereas the other hormones (LH/FSH, prolactin, TSH) can typically be tested with basal levels. There is no adequate direct test for ADH levels, but ADH deficiency can be confirmed indirectly; oxytocin levels are not routinely measured.[1]

Generally, the finding of a combination of a low pituitary hormone together with a low hormone from the effector gland is indicative of hypopituitarism.[12] Occasionally, the pituitary hormone may be normal but the effector gland hormone decreased; in this case, the pituitary is not responding appropriately to effector hormone changes, and the combination of findings is still suggestive of hypopituitarism.[5]

Levels of LH/FSH may be suppressed by a raised prolactin level, and are therefore not interpretable unless prolactin is low or normal. In men, the combination of low LH and FSH in combination with a low testosterone confirms LH/FSH deficiency; a high testosterone would indicate a source elsewhere in the body (such as a testosterone-secreting tumor). In women, the diagnosis of LH/FSH deficiency depends on whether the woman has been through the menopause. Before the menopause, abnormal menstrual periods together with low estradiol and LH/FSH levels confirm a pituitary problem; after the menopause (when LH/FSH levels are normally elevated and the ovaries produce less estradiol), inappropriately low LH/FSH alone is sufficient.[1] Stimulation tests with GnRH are possible, but their use is not encouraged.[5][7]

For TSH, basal measurements are usually sufficient, as well as measurements of thyroxine to ensure that the pituitary is not simply suppressing TSH production in response to hyperthyroidism (an overactive thyroid gland). A stimulation test with thyrotropin-releasing hormone (TRH) is not regarded as useful.[7] Prolactin can be measured by basal level, and is required for the interpretation of LH and FSH results in addition to the confirmation of hypopituitarism or diagnosis of a prolactin-secreting tumor.[1]

Growth hormone deficiency is almost certain if all other pituitary tests are also abnormal, and insulin-like growth factor 1 (IGF-1) levels are decreased. If this is not the case, IGF-1 levels are poorly predictive of the presence of GH deficiency; stimulation testing with the insulin tolerance test is then required. This is performed by administering insulin to lower the blood sugar to a level below 2.2mmol/l. Once this occurs, growth hormone levels are measured. If they are low despite the stimulatory effect of the low blood sugars, growth hormone deficiency is confirmed. The test is not without risks, especially in those prone to seizures or are known to have heart disease, and causes the unpleasant symptoms of hypoglycemia.[1][5] Alternative tests (such as the growth hormone releasing hormone stimulation test) are less useful, although a stimulation test with arginine may be used for diagnosis, especially in situations where an insulin tolerance test is thought to be too dangerous.[18] If GH deficiency is suspected, and all other pituitary hormones are normal, two different stimulation tests are needed for confirmation.[7]

If morning cortisol levels are over 500nmol/l, ACTH deficiency is unlikely, whereas a level less than 100 is indicative. Levels between 100-500 require a stimulation test.[5] This, too, is done with the insulin tolerance test. A cortisol level above 500 after achieving a low blood sugar rules out ACTH deficiency, while lower levels confirm the diagnosis. A similar stimulation test using corticotropin-releasing hormone (CRH) is not sensitive enough for the purposes of the investigation. If the insulin tolerance test yields an abnormal result, a further test measuring the response of the adrenal glands to synthetic ACTH (the ACTH stimulation test) can be performed to confirm the diagnosis.[19] Stimulation testing with metyrapone is an alternative.[19] Some suggest that an ACTH stimulation test is sufficient as first-line investigation, and that an insulin tolerance test is only needed if the ACTH test is equivocal.[5][7] The insulin tolerance test is discouraged in children.[5] None of the tests for ACTH deficiency are perfect, and further tests after a period of time may be needed if initial results are not conclusive.[1]

Symptoms of diabetes insipidus should prompt a formal fluid deprivation test to assess the body’s response to dehydration, which normally causes concentration of the urine and increasing osmolarity of the blood. If these parameters are unchanged, desmopressin (an ADH analogue) is administered. If the urine then becomes concentrated and the blood osmolarity falls, there is a lack of ADH due to lack of pituitary function (“cranial diabetes insipidus”). In contrast, there is no change if the kidneys are unresponsive to ADH due to a different problem (“nephrogenic diabetes insipidus”).[1]

If one of these tests shows a deficiency of hormones produced by the pituitary, magnetic resonance imaging (MRI) scan of the pituitary is the first step in identifying an underlying cause. MRI may show various tumors and may assist in delineating other causes. Tumors smaller than 1cm are referred to as microadenomas, and larger lesions are called macroadenomas.[1]Computed tomography with radiocontrast may be used if MRI is not available.[7] Formal visual field testing by perimetry is recommended, as this would show evidence of optic nerve compression by a tumor.[7]

Other tests that may assist in the diagnosis of hypopituitarism, especially if no tumor is found on the MRI scan, are ferritin (elevated in hemochromatosis), angiotensin converting enzyme (ACE) levels (often elevated in sarcoidosis), and human chorionic gonadotropin (often elevated in tumor of germ cell origin). If a genetic cause is suspected, genetic testing may be performed.[7]

Treatment of hypopituitarism is threefold: removing the underlying cause, treating the hormone deficiencies, and addressing any other repercussions that arise from the hormone deficiencies.[1]

Pituitary tumors require treatment when they are causing specific symptoms, such as headaches, visual field defects or excessive hormone secretion. Transsphenoidal surgery (removal of the tumor by an operation through the nose and the sphenoidal sinuses) may, apart from addressing symptoms related to the tumor, also improve pituitary function, although the gland is sometimes damaged further as a result of the surgery. When the tumor is removed by craniotomy (opening the skull), recovery is less likelybut sometimes this is the only suitable way to approach the tumor.[1][17] After surgery, it may take some time for hormone levels to change significantly. Retesting the pituitary hormone levels is therefore performed 2 to 3 months later.[5]

Prolactinomas may respond to dopamine agonist treatmentmedication that mimics the action of dopamine on the lactrotrope cells, usually bromocriptine or cabergoline. This approach may improve pituitary hormone secretion in more than half the cases, and make supplementary treatment unnecessary.[1][5][17][20]

Other specific underlying causes are treated as normally. For example, hemochromatosis is treated by venesection, the regular removal of a fixed amount of blood. Eventually, this decreases the iron levels in the body and improves the function of the organs in which iron has accumulated.[21]

Most pituitary hormones can be replaced indirectly by administering the products of the effector glands: hydrocortisone (cortisol) for adrenal insufficiency, levothyroxine for hypothyroidism, testosterone for male hypogonadism, and estradiol for female hypogonadism (usually with a progestogen to inhibit unwanted effects on the uterus). Growth hormone is available in synthetic form, but needs to be administered parenterally (by injection). Antidiuretic hormone can be replaced by desmopressin (DDAVP) tablets or nose spray. Generally, the lowest dose of the replacement medication is used to restore wellbeing and correct the deranged results, as excessive doses would cause side-effects or complications.[1][5][7] Those requiring hydrocortisone are usually instructed to increase their dose in physically stressful events such as injury, hospitalization and dental work as these are times when the normal supplementary dose may be inadequate, putting the patient at risk of adrenal crisis.[5][12]

Long-term follow up by specialists in endocrinology is generally needed for people with known hypopituitarism. Apart from ensuring the right treatment is being used and at the right doses, this also provides an opportunity to deal with new symptoms and to address complications of treatment.[5][7]

Difficult situations arise in deficiencies of the hypothalamus-pituitary-gonadal axis in people (both men and women) who experience infertility; infertility in hypopituitarism may be treated with subcutaneous infusions of FSH, human chorionic gonadotropinwhich mimics the action of LHand occasionally GnRH.[1][5][7]

Several hormone deficiencies associated with hypopituitarism may lead to secondary diseases. For instance, growth hormone deficiency is associated with obesity, raised cholesterol and the metabolic syndrome, and estradiol deficiency may lead to osteoporosis. While effective treatment of the underlying hormone deficiencies may improve these risks, it is often necessary to treat them directly.[5]

Several studies have shown that hypopituitarism is associated with an increased risk of cardiovascular disease and some also an increased risk of death of about 50% to 150% the normal population.[5][12] It has been difficult to establish which hormone deficiency is responsible for this risk, as almost all patients studied had growth hormone deficiency.[7] The studies also do not answer the question as to whether the hypopituitarism itself causes the increased mortality, or whether some of the risk is to be attributed to the treatments, some of which (such as sex hormone supplementation) have a recognized adverse effect on cardiovascular risk.[7]

The largest study to date followed over a thousand people for eight years; it showed an 87% increased risk of death compared to the normal population. Predictors of higher risk were: female sex, absence of treatment for sex hormone deficiency, younger age at the time of diagnosis, and a diagnosis of craniopharyngioma. Apart from cardiovascular disease, this study also showed an increased risk of death from lung disease.[7][22]

Quality of life may be significantly reduced, even in those people on optimum medical therapy. Many report both physical and psychological problems. It is likely that the commonly used replacement therapies still do not completely mimic the natural hormone levels in the body.[5] Health costs remain about double those of the normal population.[5]

Hypopituitarism is usually permanent. It requires lifelong treatment with one or more medicines.

There is only one study that has measured the prevalence (total number of cases in a population) and incidence (annual number of new cases) of hypopituitarism.[1] This study was conducted in Northern Spain and used hospital records in a well-defined population. The study showed that 45.5 people out of 100,000 had been diagnosed with hypopituitarism, with 4.2 new cases per year.[6] 61% were due to tumors of the pituitary gland, 9% due to other types of lesions, and 19% due to other causes; in 11% no cause could be identified.[1][6]

Recent studies have shown that people with a previous traumatic brain injury, spontaneous subarachnoid hemorrhage (a type of stroke) or radiation therapy involving the head have a higher risk of hypopituitarism.[23] After traumatic brain injury, as much as a quarter have persistent pituitary hormone deficiencies.[24] Many of these people may have subtle or non-specific symptoms that are not linked to pituitary problems but attributed to their previous condition. It is therefore possible that many cases of hypopituitarism remain undiagnosed, and that the annual incidence would rise to 31 per 100,000 annually if people from these risk groups were to be tested.[1]

The pituitary was known to the ancients, such as Galen, and various theories were proposed about its role in the body, but major clues as to the actual function of the gland were not advanced until the late 19th century, when acromegaly due to pituitary tumors was described.[25] The first known report of hypopituitarism was made by the German physician and pathologist Dr Morris Simmonds. He described the condition on autopsy in a 46-year-old woman who had suffered severe puerperal fever eleven years earlier, and subsequently suffered amenorrhea, weakness, signs of rapid aging and anemia. The pituitary gland was very small and there were few remnants of both the anterior and the posterior pituitary.[1][4] The eponym Simmonds’ syndrome is used infrequently for acquired hypopituitarism, especially when cachexia (general ill health and malnutrition) predominates.[26][27] Most of the classic causes of hypopituitarism were described in the 20th century; the early 21st century saw the recognition of how common hypopituitarism could be in previous head injury victims.[1]

Until the 1950s, the diagnosis of pituitary disease remained based on clinical features and visual field examination, sometimes aided by pneumoencephalography and X-ray tomography. Nevertheless, the field of pituitary surgery developed during this time. The major breakthrough in diagnosis came with the discovery of the radioimmunoassay by Rosalyn Yalow and Solomon Berson in the late 1950s.[28] This allowed the direct measurement of the hormones of the pituitary, which as a result of their low concentrations in blood had previously been hard to measure.[25] Stimulation tests were developed in the 1960s, and in 1973 the triple bolus test was introduced, a test that combined stimulation testing with insulin, GnRH and TRH.[29] Imaging of the pituitary, and therefore identification of tumors and other structural causes, improved radically with the introduction of computed tomography in the late 1970s and magnetic resonance imaging in the 1980s.[25]

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Hypopituitarism – Wikipedia

Hypopituitarism Hypopituitarism

Hypopituitarism Definition

Hypopituitarism is loss of function in an endocrine gland due to failure of the pituitary gland to secrete hormones which stimulate that glands function. The pituitary gland is located at the base of the brain. Patients diagnosed with hypopituitarism may be deficient in one single hormone, several hormones, or have complete pituitary failure.

The pituitary is a pea-sized gland located at the base of the brain, and surrounded by bone. The hypothalamus, another endocrine organ in the brain, controls the function of the pituitary gland by providing hormonal orders. In turn, the pituitary gland regulates the many hormones that control various functions and organs within the body. The posterior pituitary acts as a sort of storage area for the hypothalamus and passes on hormones that control function of the muscles and kidneys. The anterior pituitary produces its own hormones which help to regulate several endocrine functions.

In hypopituitarism, something interferes with the production and release of these hormones, thus affecting the function of the target gland. Commonly affected hormones may include:

Gonadotropin deficiency involves two distinct hormones affecting the reproductive system. Luteinizing hormone (LH) stimulates the testes in men and the ovaries in women. This deficiency can affect fertility in men and women and menstruation in women. Follicle-stimulating hormone (FSH) has similar effects to LH.

Also known as corticotropin, adrenocorticotopic hormone (ACTH) stimulates the adrenal gland to produce a hormone similar to cortisone, called cortisol. The loss of this hormone can lead to serious problems.

Growth hormone (GH) regulates the bodys growth. Patients who lose supply of this hormone before physical maturity will suffer impaired growth. Loss of the hormone can also affect adults.

Deficiency of a single pituitary hormone occurs less commonly than deficiency of more than one hormone. Sometimes referred to as progressive pituitary hormone deficiency or partial hypopituitarism, there is usually a predictable order of hormone loss. Generally, growth hormone is lost first, then luteinizing hormone deficiency follows. The loss of follicle-stimulating hormone, thyroid stimulating hormone and adrenocorticotopic hormones follow much later. The progressive loss of pituitary hormone secretion is usually a slow process, which can occur over a period of months or years. Hypopituitarism does occasionally start suddenly with rapid onset of symptoms.

This condition represents the loss of all hormones released by the anterior pituitary gland. Panhypopituitarism is also known as complete pituitary failure.

There are three major mechanisms which lead to the development of hypopituitarism. The first involves decreased release of hypothalamic hormones that stimulate pituitary function. The cause of decreased hypothalamic function may be congenital or acquired through interference such as tumors, inflammation, infection, mass lesions or interruption of blood supply. A second category of causes is any event or mass which interrupts the delivery of hormones from the hypothalamus. These may include particular tumors and aneurysms. Damage to the pituitary stalk from injury or surgery can also lead to hypopituitarism.

Hypopituitarism is a partial or complete insufficiency of pituitary hormone secretion that may derive from pituitary or hypothalamic disease. The onset can

Read more: Pediatric Hypopituitarism: Background, Etiology, Epidemiology

Symptoms of Hypopituitarism

The list of signs and symptoms mentioned in various sources for Hypopituitarism includes the 21 symptoms listed below:

Research symptoms & diagnosis of Hypopituitarism:

Review the available symptom checkers for these symptoms of Hypopituitarism:

Review the available Assessment Questionnaires for the symptoms of Hypopituitarism:

Read information about complications of Hypopituitarism.

Do I have Hypopituitarism?

Home medical tests related to Hypopituitarism:

The list of other diseases or medical conditions that may be on the differential diagnosis list of alternative diagnoses for Hypopituitarism includes:

See the full list of 12

More information about symptoms of Hypopituitarism and related conditions:

Click on any of the symptoms below to see a full list of other causes including diseases, medical conditions, toxins, drug interactions, or drug side effect causes of that symptom.

When considering symptoms of Hypopituitarism, it is also important to consider Hypopituitarism as a possible cause of other medical conditions. The Disease Database lists the following medical conditions that Hypopituitarism may cause:

For a more detailed analysis of Hypopituitarism as a symptom, including causes, drug side effect causes, and drug interaction causes, please see our Symptom Center information for Hypopituitarism.

These general reference articles may be of interest in relation to medical signs and symptoms of disease in general:

Full list of premium articles on symptoms and diagnosis

The symptom information on this page attempts to provide a list of some possible signs and symptoms of Hypopituitarism. This signs and symptoms information for Hypopituitarism has been gathered from various sources, may not be fully accurate, and may not be the full list of Hypopituitarism signs or Hypopituitarism symptoms. Furthermore, signs and symptoms of Hypopituitarism may vary on an individual basis for each patient. Only your doctor can provide adequate diagnosis of any signs or symptoms and whether they are indeed Hypopituitarism symptoms.

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by Ian M. Chapman, MBBS, PhD

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* THIS IS THE CONSUMER VERSION *

Hypopituitarism is an underactive pituitary gland that results in deficiency of one or more pituitary hormones.

Hypopituitarism can be caused by several factors, including certain inflammatory disorders, a tumor of the pituitary gland, or an insufficient blood supply to the pituitary gland.

Symptoms depend on what hormone is deficient and may include short height, infertility, intolerance to cold, fatigue, and an inability to produce breast milk.

The diagnosis is based on measuring the blood levels of hormones produced by the pituitary gland and on imaging tests done on the pituitary gland.

Treatment focuses on replacing deficient hormones with synthetic ones but sometimes includes surgical removal or irradiation of any pituitary tumors.

Hypopituitarism, an uncommon disorder, can be caused by a number of factors, including a pituitary tumor or an insufficient blood supply to the pituitary gland.

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The rest is here: Hypopituitarism Hormonal and Metabolic Disorders Merck

Hypopituitarism What is hypopituitarism?

Hypopituitarism, also called an underactive pituitary gland, is a condition that affects the anterior lobe of the pituitary glandusually resulting in a partial or complete loss of functioning of that lobe. The resulting symptoms depend on which hormones are no longer being produced by the gland. Because the pituitary gland affects the other endocrine organs, effects of hypopituitarism may be gradual or sudden and dramatic.

Symptoms vary depending on what hormones are insufficiently produced by the pituitary gland. The following are common symptoms associated with reduced production of certain hormones:

Insufficient gonadotropins production (luteinizing hormone and follicle-stimulating hormone)

In premenopausal women, this leads to absent menstrual cycles, infertility, vaginal dryness, and loss of some female characteristics. In men, this deficiency leads to impotence, shriveling of testes, decreased sperm production, infertility, erectile dysfunction,and loss of some male characteristics.

Insufficient growth hormone production

This usually produces no symptoms in adults. However, it can cause loss of bone density and loss of muscle mass in adults. In children, this deficiency can lead to stunted growth and dwarfism.

Insufficient thyroid-stimulating hormone production

This usually leads to an underactive thyroid and may cause confusion, cold intolerance, weight gain, constipation, and dry skin.

Insufficientadrenocorticotropin hormone production

This rare deficiency leads to an underactive adrenal gland, resulting in low blood pressure, a low blood sugar level, fatigue, and a low tolerance for stress.

Insufficient prolactin production

This rare deficiency may cause an inability to produce breast milk after childbirth in some women.

The symptoms of hypopituitarism may resemble other conditions or medical problems. Always consult yourdoctor for a diagnosis.

Causes of hypopituitarism can directly affect the pituitary gland, or indirectly affect the glandthrough changes inthe hypothalamus.

Causes of primary hypopituitarism (directly affecting pituitary gland)

Causes of secondary hypopituitarism (affecting the hypothalamus)

Pituitary tumors

Inadequate blood supply to pituitary gland (stroke)

Infections and/or inflammatory diseases

Sarcoidosis. A rare inflammation of the lymph nodes and other tissues throughout the body

Amyloidosis.A rare disease which causes the buildup of amyloid, a protein and starch, in tissues and organs

Radiation therapy

Surgical removal of pituitary tissue

Autoimmune diseases

Head trauma

Genetic diseases

Tumors of the hypothalamus

Inflammatory disease or a disease that spreads, such as cancer

Head injuries

Surgical damage to thehypothalamusand/or blood vessels or nerves leading to it

Symptoms of several underactive glands may help adoctor diagnose hypopituitarism. In addition to a complete medical history and medical examination, diagnostic procedures for hypopituitarism may include:

Computed tomography (CT or CAT scan).A noninvasive diagnostic procedure that uses a combination of X-rays and computer technology to produce horizontal, or axial, images of the body to detect any abnormalities that may not show up on an ordinary X-ray.

Magnetic resonance imaging (MRI).A noninvasive procedure that produces two-dimensional views of an internal organ or structure.

Blood and urine tests.These tests will measure various hormone levels.

Treatment of hypopituitarism depends on its cause. The goal of treatment is to restore the pituitary gland to normal function when possible, or to replace or substitute for inadequate hormones when necessary.

Treatment may include replacement hormone therapy, surgical tumor removal, and/or radiation therapy.

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There are notable differences between the terms hypopituitarism and panhypopituitarism. Hypopituitarism is a rare condition that refers to a decrease of function of two or more hormones produced by the pituitary gland. When all pituitary hormone production is deficient or decreased, the term Panhypopituitarism is used. Both Hypopituitarism and Panhypopituitarism are very complicated. They involved many endocrine functions and hormones.

The Introduction will help you understand the differences withspecific details.

Introduction Panhypopituitarism

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Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Job Classification

In most duration tables, five job classifications are displayed. These job classifications are based on the amount of physical effort required to perform the work. The classifications correspond to the Strength Factor classifications described in the United States Department of Labors Dictionary of Occupational Titles. The following definitions are quoted directly from that publication.

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Hypopituitarism Hypopituitarism

Hypopituitary: Pituitary Gland Disorder Causes & Treatments

Hypopituitary Overview

Hypopituitarism is a condition in which the pituitary gland (a small gland at the base of the brain) does not produce one or more of its hormones or else not enough of them. This condition may occur because of disease in the pituitary or hypothalamus (a part of the brain that contains hormones that control the pituitary gland). When there is low or no production of all the pituitary hormones, the condition is called panhypopituitarism. This condition may affect either children or adults.

The pituitary gland sends signals to other glands, for example the thyroid gland, to produce hormones, such as thyroid hormone. The hormones produced by the pituitary gland and other glands have a significant impact on bodily functions, such as growth, reproduction, blood pressure, and metabolism. When one or more of these hormones is not produced properly, the bodys normal functions can be affected. Some of the problems with hormones, such as with cortisol or thyroid hormone, may require prompt treatment. Others may not be life threatening.

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The pituitary gland produces several hormones. Some important hormones include:

In hypopituitarism, one or more of these pituitary hormones is missing. The lack of hormone results in a loss of function of the gland or organ that it controls.

A loss of function of the pituitary gland or hypothalamus results in low or absent hormones. Tumors can cause damage to the pituitary gland or hypothalamus and can therefore result in a loss of function. Damage to the pituitary gland can also be caused by radiation, surgery, infections such as meningitis, or various other conditions. In some cases, the cause is unknown.

Some people may have no symptoms or a gradual onset of symptoms. In other people, the symptoms may be sudden and dramatic. The symptoms depend on the cause, how fast they come on, and the hormone that is involved.

Call the doctor or health care practitioner if any of the above symptoms develop.

The doctor or health care practitioner may perform blood tests to determine which hormone level is low and to rule out other causes. The following tests may be performed:

An MRI or CT scan of the pituitary gland may be obtained to determine if a tumor is present.

In children, X-rays of the hands may be taken to determine if bones are growing normally.

Medical treatment consists of hormone replacement therapy and treatment of the underlying cause.

Drugs used to treat hypopituitarism replace the deficient hormone.

If a tumor is involved, surgery may be performed, depending on its type and location.

Checkups with the doctor or health care practitioner are important. The doctor may need to adjust the dose of hormone replacement therapy.

If hormone replacement therapy is adequate, the prognosis is good. Complications are often related to the underlying disease.

Visit the Pituitary Network Association web site.

hypopituitarism, panhypopituitarism, pituitary gland, hypothalamus, pituitary insufficiency, underactive pituitary gland, thyroid hormone deficiency, growth hormone deficiency, FSH, follicle-stimulating hormone, LH, luteinizing hormone, adrenocorticotropin hormone, ACTH, prolactin, ADH, antidiuretic hormone, low hormones

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Hypopituitary: Pituitary Gland Disorder Causes & Treatments

Panhypopituitarism: Background, Pathophysiology, Epidemiology

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Matthai SM, Smith CS. Pituitary hypoplasia associated with a single central maxillary incisor. J Pediatr Endocrinol Metab. 1996 Sep-Oct. 9(5):543-4. [Medline].

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Setian N, Aquiar CH, Galvao JA. Rathke’s cleft cyst as a cause of growth hormone deficiency and micropenis. Child’s Nervous System. 1999. Vol 5: 271-3.

Rajaratnam S, Seshadri MS, Chandy MJ, Rajshekhar V. Hydrocortisone dose and postoperative diabetes insipidus in patients undergoing transsphenoidal pituitary surgery: a prospective randomized controlled study. Br J Neurosurg. 2003 Oct. 17(5):437-42. [Medline].

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Rosenbloom AL, Almonte AS, Brown MR, et al. Clinical and biochemical phenotype of familial anterior hypopituitarism from mutation of the PROP1 gene. J Clin Endocrinol Metab. 1999 Jan. 84(1):50-7. [Medline].

Ward L, Chavez M, Huot C, et al. Severe congenital hypopituitarism with low prolactin levels and age- dependent anterior pituitary hypoplasia: a clue to a PIT-1 mutation. J Pediatr. 1998 Jun. 132(6):1036-8. [Medline].

Vieira TC, Boldarine VT, Abucham J. Molecular analysis of PROP1, PIT1, HESX1, LHX3, and LHX4 shows high frequency of PROP1 mutations in patients with familial forms of combined pituitary hormone deficiency. Arq Bras Endocrinol Metabol. 2007 Oct. 51(7):1097-103. [Medline].

van Aken MO, Lamberts SW. Diagnosis and treatment of hypopituitarism: an update. Pituitary. 2005. 8(3-4):183-91. [Medline].

Bettendorf M, Fehn M, Grulich-Henn J, et al. Lymphocytic hypophysitis with central diabetes insipidus and consequent panhypopituitarism preceding a multifocal, intracranial germinoma in a prepubertal girl. Eur J Pediatr. 1999 Apr. 158(4):288-92. [Medline].

Maghnie M, Genovese E, Sommaruga MG, et al. Evolution of childhood central diabetes insipidus into panhypopituitarism with a large hypothalamic mass: is ‘lymphocytic infundibuloneurohypophysitis’ in children a different entity?. Eur J Endocrinol. 1998 Dec. 139(6):635-40. [Medline].

Mikami-Terao Y, Akiyama M, Yanagisawa T, et al. Lymphocytic hypophysitis with central diabetes insipidus and subsequent hypopituitarism masking a suprasellar germinoma in a 13-year-old girl. Childs Nerv Syst. 2006 Mar 25. [Medline].

Tanriverdi F, Senyurek H, Unluhizarci K, et al. High risk of hypopituitarism after traumatic brain injury: a prospective investigation of anterior pituitary function in the acute phase and at 12-months after the trauma. J Clin Endocrinol Metab. 2006 Mar 7. [Medline].

Behan LA, Phillips J, Thompson CJ, Agha A. Neuroendocrine disorders after traumatic brain injury. J Neurol Neurosurg Psychiatry. 2008 Jul. 79(7):753-9. [Medline].

Acerini CL, Tasker RC, Bellone S, Bona G, Thompson CJ, Savage MO. Hypopituitarism in childhood and adolescence following traumatic brain injury: the case for prospective endocrine investigation. Eur J Endocrinol. 2006 Nov. 155(5):663-9. [Medline].

Abdu TA, Elhadd TA, Neary R, Clayton RN. Comparison of the low dose short synacthen test (1 microg), the conventional dose short synacthen test (250 microg), and the insulin tolerance test for assessment of the hypothalamo-pituitary-adrenal axis in patients with pituitary disease. J Clin Endocrinol Metab. 1999 Mar. 84(3):838-43. [Medline].

Streeten DH. Shortcomings in the low-dose (1 microg) ACTH test for the diagnosis of ACTH deficiency states. J Clin Endocrinol Metab. 1999 Mar. 84(3):835-7. [Medline].

Chanoine JP, Rebuffat E, Kahn A, et al. Glucose, growth hormone, cortisol, and insulin responses to glucagon injection in normal infants, aged 0.5-12 months. J Clin Endocrinol Metab. 1995 Oct. 80(10):3032-5. [Medline].

Fischli S, Jenni S, Allemann S, et al. Dehydroepiandrosterone sulfate in the assessment of the hypothalamic-pituitary-adrenal axis. J Clin Endocrinol Metab. 2008 Feb. 93(2):539-42. [Medline].

Coutant R, Biette-Demeneix E, Bouvattier C, et al. Baseline inhibin B and anti-Mullerian hormone measurements for diagnosis of hypogonadotropic hypogonadism (HH) in boys with delayed puberty. J Clin Endocrinol Metab. 2010 Dec. 95(12):5225-32. [Medline].

Carel JC, Tresca JP, Letrait M, et al. Growth hormone testing for the diagnosis of growth hormone deficiency in childhood: a population register-based study. J Clin Endocrinol Metab. 1997 Jul. 82(7):2117-21. [Medline].

Marin G, Domene HM, Barnes KM, et al. The effects of estrogen priming and puberty on the growth hormone response to standardized treadmill exercise and arginine-insulin in normal girls and boys. J Clin Endocrinol Metab. 1994 Aug. 79(2):537-41. [Medline].

Li G, Shao P, Sun X, Wang Q, Zhang L. Magnetic resonance imaging and pituitary function in children with panhypopituitarism. Horm Res Paediatr. 2010. 73(3):205-9. [Medline].

DeVile CJ, Stanhope R. Hydrocortisone replacement therapy in children and adolescents with hypopituitarism. Clin Endocrinol (Oxf). 1997 Jul. 47(1):37-41. [Medline].

Charmandari E, Lichtarowicz-Krynska EJ, Hindmarsh PC, et al. Congenital adrenal hyperplasia: management during critical illness. Arch Dis Child. 2001 Jul. 85(1):26-8. [Medline].

Bates AS, Van’t Hoff W, Jones PJ, Clayton RN. The effect of hypopituitarism on life expectancy. J Clin Endocrinol Metab. 1996 Mar. 81(3):1169-72. [Medline].

Rosen T, Bengtsson BA. Premature mortality due to cardiovascular disease in hypopituitarism. Lancet. 1990 Aug 4. 336(8710):285-8. [Medline].

Twickler TB, Wilmink HW, Schreuder PC, et al. Growth hormone (GH) treatment decreases postprandial remnant-like particle cholesterol concentration and improves endothelial function in adult-onset GH deficiency. J Clin Endocrinol Metab. 2000 Dec. 85(12):4683-9. [Medline].

Claessen KM, Appelman N, Pereira AM, Joustra SD, Mutsert R, Gast KB, et al. Abnormal metabolic phenotype in middle-aged Growth Hormone Deficient (GHD) adults despite long-term recombinant human GH (rhGH) replacement. Eur J Endocrinol. 2013 Nov 11. [Medline].

Hoffman RP. Growth hormone (GH) treatment does not restore endothelial function in children with GH deficiency. J Pediatr Endocrinol Metab. 2008 Apr. 21(4):323-8. [Medline].

Lanes R, Soros A, Flores K, Gunczler P, Carrillo E, Bandel J. Endothelial function, carotid artery intima-media thickness, epicardial adipose tissue, and left ventricular mass and function in growth hormone-deficient adolescents: apparent effects of growth hormone treatment on these parameters. J Clin Endocrinol Metab. 2005 Jul. 90(7):3978-82. [Medline].

O’Neal D, Hew FL, Sikaris K, Ward G, Alford F, Best JD. Low density lipoprotein particle size in hypopituitary adults receiving conventional hormone replacement therapy. J Clin Endocrinol Metab. 1996 Jul. 81(7):2448-54. [Medline].

Santoro SG, Guida AH, Furioso AE, Glikman P, Rogozinski AS. Panhypopituitarism due to Wegener’s granulomatosis. Arq Bras Endocrinol Metabol. 2011 Oct. 55(7):481-5. [Medline].

Gazzaruso C, Gola M, Karamouzis I, Giubbini R, Giustina A. Cardiovascular Risk in Adult Patients With Growth Hormone (GH) Deficiency and Following Substitution with GH–An Update. J Clin Endocrinol Metab. 2013 Nov 11. [Medline].

Carel JC, Ecosse E, Landier F, Meguellati-Hakkas D, Kaguelidou F, Rey G, et al. Long-term mortality after recombinant growth hormone treatment for isolated growth hormone deficiency or childhood short stature: preliminary report of the French SAGhE study. J Clin Endocrinol Metab. 2012 Feb. 97(2):416-25. [Medline].

Svendahl L, Maes M, Albertsson-Wikland K, Borgstrm B, Carel JC, Henrard S, et al. Long-term mortality and causes of death in isolated GHD, ISS, and SGA patients treated with recombinant growth hormone during childhood in Belgium, The Netherlands, and Sweden: preliminary report of 3 countries participating in the EU SAGhE study. J Clin Endocrinol Metab. 2012 Feb. 97(2):E213-7. [Medline].

Mo D, Hardin DS, Erfurth EM, Melmed S. Adult mortality or morbidity is not increased in childhood-onset growth hormone deficient patients who received pediatric GH treatment: an analysis of the Hypopituitary Control and Complications Study (HypoCCS). Pituitary. 2013 Oct 12. [Medline].

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Panhypopituitarism: Background, Pathophysiology, Epidemiology

Symptoms of Hypopituitarism – RightDiagnosis.com

Symptoms of Hypopituitarism

The list of signs and symptoms mentioned in various sources for Hypopituitarism includes the 21 symptoms listed below:

Research symptoms & diagnosis of Hypopituitarism:

Review the available symptom checkers for these symptoms of Hypopituitarism:

Review the available Assessment Questionnaires for the symptoms of Hypopituitarism:

Read information about complications of Hypopituitarism.

Do I have Hypopituitarism?

Home medical tests related to Hypopituitarism:

The list of other diseases or medical conditions that may be on the differential diagnosis list of alternative diagnoses for Hypopituitarism includes:

See the full list of 12

More information about symptoms of Hypopituitarism and related conditions:

Click on any of the symptoms below to see a full list of other causes including diseases, medical conditions, toxins, drug interactions, or drug side effect causes of that symptom.

When considering symptoms of Hypopituitarism, it is also important to consider Hypopituitarism as a possible cause of other medical conditions. The Disease Database lists the following medical conditions that Hypopituitarism may cause:

For a more detailed analysis of Hypopituitarism as a symptom, including causes, drug side effect causes, and drug interaction causes, please see our Symptom Center information for Hypopituitarism.

These general reference articles may be of interest in relation to medical signs and symptoms of disease in general:

Full list of premium articles on symptoms and diagnosis

The symptom information on this page attempts to provide a list of some possible signs and symptoms of Hypopituitarism. This signs and symptoms information for Hypopituitarism has been gathered from various sources, may not be fully accurate, and may not be the full list of Hypopituitarism signs or Hypopituitarism symptoms. Furthermore, signs and symptoms of Hypopituitarism may vary on an individual basis for each patient. Only your doctor can provide adequate diagnosis of any signs or symptoms and whether they are indeed Hypopituitarism symptoms.

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Symptoms of Hypopituitarism – RightDiagnosis.com

Hypopituitarism.

Hypopituitarism is the partial or complete insufficiency of anterior pituitary hormone secretion and may result from pituitary or hypothalamic disease. The reported incidence (12-42 new cases per million per year) and prevalence (300-455 per million) is probably underestimated if its occurrence after brain injuries (30-70% of cases) is considered. Clinical manifestations depend on the extent of hormone deficiency and may be non specific, such as fatigue, hypotension, cold intolerance, or more indicative such as growth retardation or impotence and infertility in GH and gonadotropin deficiency, respectively.A number of inflammatory, granulomatous or neoplastic diseases as well as traumatic or radiation injuries involving the hypothalamic-pituitary region can lead to hypopituitarism. Several genetic defects are possible causes of syndromic and non syndromic isolated/multiple pituitary hormone deficiencies. Unexplained gonadal dysfunctions, developmental craniofacial abnormalities, newly discovered empty sella and previous pregnancy-associated hemorrhage or blood pressure changes may be associated with defective anterior pituitary function.The diagnosis of hypopituitarism relies on the measurement of basal and stimulated secretion of anterior pituitary hormones and of the hormones secreted by pituitary target glands. MR imaging of the hypothalamo-pituitary region may provide essential information. Genetic testing, when indicated, may be diagnostic.Secondary hypothyroidism is a rare disease. The biochemical diagnosis is suggested by low serum FT4 levels and inappropriately normal or low basal TSH levels that do not rise normally after TRH. L-thyroxine is the treatment of choice. Before starting replacement therapy, concomitant corticotropin deficiency should be excluded in order to avoid acute adrenal insufficiency. Prolactin deficiency is also very rare and generally occurs after global failure of pituitary function. Prolactin deficiency prevents lactation. Hypogonadotropic hypogonadism in males is characterized by low testosterone with low or normal LH and FSH serum concentrations and impaired spermatogenesis. Hyperprolactinemia as well as low sex hormone binding globulin concentrations enter the differential diagnosis. Irregular menses and amenorrhea with low serum estradiol concentration (

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Hypopituitarism.

Hypopituitarism – Hormonal and Metabolic Disorders – Merck …

By Ian M. Chapman, MBBS, PhD

NOTE: This is the Consumer Version. CONSUMERS: Click here for the Professional Version

NOTE: This is the Consumer Version. DOCTORS: Click here for the Professional Version

Hypopituitarism is an underactive pituitary gland that results in deficiency of one or more pituitary hormones.

Hypopituitarism can be caused by several factors, including certain inflammatory disorders, a tumor of the pituitary gland, or an insufficient blood supply to the pituitary gland.

Symptoms depend on what hormone is deficient and may include short height, infertility, intolerance to cold, fatigue, and an inability to produce breast milk.

The diagnosis is based on measuring the blood levels of hormones produced by the pituitary gland and on imaging tests done on the pituitary gland.

Treatment focuses on replacing deficient hormones with synthetic ones but sometimes includes surgical removal or irradiation of any pituitary tumors.

Hypopituitarism, an uncommon disorder, can be caused by a number of factors, including a pituitary tumor or an insufficient blood supply to the pituitary gland.

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Hypopituitarism – Hormonal and Metabolic Disorders – Merck …

Hypopituitarism – RightDiagnosis.com

Hypopituitarism: Introduction

Hypopituitarism: A condition characterized by diminished hormonal section by the pituitary gland. See detailed information below for a list of 22 causes of Hypopituitarism, Symptom Checker, including diseases and drug side effect causes.

Review Causes of Hypopituitarism: Causes | Symptom Checker

Home medical tests possibly related to Hypopituitarism:

Listed below are some combinations of symptoms associated with Hypopituitarism, as listed in our database. Visit the Symptom Checker, to add and remove symptoms and research your condition.

See full list of 501 Symptom Checkers for Hypopituitarism

Review further information on Hypopituitarism Treatments.

Real-life user stories relating to Hypopituitarism:

Some of the comorbid or associated medical symptoms for Hypopituitarism may include these symptoms:

See all associated comorbid symptoms for Hypopituitarism

Research the causes of these more general types of symptom:

Research the causes of these symptoms that are similar to, or related to, the symptom Hypopituitarism:

Read more about causes and Hypopituitarism deaths.

Pituitary conditions often undiagnosed cause of symptoms: There are a variety of symptoms that can be caused by a pituitary disorder (see symptoms of pituitary disorders). For example, fatigue, headache, weight…read more

Read more about Misdiagnosis and Hypopituitarism

Other medical conditions listed in the Disease Database as possible causes of Hypopituitarism as a symptom include:

See full list of 22 causes of Hypopituitarism – (Source – Diseases Database)

Diminution or cessation of secretion of one or more hormones from the anterior pituitary gland (including LH; FOLLICLE STIMULATING HORMONE; SOMATOTROPIN; and CORTICOTROPIN). This may result from surgical or radiation ablation, non-secretory PITUITARY NEOPLASMS, metastatic tumors, infarction, PITUITARY APOPLEXY, infiltrative or granulomatous processes, and other conditions. – (Source – Diseases Database)

Diminution or cessation of secretion of one or more hormones from the anterior pituitary gland (including luteinizing hormone, follicle stimulating hormone, somatotropin; and corticotropin); may result from surgical or radiation ablation, non-secretory pituitary neoplasms, metastatic tumors, infarction, pituitary apoplexy, infiltrative or granulomatous processes, and other conditions. – (Source – CRISP)

Hypopituitarism is listed as a “rare disease” by the Office of Rare Diseases (ORD) of the National Institutes of Health (NIH). This means that Hypopituitarism, or a subtype of Hypopituitarism, affects less than 200,000 people in the US population. – (Source – National Institute of Health)

The list below shows some of the causes of Hypopituitarism mentioned in various sources:

See full list of 22 causes of Hypopituitarism

This information refers to the general prevalence and incidence of these diseases, not to how likely they are to be the actual cause of Hypopituitarism. Of the 22 causes of Hypopituitarism that we have listed, we have the following prevalence/incidence information:

See the analysis of the prevalence of 22 causes of Hypopituitarism

The following list of conditions have ‘Hypopituitarism’ or similar listed as a symptom in our database. This computer-generated list may be inaccurate or incomplete. Always seek prompt professional medical advice about the cause of any symptom.

Select from the following alphabetical view of conditions which include a symptom of Hypopituitarism or choose View All.

The following list of medical conditions have Hypopituitarism or similar listed as a medical complication in our database. The distinction between a symptom and complication is not always clear, and conditions mentioning this symptom as a complication may also be relevant. This computer-generated list may be inaccurate or incomplete. Always seek prompt professional medical advice about the cause of any symptom.

Ask or answer a question about symptoms or diseases at one of our free interactive user forums.

Medical story forums: If you have a medical story then we want to hear it.

See a list of all the medical forums

Adenohypophyseal hyposecretion, Pituitary failure – (Source – Diseases Database)

Medical Conditions associated with Hypopituitarism:

Pituitary symptoms (18 causes), Endocrine symptoms (217 causes)

Symptoms related to Hypopituitarism:

Pituitary symptoms (18 causes), Pituitary disorders, Arthrogryposis (47 causes), Distal, With hypopituitarism, Mental retardation (2098 causes), Facial anomalies (72 causes), Combined pituitary hormone deficiency (PROP1 gene), Craniopharyngioma, Angelmann’s syndrome, Froehlich syndrome

Doctor-patient articles related to symptoms and diagnosis:

These general medical articles may be of interest:

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Hypopituitarism – RightDiagnosis.com

Symptoms and causes – Hypopituitarism – Mayo Clinic

Symptoms

Hypopituitarism is often progressive. Although the signs and symptoms can occur suddenly, they more often develop gradually. They are sometimes subtle and may be overlooked for months or even years.

Signs and symptoms of hypopituitarism vary, depending on which pituitary hormones are deficient and how severe the deficiency is. They may include:

See your doctor if you develop signs and symptoms associated with hypopituitarism.

Contact your doctor immediately if certain signs or symptoms of hypopituitarism develop suddenly or are associated with a severe headache, visual disturbances, confusion or a drop in blood pressure. Such signs and symptoms could represent sudden bleeding into the pituitary gland (pituitary apoplexy), which requires prompt medical attention.

Hypopituitarism may be the result of inherited disorders, but more often it’s acquired. Hypopituitarism frequently is triggered by a tumor of the pituitary gland. As a pituitary tumor increases in size, it can compress and damage pituitary tissue, interfering with hormone production. A tumor can also compress the optic nerves, causing visual disturbances.

The cause of hypopituitarism can also be other diseases and events that damage the pituitary, such as:

Diseases of the hypothalamus, a portion of the brain situated just above the pituitary, also can cause hypopituitarism. The hypothalamus produces hormones of its own that directly affect the activity of the pituitary.

In some cases, the cause of hypopituitarism is unknown.

April 23, 2016

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Symptoms and causes – Hypopituitarism – Mayo Clinic

Hypopituitarism | Boston Children’s Hospital

Over the past two decades or so, we’ve learned a lot about how the pituitary gland develops. Today, that ever-evolving knowledge helps us better serve our patients and their families.

Laurie Cohen, MD, director, Neuroendocrinology Program

You may have never heard of hypopituitarism until your child was diagnosed with it. Hypopituitarism occurs when the anterior (front) lobe of the pituitary gland loses its ability to make hormones. The resulting symptoms depend on which hormones are no longer being produced by the gland.

The good news is that treating the underlying condition thats causing your childs hypopituitarism often leads to a full recovery.

How Childrens Hospital Boston approaches hypopituitarism

At Childrens, you can rest assured knowing that your child will be cared for by knowledgeable physicians whove devoted their careers to understanding this condition. We treat children with hypopituitarism in our General Endocrinology Programa multidisciplinary program dedicated to the treatment of children with a wide range of endocrinological disorders. For these children, our dedicated team of doctors, nurses and other caregivers offer hope for a healthier future.

Ranked #1 in Endocrinology In 2015, Boston Children’s Hospital was ranked #1 in Endocrinology by U.S. News & World Report.

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Hypopituitarism | Boston Children’s Hospital

What Is Hypopituitarism (Dwarfism)? – Child Growth and …

Hypopituitarism is a rare disorder involving underproduction of hormones by the pituitary gland. The pituitary, deep in the brain, is the most important gland in the bodys endocrine, or hormonal, system.

One of the six hormones produced by the anterior portion of the pituitary is human growth hormone (HGH). In children, HGH deficiency may lead to impaired growth, or dwarfism. Early diagnosis and administration of HGH can correct this hormonal deficiency and result in normal or near-normal height.

Deficiencies in other pituitary hormones produce a wide variety of symptoms; in panhypopituitarism, deficiencies occur in all pituitary hormones. Because pituitary hormones stimulate hormone production in other glands, hypopituitarism may have a snowball effect, resulting in deficiencies of adrenal, thyroid, and sex hormones

Sources:

Johns Hopkins Symptoms and Remedies: The Complete Home Medical Reference

Simeon Margolis, M.D., Ph.D., Medical Editor

Prepared by the Editors of The Johns Hopkins Medical Letter: Health After 50

Updated by Remedy Health Media

Publication Review By: the Editorial Staff at Healthcommunities.com

Published: 16 Nov 2011

Last Modified: 06 Nov 2014

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What Is Hypopituitarism (Dwarfism)? – Child Growth and …

Hypopituitarism Hypopituitarism Hypopituitarism

What is hypopituitarism?

Hypopituitarism (also called pituitary insufficiency) is a rare condition in which your pituitary gland doesnt make enough of certain hormones. Your body cant work properly when important glands, such as your thyroid gland and adrenal gland, dont get the hormones they need from your pituitary gland.

The pituitary gland is a pea-sized gland found at the base of your brain. It is called the master gland because it affects the action of many other important glands that produce their own hormones. The pituitary gland affects almost all parts of your body.

Hypopituitarism can develop very slowly, over several months or even over several years.

Hypopituitarism can be caused by

Sometimes, the cause is unknown.

Symptoms can include one or more of the following:

Your doctor will check your hormone levels with blood tests. You may have other tests, such as an MRI of your pituitary gland, to help find the cause of your hypopituitarism.

Treatment usually includes taking the hormones youre missing, sometimes for life. Your doctor also will teach you how to take extra cortisone (a hormone) when you are sick or under stress. If a tumor is causing your hypopituitarism, you might need surgery to remove it and/or possibly radiation treatment. If needed, you can take medicine for infertility.

You will need to get regular check-ups. Its wise to wear medical identification, such as a bracelet or pendant, which provides information about your condition in case of an emergency.

You can expect a normal life span, as long as you regularly take the medications recommended by your doctor.

Read the original here: Hypopituitarism Symptoms and Treatment | Hormone Health

Hypopituitarism is a general term that refers to any under-performance of the pituitary gland. This is a clinical definition used by endocrinologists and is interpreted to mean that one or more functions of the pituitary are deficient. The term may refer to both anterior and posterior pituitary gland failure. Below is a list of the hormones secreted by the pituitary and their functions:

In cases of hypopituitarism, single or multiple hormone deficiencies are present. The deficiencies affect the target organ activity or secretion (the thyroid; the adrenals; or the gonads, which includes both female and male sexual development and function). Causes of hypopituitarism are tumors or lesions of various origins, congenital defects, trauma, radiation, surgery, encephalitis, hemochromatosis, and stroke. In children, the condition results in slowed growth and development and is known as dwarfism. The cause may also be unknown.

Deficient pituitary gland function can result from damage to either the pituitary or the area just above the pituitary, namely the hypothalamus. The hypothalamus contains releasing and inhibitory hormones that control the pituitary. Since these hormones are necessary for normal pituitary function, damage to the hypothalamus can also result in deficient pituitary gland function. Injury to the pituitary can occur from a variety of insults, including damage from an enlarging pituitary tumor, irradiation of the pituitary gland, limited blood supply (as experienced in a stroke), trauma or abnormal iron storage (hemochromatosis). There appears to be a predictable loss of hormonal function with increasing damage. The progression from most vulnerable to least vulnerable is usually as follows:

Additional symptoms that may be associated with this disease:

Men develop testicular suppression with decreased libido, impotence, decreased ejaculate volume, loss of body and facial hair, weakness, fatigue and often anemia. On testing, blood levels of testosterone are low and should be replaced. In the United States, testosterone may be given as a bi-weekly intramuscular injection, in a patch form or as a gel or creme preparation. In some countries, oral preparations of testosterone are available.

Thyroid Stimulation Hormone (TSH) Deficiency Deficiency of thyroid hormone causes a syndrome consisting of decreased energy, increased need to sleep, intolerance of cold (inability to stay warm), dry skin, constipation, muscle aching and decreased mental functions. This variety of symptoms is very uncomfortable and is often the symptom complex that drives patients with pituitary disease to seek medical attention. Replacement therapy consists of a either T4 (thyroxine) and/or T3 (triiodothyronine). The correct dose is determined through experimentation and blood tests.

Adrenal Hormone Deficiency Deficiency of ACTH resulting in cortisol deficiency is the most dangerous and life-threatening of the hormonal deficiency syndromes. With gradual onset of deficiency over days or weeks, symptoms are often vague and may include weight loss, fatigue, weakness, depression, apathy, nausea, vomiting, anorexia and hyperpigmentation. As the deficiency becomes more serious or has a more rapid onset (Addison crisis), symptoms of confusion, stupor, psychosis, abnormal electrolytes (low serum sodium, elevated serum potassium), and vascular collapse (low blood pressure and shock) can occur. Treatment consists of cortisol administration or another similar steroid (like prednisone). For patients with acute adrenal insufficiency, rapid intravenous administration of high dose steroids is essential to reverse the crisis.

Posterior Pituitary Antidiuretic Hormone (ADH) Deficiency Replacement of antidiuretic hormone resolves the symptoms of increased thirst and urination seen in diabetes insipidus. Antidiuretic hormone (ADH) is currently replaced by administration of a synthetic type of ADH either by subcutaneous injection, intranasal spray, or by tablet, usually once or twice a day.

Endocrine substitution therapy is indicated for replacement of hormones for the affected organs. These include corticosteroids, thyroid hormone, sex hormones (testosterone for men and estrogen for women), and growth hormone. Drugs are available to treat associated infertility in men and women.

Growth hormone is only available in injectable form and is usually given 6-7 times per week. Homeopathic GH or IGF has been proven to provide benefits in blinded trials.

Follow this link: Hypopituitarism Symptoms, Diagnosis, Treatment and

What are the symptoms of hypopituitarism?

The symptoms of hypopituitarism depend on the specific hormone that is lacking. For example, patients with reduced ACTH secretion have low cortisol levels, which can result in loss of appetite, weight loss, nausea, vomiting, fatigue, weakness and/or lightheadedness. This condition is called adrenal insufficiency. Patients with reduced TSH secretion have low thyroid hormone levels resulting in a condition called hypothyroidism. Signs and symptoms of hypothyroidism can include weight gain, fatigue, dry skin, constipation, cold intolerance and hair loss. Women of reproductive age with reduced LH and FSH secretion develop amenorrhea (absence of menstrual periods), infertility, and bone loss due to low estrogen levels. Men with low LH and FSH levels develop low testosterone levels, which results in lack of libido (sex drive), erectile dyfunction, infertility, fatigue, body composition abnormalities (loss of muscle mass and an increase in abdominal fat), bone loss, and sometimes, depression. Low growth hormone (GH) in children leads to short stature. In adults, GH deficiency is associated with a diminished quality of life, body composition abnormalities (including a reduction in muscle mass and increase in abdominal fat mass) and low bone density. Women with low prolactin are unable to breastfeed, but there are no known adverse effects of low prolactin in men.

Pituitary Symptoms

Hypopituitarism is caused by damage to the pituitary gland, usually from a tumor, radiation, surgery. Traumatic brain injury and subarachnoid hemorrhages can also cause hypopituitarism. Occasionally inflammation can cause hypopituitarism and sometimes the cause is unclear. Medications can also cause hypopituitarism. For example, high-dose steroid use can lead to adrenal insufficiency and anabolic steroid use can result in low testosterone that lasts beyond the time in which the medication is used and can be permanent.

Research Studies

The complications of hypopituitarism are due to the specific hormone deficiency. See What are the symptoms of hypopituitarism above. Patient with hypopituitarism not receiving appropriate hormone replacement therapies have an increased risk of mortality.

Research Studies

Youre likely to start by seeing your family doctor or a general practitioner. However, in some cases when you call to set up an appointment, you may be referred immediately to an endocrinologist, a doctor who specializes in endocrine (hormonal) disorders.

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Hypopituitarism (Medical Condition) Symptoms, risk factors and treatments of Hypopituitarism (Medical Condition) Hypopituitarism is the decreased secretion of one or more of the eight hormones normally produced by the pituitary

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Hypopituitarism is the failure of production of one or more hormones from the pituitary gland.

Hypopit; pituitary insufficiency; partial hypopituitarism; panhypopituitarism (pan referring to all pituitary hormones being affected); anterior hypopituitarism.

Hypopituitarism is failure of the pituitary gland to produce one, some, or all of the hormones it normally produces. The pituitary gland has two parts, anterior pituitary and posterior pituitary, and hormone production can be affected in both parts.

Below are listed some of the causes of hypopituitarism:

The signs and symptoms of hypopituitarism depend on which of the pituitary gland hormones are involved, to what extent and for how long. It also depends on whether the hormone deficiencies began as a child or later in adult life. Symptoms can be slow at the start and vague.It is worth understanding the normal function and effects of these hormones in order to understand the signs and symptoms of hypopituitarism. (See the article on pituitary gland.) There may also be additional symptoms due to the underlying cause of the hypopituitarism, such as the effects of pressure from a tumour.

Symptoms can include:

Hypopituitarism is rare. At any given time, between 300 and 455 people in a million may have hypopituitarism. A number of endocrinologists believe that hypopituitarism is quite common after brain injuries. If this belief is confirmed, then hypopituitarism may be significantly more common than previously believed.

Most cases of hypopituitarism are not inherited.However, there are some very rare genetic abnormalities than can cause hypopituitarism.

Blood tests are required to check the level of the hormones which are either produced by the pituitary gland itself or peripheral endocrine glands controlled by the pituitary gland. These blood tests may be one-off samples or the patient may require more detailed testing on a day-unit. These are called dynamic tests and they measure hormone levels before and after stimulation to see if the normal pituitary gland is working properly.They usually last between1 to 4 hours.

If it is suspected that there is a lack of anti-diuretic hormone, the doctor may organise a water deprivation test. The patient will be deprived of water for a period of eight hours under very close supervision with regular blood and urine tests.The test may be extended to a 24 hour period if needed which means an overnight stay in hospital.

See more here: You & Your Hormones | Endocrine conditions | Hypopituitarism

Hypopituitarism is a general term that refers to any under function of the pituitary gland. This is a clinical definition used by endocrinologists and is interpreted to mean that one or more functions of the pituitary are deficient. The term may refer to both anterior and posterior pituitary gland failure.

Deficient pituitary gland function can result from damage to either the pituitary or the area just above the pituitary, the hypothalamus. The hypothalamus contains releasing and inhibitory hormones which control the pituitary. Since these hormones are necessary for normal pituitary function, damage to the hypothalamus can also result in deficient pituitary gland function. Injury to the pituitary can occur from a variety of insults, including damage from an enlarging pituitary tumor, irradiation to the pituitary, pituitary apoplexy, trauma and abnormal iron storage (hemochromatosis). With increasing damage there is a progressive decrease in function. There appears to be a predictable loss of hormonal function with increasing damage. The progression from most vulnerable to least vulnerable is usually as follows: first is growth hormone (GH), next the gonadotropins (LH and FSH which control sexual/reproductive function), followed by TSH (which control thyroid hormone release) and finally the last to be lost is typically ACTH (which controls adrenal function).

Sheehans syndrome is a condition that may occur in a woman who has a severe uterine hemorrhage during childbirth. The resulting severe blood loss causes tissue death in her pituitary gland and leads to hypopituitarism following the birth. For more on this Sheehans syndrome, please visit MedlinePlus on Sheehans Syndrome.

Deficiency of ACTH resulting in cortisol deficiency is the most dangerous and life threatening of the hormonal deficiency syndromes. With gradual onset of deficiency over days or weeks, symptoms are often vague and may include weight loss, fatigue, weakness, depression, apathy, nausea, vomiting, anorexia and hyperpigmentation. As the deficiency becomes more serious or has a more rapid onset, (Addisonian crisis) symptoms may include confusion, stupor, psychosis, abnormal electrolytes (low serum sodium, elevated serum potassium), and vascular collapse (low blood pressure and shock) which can be fatal. Treatment consists of cortisol administration or another similar steroid (like prednisone). For patients with acute adrenal insufficiency (Addisonian crisis), rapid intravenous administration of high dose steroids is essential to reverse the crisis.

Deficiency of thyroid hormone causes a syndrome consisting of decreased energy, increased need to sleep, intolerance of cold (inability to stay warm), dry skin, constipation, muscle aching and decreased mental functions. This constellation of symptoms is very uncomfortable and is often the symptom complex that drives patients with pituitary disease to seek medical attention. Replacement therapy consists of a daily pill called thyroxine (Synthroid, Levothyroxine etc). The correct dose is determined through blood tests.

Women develop ovarian suppression with irregular periods or absence of periods (amenorrhea), infertility, decreased libido, decreased vaginal secretions, breast atrophy, and osteoporosis. Blood levels of estradiol are low. Estrogen should be replaced and can be given orally as Premarin or estrace, or can be given as a patch applied twice weekly. Women taking estrogen also need to take progesterone replacement (unless they have undergone a hysterectomy). Annual pap smears and mammograms are mandatory.

Men develop testicular suppression with decreased libido, impotence, decreased ejaculate volume, loss of body and facial hair, weakness, fatigue and often anemia. On testing, blood levels of testosterone are low and should be replaced. In the United States, testosterone may be given as a bi-weekly intramuscular injection, a patch form, or a gel preparation. In other countries, oral preparations of testosterone are available.

Growth hormone is necessary in children for growth, but also appears necessary in adults to maintain normal body composition (muscle and bone mass). It may also be helpful for maintaining an adequate energy level, optimal cardiovascular status and some mental functions. Symptoms of GH deficiency in adults include fatigue, poor exercise performance and symptoms of social isolation. GH is only available in injectable form and must be given 6-7 times per week.

This problem arises from damage to the pituitary stalk or the posterior pituitary gland. It may occur transiently after transsphenoidal surgery but is rarely permanent. Patients with diabetes insipidus have increased thirst and urination. Replacement of antidiuretic hormone resolves these symptoms. Antidiuretic hormone (ADH) is currently replaced by administration of DDAVP (also called Desmopressin) a synthetic type of ADH. DDAVP can be given by subcutaneous injection, intranasal spray, or by tablet, usually once or twice a day.

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How to Pronounce Hypopituitarism This video shows you how to pronounce Hypopituitarism.

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Over the past two decades or so, weve learned a lot about how the pituitary gland develops. Today, that ever-evolving knowledge helps us better serve our patients and their families.

Laurie Cohen, MD, director, Neuroendocrinology Program

You may have never heard of hypopituitarism until your child was diagnosed with it. Hypopituitarism occurs when the anterior (front) lobe of the pituitary gland loses its ability to make hormones. The resulting symptoms depend on which hormones are no longer being produced by the gland.

The good news is that treating the underlying condition thats causing your childs hypopituitarism often leads to a full recovery.

How Childrens Hospital Boston approaches hypopituitarism

At Childrens, you can rest assured knowing that your child will be cared for by knowledgeable physicians whove devoted their careers to understanding this condition. We treat children with hypopituitarism in our General Endocrinology Programa multidisciplinary program dedicated to the treatment of children with a wide range of endocrinological disorders. For these children, our dedicated team of doctors, nurses and other caregivers offer hope for a healthier future.

Ranked #1 in Endocrinology In 2014, Boston Childrens Hospital was ranked #1 in Endocrinology by U.S. News & World Report.

Reviewed by Laurie Cohen, MD Childrens Hospital Boston, 2010

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Hypopituitarism refers to under-function of the Pituitary Gland. The term refers to both anterior and posterior pituitary gland dysfunction. It may be temporary or permanent. Panhypopituitarism refers to complete loss of all pituitary function. Patients with pan-hypopituitarism should carry a Medic Alert Bracelet at all times to notify health care personnel of this problem in case of an emergency.

There appears to be a predictable loss of hormonal function: the growth hormone (GH), luteinizing hormone (LH) and follicle-stimulating hormone (FSH) secreting cells appear most vulnerable while thyroid stimulating (TSH) and adrenocorticotropic hormone (ACTH) secreting cells are less vulnerable. Approximately 50% of patients will have some recovery of pituitary function after surgical removal of a pituitary adenoma. Approximately 45% will have no recovery or change, and 5% will have diminished pituitary function.

Deficiency of Acth and Cortisol

Treatment consists of glucocorticoids (hydrocortisone, dexamethasone or prednisone). For patients with acute adrenal insufficiency (Addisonian crisis), rapid intravenous administration of high dose steroids is essential.

Definciency of TSH and Thyroid Hormone

Treatment with thyroxin (Synthroid) reverses the symptoms and signs over days or weeks and requires careful monitoring of free T4 or total T4 (thyroid function levels).

Deficiency of LH and FSH (Hypogonadotropic Hypogonadism)

Women on estrogen also need progesterone. Men with hypogonadism develop decreased libido, impotence, decreased ejaculate volume, loss of body and facial hair, weakness, fatigue and often anemia. Blood testosterone levels are low and should be replaced as a daily patch or gel or as an injection every 2-3 weeks.

Growth Hormone Deficiency

Antidiuretic Hormone Deficiency (ADH) and Diabetes Insipidus (DI)

Read the original post: Hypopituitarism (Pituitary Gland Failure) | Providence

Home Frequently asked HYPOPITUITARY questions.and their answers

When not on any thyroid meds, you find yourself with a very low TSH lab (the TSH is a pituitary hormone), yet you have a low free T3, plus hypothyroid symptoms, you may have hypopituitarism.

Here are the most frequently asked questions concerning this condition, created by Chris, a hypopituitary patient who has worked with other hypopituitary patients for several years. Please note these are quick general answers so its recommended you do your own research to learn more. You can also join Chriss Hypopituitary Support Group on Yahoo. It is closed to posting, but you can join to access the great deal of information it contains, including over 500 links and 100 files.

1) What is hypopituitarism? 2) What are symptoms of hypopituitarism? 3) What causes hypopituitarism? 4) Is adrenal and/or thyroid treatment different if I am hypopituitary? 5) What labs will detect hypopituitarism? 6) If I cant afford all those labs, can you tell just from TSH? DHEA? 7) Can you detect hypopituitarism from saliva cortisol labs? 8 ) Im already on HC, can I test cortisol or ACTH levels? 9) Is there any test for hypopituitarism once Im already on HC? 10) If one pituitary hormone is low, does that mean all of them are? 11) My Dr or Insurance wont approve further tests what should I do? 12) Should I start treating the sex hormones right away? 13) Is hypopituitarism curable? 14) My doctor says my cortisol doubled during the ACTH stimulation test, so I am ok-is he right? 15) Could I have a pituitary tumor? Should I get an MRI? Is it gonna grow? Will I need an operation? 16) Are there shades of Gray on this? Does someone get sort-of hypo-pit, then then next guys labs even more so, then finally one sets off the buzzer and gets a definitive label of Hypo-Pit? 1) What is hypopituitarism? Hypopituitary is the pituitary gland functioning below where it needs to be, and one or more hormones can be involved. The pituitary is a pea sized gland located at the base of the brain and it runs the adrenals, thyroid, and sex hormones. It also produces growth hormone and stores oxytocin and vasopressin, both of which are made in the hypothalamus. If the pituitary doesnt put out enough TSH, thyroid hormone production can decrease. It the pituitary doesnt produce enough ACTH, cortisol (and DHEA) can decrease. 2) What are the symptoms of hypopituitarism? Because the pituitary may not be sending adequate levels of TSH and or ACTH, you could feel fatigue, weakness, have low blood pressure, feel colder than normal, have a decrease in your appetite, headaches, and depression. Symptoms of hypopit (concerning low TSH, low ACTH, low LH and FSH) are the same as if thyroid-adrenals-gonads are the cause. In most cases you cant tell by symptoms if you may be hypopituitary or not. If you arent getting enough ACTH, you could have symptoms of weight loss and nausea, plus the fatigue, low blood pressure, weakness, and depression. Because of a deficiency of TSH and LH, women could lose their periods, or have problems conceiving. Men could have a decreased libido, erectile dysfunction, and loss of facial hair. If hypopituitary occurs in childhood, the result can be a short stature. Thirst and increased need to urinate can occur is you have an ADH deficiency. (Note: a large body of hypothyroid patients have a low normal TSH without hypopituitarism. Why? Because the man-made TSH lab is often slow to reveal the hypothyroid state. Those with hypopituitarism will often have a TSH at 0.8 and lower for women, and 1.8 and lower for men, with accompanying hypo symptoms. See #5 and 6 below.)

3) What causes hypopituitarism? A common cause of hypopituitarism is head injury. Even a seemingly mild bump to the head can damage the pituitary. A Pituitary tumor can also cause hypopituitary, though perhaps less than 3 percent have this as a cause. Sheehans syndrome is another cause, which is any type of blood loss, and where the pituitary at least partially dies from the lack of blood. Blood loss from childbirth, or an injury can result in Sheehans syndrome. Other causes can be radiation, antibody attack, and environmental. In most cases, it can not be known for sure what the cause is.

4) Is adrenal and/or thyroid treatment different if I am hypopituitary? In treating the adrenals and thyroid caused by low ACTH (secondary AI) and low TSH (secondary hypothyroid), treatment is the same as it is for primary Adrenal Insufficiency and primary hypothyroid. Sex hormone treatment can be different with the use of HCG (almost identical to LH) in secondaries hypogonadism (low LH and FSH production in the pituitary which will cause low sex hormones in men and women), whereas primary hypogonadism involves the gonads being the cause of low sex hormones, LH and FSH will go up. The treatment for primary hypogonadism is the use of testosterone (in men, sometimes along with estrogen blocker) and estrogen, progesterone and even testosterone in women. Some men with primary hypogonadism also use HCG, but is rarely used in women.

5) What labs will detect hypopituitarism? -low TSH (below 1.8 for men, below 0.8 for women) -low ACTH (below 30 for am. Is possible to be secondary with ACTH as high as low 40s) -ACTH stimulation or ITT that doubles cortisol from a low base value. -ITT for GH stim -low GHRH -low TRH -low vasopressin (hypothalamic hormone which is stored in the pituitary) -low renin and low aldosterone -very low or below range prolactin-usually this test is inconclusive for determing if other low pituitary hormones could be present. -low oxytocin (rarely tested, is a hypothalamic hormone which isstored and released from the pituitary) -alpha MSH (rarely tested, is a byproduct of ACTH) 6) If I cant afford all those labs, can you tell just from TSH? DHEA? If not on any thyroid treatment, I go by the TSH: less than .8 for women, less than 1.8 for men for determining secondary hypothyroid. I use 1.3 and above for women and 2.2 and above for men to determine primary hypo. In between .8 and 1.3 for women and 1.8 and 2.2 for men is less certain to whether secondary or not. A serum TRH and TRH STIM can help if you fall in that grey area. DHEA, if in the lower half of the range usually, but not always, indicates possible secondary adrenal insufficiency. Serum ACTH and ACTH STIM are the best tests for determining if secondary. If one has already started steroid without proper testing, the next best test for determining secondary AI is the renin test.

7) Can you detect hypopituitarism from saliva cortisol labs? No, because the test only shows what cortisol levels are, not what ACTH levels are doing. There is no saliva lab for ACTH as far as I know. 8 ) Im already on hydrocortisone (HC), can I test cortisol and or ACTH levels? No, once steroid is started, those tests are not reliable. In every case Ive seen where a doctor uses these tests for dosing a patients cortisol replacement, the patient was left undertreated. ACTH will go to pretty much zero in proper cortisol dosing.

9) Is there any test for hypopituitarism once started on HC? For detecting secondary (low ACTH) AI when proper testing hasnt been done (serum acth, DHEA-S, acth stimulation test), the renin test (with aldosterone) is the next best thing and is highly reliable if the test is done right (fast salt for 24 hours). Renin is low 99% of the time in secondaries.seehttp://www.ncbi.nlm.nih.gov/pubmed/518024

10) If one pituitary hormone is low, does that mean all of them are? In more than 99% of cases of hypopituitary, 2 to 3 pituitary hormones will be deficient. Keep in mind interpreting tests is subjective. One doc like an osteopath (US) may see problems, an endocrinologist will probably will say your tests are ok. When all pituitary hormones are deficient to missing, this is called panhypopituitarism. True panhypopituitarism is fairly rare. Some definitions say not all pituitary hormones have to be deficient, but most. I go by the the strict definition all pituitary hormones being deficient or absent in the anterior pituitary. Ive seen one case of real panhypopituitarism.

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Hypopituitarism Hypopituitarism Hypopituitarism

Hypopituitarism: Check Your Symptoms and Signs

Hypopituitarism Symptoms & Signs

Medical Author: Melissa Conrad Stppler, MD

The symptoms of hypopituitarism result from decreased hormone production by the pituitary gland. When all the pituitary hormones are affected, the condition is known as panhypopituitarism. Isolated or partial hypopituitarism results when the production of one or more hormones is decreased. The symptoms are variable and depend on the severity of the condition and the number of hormones that are affected. Symptoms can include anemia, decreased appetite, weight loss or gain, sensitivity to cold, fatigue, and a decreased sex drive. Women may experience irregular menstrual cycles, loss of menstruation (amenorrhea), infertility, and the inability to produce milk. Infertility can affect males, as well as a reduction in hair on the face or body. Hypopituitarism in children can lead to short stature and delayed growth and development. Other symptoms include weakness, headache, abdominal pain, low blood pressure, vision problems, facial swelling, hoarseness, joint stiffness, and loss of pubic or armpit hair.

Medically Reviewed by a Doctor on 4/30/2014

REFERENCES:

Corenblum, Bernard. “Hypopituitarism.” Medscape.com. Feb. 20, 2013. .

Longo, Dan, et al. Harrison’s Principles of Internal Medicine. 18th ed. New York: McGraw-Hill Professional, 2011.

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Hypopituitarism: Check Your Symptoms and Signs

Hypopituitarism – Symptoms, Diagnosis and Treatment

Hypopituitarism is a general term that refers to any under-performance of the pituitary gland. This is a clinical definition used by endocrinologists and is interpreted to mean that one or more functions of the pituitary are deficient. The term may refer to both anterior and posterior pituitary gland failure.

(Article continues below…)

Concerned or curious about your health? Click below…

Below is a list of the hormones secreted by the pituitary and their functions:

Growth hormone is necessary in children for growth, but also appears necessary in adults to maintain normal body composition (muscle and bone mass). It may also be helpful for maintaining an adequate energy level, optimal cardiovascular status and some mental functions.

The incidence is 1 out of 10,000 people.

In cases of hypopituitarism, single or multiple hormone deficiencies are present. The deficiencies affect the target organ activity or secretion (the thyroid; the adrenals; or the gonads, which includes both female and male sexual development and function). Causes of hypopituitarism are tumors or lesions of various origins, congenital defects, trauma, radiation, surgery, encephalitis, hemochromatosis, and stroke. In children, the condition results in slowed growth and development and is known as dwarfism. The cause may also be unknown.

Deficient pituitary gland function can result from damage to either the pituitary or the area just above the pituitary, namely the hypothalamus. The hypothalamus contains releasing and inhibitory hormones that control the pituitary. Since these hormones are necessary for normal pituitary function, damage to the hypothalamus can also result in deficient pituitary gland function. Injury to the pituitary can occur from a variety of insults, including damage from an enlarging pituitary tumor, irradiation of the pituitary gland, limited blood supply (as experienced in a stroke), trauma or abnormal iron storage (hemochromatosis). There appears to be a predictable loss of hormonal function with increasing damage. The progression from most vulnerable to least vulnerable is usually as follows:

Risk factors are related to the cause and may include previous history of diabetes insipidus, previous history of adrenal insufficiency, previous history of a pituitary tumor, cessation of menses in a premenopausal woman, and short stature.

Symptoms of growth hormone deficiency in adults include:

Note: Symptoms may develop slowly and may vary greatly depending upon the severity of the disorder and the number of deficient hormones and their target organs.

Additional symptoms that may be associated with this disease:

Gonadotropin Deficiency Women develop ovarian suppression with irregular periods or absence of periods (amenorrhea), infertility, decreased libido, decreased vaginal secretions, breast atrophy, and osteoporosis. Blood levels of estradiol are low. Estrogen should be replaced along with progesterone. Annual pap smears and mammograms are mandatory.

Men develop testicular suppression with decreased libido, impotence, decreased ejaculate volume, loss of body and facial hair, weakness, fatigue and often anemia. On testing, blood levels of testosterone are low and should be replaced. In the United States, testosterone may be given as a biweekly intramuscular injection, in a patch form or as a gel or cream preparation. In some countries, oral preparations of testosterone are available.

Thyroid Stimulation Hormone (TSH) Deficiency Deficiency of thyroid hormone causes a syndrome consisting of decreased energy, increased need to sleep, intolerance of cold (inability to stay warm), dry skin, constipation, muscle aching and decreased mental functions. This variety of symptoms is very uncomfortable and is often the symptom complex that drives patients with pituitary disease to seek medical attention. Replacement therapy consists of a either T4 (thyroxine) and/or T3 (triiodothyronine). The correct dose is determined through experimentation and blood tests.

Adrenal Hormone Deficiency Deficiency of ACTH resulting in cortisol deficiency is the most dangerous and life-threatening of the hormonal deficiency syndromes. With gradual onset of deficiency over days or weeks, symptoms are often vague and may include weight loss, fatigue, weakness, depression, apathy, nausea, vomiting, anorexia and hyperpigmentation. As the deficiency becomes more serious or has a more rapid onset (Addison crisis), symptoms of confusion, stupor, psychosis, abnormal electrolytes (low serum sodium, elevated serum potassium), and vascular collapse (low blood pressure and shock) can occur. Treatment consists of cortisol administration or another similar steroid (like prednisone). For patients with acute adrenal insufficiency, rapid intravenous administration of high dose steroids is essential to reverse the crisis.

Posterior Pituitary Antidiuretic Hormone (ADH) Deficiency Replacement of antidiuretic hormone resolves the symptoms of increased thirst and urination seen in diabetes insipidus. Antidiuretic hormone (ADH) is currently replaced by administration of a synthetic type of ADH either by subcutaneous injection, intranasal spray, or by tablet, usually once or twice a day.

Diagnosis of hypopituitarism must confirm hormonal deficiency due to abnormality of the pituitary gland, and rule out disease of the target organ.

This disease may also alter the results of the following tests:

If the hypopituitarism is caused by a lesion or tumor, removal of the tumor or radiation or both are treatment options. Hormone replacement therapy may be required permanently after such a procedure.

Endocrine substitution therapy is indicated for replacement of hormones for the affected organs. These include corticosteroids, thyroid hormone, sex hormones (testosterone for men and estrogen for women), and growth hormone. Drugs are available to treat associated infertility in men and women.

Growth hormone is only available in injectable form and is usually given 6-7 times per week. Homeopathic GH or IGF has been proven to provide benefits in blinded trials.

In most cases, the disorder is not preventable. Awareness of risk may allow early diagnosis and treatment.

Hypopituitarism is usually permanent and requires life-long treatment; however, a normal life span can be expected.

Side-effects of drug therapy can develop.

Call your health care provider if symptoms of hypopituitarism develop.

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Hypopituitarism – Symptoms, Diagnosis and Treatment

Hypopituitarism | The Pituitary Foundation

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The pituitary gland produces a number of hormones or chemicals which are released into the blood to control other glands in the body. If the pituitary is not producing one or more of these hormones, or not producing enough, then this condition is known as hypopituitarism.

The term Multiple Pituitary Hormone Deficiency (MPHD) is sometimes used to describe the condition when the pituitary is not producing two or more of these hormones. If all the hormones produced by the pituitary are affected this condition is known as panhypopituitarism.

Hypopituitarism is most often caused by a benign (i.e. not cancerous) tumour of the pituitary gland, or of the brain in the region of the hypothalamus. Pituitary underactivity may be caused by the direct pressure of the tumour mass on the normal pituitary or by the effects of surgery or radiotherapy used to treat the tumour. Less frequently, hypopituitarism can be caused by infections (such as meningitus) in or around the brain or by severe blood loss, by head injury, or by various rare diseases such as sarcoidosis (an illness which resembles tuberculosis).

More information about conditions which result in hypopituitarism can be found in the Rarer Disorders section.

Each of the symptoms described above occur in response to the loss of one or more of the hormones produced by the pituitary. Decrease in the production of only one hormone would not lead to all the symptoms described above.

Read a patient’s experience with hypopituitarism

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Hypopituitarism | The Pituitary Foundation

Clinically Non-Functioning Pituitary Adenomas | UCLA …

Pituitary tumors (adenomas) that do not secrete active hormones are called clinically nonfunctioning pituitary adenomas. Most are large (macroadenomas), measuring more than one centimeter in size at the time of diagnosis. Patients start experiencing symptoms when the large tumor compresses the optic nerves, leading to vision loss, or the loss of normal pituitary function.

The UCLA Pituitary Tumor Program offers comprehensive management of clinically nonfunctioning pituitary adenomas. Our physicians have years of experience in diagnosing, treating and managing pituitary conditions.

Use these links to explore more about clinically nonfunctioning pituitary adenomas:

Clinically nonfunctioning pituitary adenomas make up about half of pituitary adenomas. The vast majority of them are benign.

There are several possible reasons why nonfunctioning pituitary adenomas could occur:

The most common symptoms are due to the large tumor compressing nearby structures, leading to:

Increased compression of the normal gland can cause hormone insufficiency, called hypopituitarism. The symptoms depend upon which hormone is involved.

More severe hypopituitarism can lead to hypothyroidism or abnormally low cortisol levels, which may be life threatening. Symptoms of severe hypopituitarism include:

Changes in hormonal function can cause electrolyte imbalance in the blood, typically low sodium levels (hyponatremia). Symptoms could include:

Imaging scans are one method doctors use to diagnose clinically nonfunctioning pituitary adenomas. We will also order hormone tests to evaluate the levels of pituitary hormone, confirming that there is no evidence of hormone production by the tumor.

Your doctor will conduct a thorough physical examination and ask you about your symptoms and medical history. He or she will then order tests as necessary, including:

MRI imaging allows us to detect whether there are tumors present. Your doctor will use a special MRI pituitary protocol to best visualize the tumor.

There are other tumors that produce symptoms similar to that of a pituitary adenoma. Your doctor will want to rule out these other tumors before confirming a diagnosis. Tumors that mimic the symptoms of a pituitary adenoma include:

If your symptoms suggest pituitary failure (hypopituitarism), your doctor may order a complete evaluation of the endocrine system. Based on results of these blood tests, you may undergo additional hormonal studies.

Learn more about hormone testing at the UCLA Pituitary Tumor Program.

If you are experiencing vision problems, your doctor will recommend that an experienced ophthalmologist evaluate you. The evaluation should include:

This will determine if you have a loss of peripheral vision.

The UCLA Pituitary Tumor Program offers comprehensive management of all types of pituitary tumors. Treatment options for pituitary adenomas include:

For most patients with nonfunctional adenomas, surgically removing the adenoma is the most effective treatment.

Whether this will lead to a long-term cure depends on the extent of surgical removal, which is related to:

If the surgeon was able to remove the entire tumor, the cure rate is 70 percent to 80 percent. Overall, surgery improves:

If the pituitary adenomas require surgery,typicallythe bestprocedureis througha nasal approach. Our neurosurgeons who specialize in pituitary tumor surgery are experts in the minimally invasive endoscopic endonasaltechnique. This procedure removes the tumor while minimizing complications, hospital time and discomfort. This advanced technique requires specialized training and equipment.

Very large tumors that extend into the brain cavity may require opening the skull (craniotomy) to access the tumor. Our surgeons are also experts in the minimally invasive “key-hole” craniotomy, utilizing a small incision hidden in the eyebrow.

If, after your surgery, some tumor cells remained or regrew, you may be a candidate for radiation therapy or a repeat surgery.

Hormone replacement may be necessary if you have pituitary insufficiency.

Doctors may recommend radiation therapy as a second-line therapy for endocrine-inactive tumors. Focused-beam radiation, named stereotactic radiosurgery, can be effective in controlling tumor growth. In some cases, radiation therapy may cause a loss of pituitary function.

To schedule an appointment with one of our physicians at the Pituitary Tumor Program, please call (310) 825 5111.

You can also email us at pituitary@mednet.ucla.edu

See more here:
Clinically Non-Functioning Pituitary Adenomas | UCLA …

Hypopituitarism Symptoms and Treatment | Hormone Health …

What is hypopituitarism?

Hypopituitarism (also called pituitary insufficiency) is a rare condition in which your pituitary gland doesnt make enough of certain hormones. Your body cant work properly when important glands, such as your thyroid gland and adrenal gland, dont get the hormones they need from your pituitary gland.

The pituitary gland is a pea-sized gland found at the base of your brain. It is called the master gland because it affects the action of many other important glands that produce their own hormones. The pituitary gland affects almost all parts of your body.

Hypopituitarism can develop very slowly, over several months or even over several years.

Hypopituitarism can be caused by

Sometimes, the cause is unknown.

Symptoms can include one or more of the following:

Your doctor will check your hormone levels with blood tests. You may have other tests, such as an MRI of your pituitary gland, to help find the cause of your hypopituitarism.

Treatment usually includes taking the hormones youre missing, sometimes for life. Your doctor also will teach you how to take extra cortisone (a hormone) when you are sick or under stress. If a tumor is causing your hypopituitarism, you might need surgery to remove it and/or possibly radiation treatment. If needed, you can take medicine for infertility.

You will need to get regular check-ups. Its wise to wear medical identification, such as a bracelet or pendant, which provides information about your condition in case of an emergency.

You can expect a normal life span, as long as you regularly take the medications recommended by your doctor.

Read more from the original source:
Hypopituitarism Symptoms and Treatment | Hormone Health …

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