Hypopituitarism

Claire E Higham; Gudmundur Johannsson; Stephen M Shalet

doi:10.1016/S0140-6736(16)30053-8

Hypopituitarism

Lancet. 2016 Nov 12;388(10058):2403-2415. doi: 10.1016/S0140-6736(16)30053-8. Epub 2016 Mar 31.

Authors

Claire E Higham¹, Gudmundur Johannsson², Stephen M Shalet³

Affiliations

¹ Department of Endocrinology, Christie Hospital NHS Foundation Trust, Manchester, UK; Centre for Endocrinology and Diabetes, Institute of Human Development, Faculty of Medical and Human Sciences, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK.
² Department of Internal Medicine and Clinical Nutrition, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Endocrinology, Sahlgrenska University Hospital, Gothenburg, Sweden.
³ Department of Endocrinology, Christie Hospital NHS Foundation Trust, Manchester, UK; Centre for Endocrinology and Diabetes, Institute of Human Development, Faculty of Medical and Human Sciences, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK. Electronic address: [email protected].

PMID: 27041067
DOI: 10.1016/S0140-6736(16)30053-8

Abstract

Hypopituitarism refers to deficiency of one or more hormones produced by the anterior pituitary or released from the posterior pituitary. Hypopituitarism is associated with excess mortality, a key risk factor being cortisol deficiency due to adrenocorticotropic hormone (ACTH) deficiency. Onset can be acute or insidious, and the most common cause in adulthood is a pituitary adenoma, or treatment with pituitary surgery or radiotherapy. Hypopituitarism is diagnosed based on baseline blood sampling for thyroid stimulating hormone, gonadotropin, and prolactin deficiencies, whereas for ACTH, growth hormone, and antidiuretic hormone deficiency dynamic stimulation tests are usually needed. Repeated pituitary function assessment at regular intervals is needed for diagnosis of the predictable but slowly evolving forms of hypopituitarism. Replacement treatment exists in the form of thyroxine, hydrocortisone, sex steroids, growth hormone, and desmopressin. If onset is acute, cortisol deficiency should be replaced first. Modifications in replacement treatment are needed during the transition from paediatric to adult endocrine care, and during pregnancy.

Publication types

Review

MeSH terms

Acute Disease
Adenoma / blood
Adenoma / radiotherapy
Adenoma / surgery
Adenoma / therapy*
Adrenocorticotropic Hormone / administration & dosage
Adrenocorticotropic Hormone / deficiency
Chronic Disease
Deamino Arginine Vasopressin / administration & dosage
Gonadal Steroid Hormones / administration & dosage
Gonadal Steroid Hormones / deficiency
Gonadotropins, Pituitary / administration & dosage
Gonadotropins, Pituitary / deficiency
Hormone Replacement Therapy / methods*
Human Growth Hormone / administration & dosage
Human Growth Hormone / deficiency
Humans
Hydrocortisone / administration & dosage
Hydrocortisone / deficiency
Hypophysectomy / adverse effects*
Hypopituitarism* / blood
Hypopituitarism* / diagnosis
Hypopituitarism* / drug therapy
Hypopituitarism* / etiology
Pituitary Gland / metabolism*
Pituitary Hormones, Anterior / administration & dosage*
Pituitary Hormones, Anterior / deficiency*
Pituitary Irradiation / adverse effects*
Pituitary Neoplasms / blood
Pituitary Neoplasms / radiotherapy
Pituitary Neoplasms / surgery
Pituitary Neoplasms / therapy*
Prolactin / administration & dosage
Prolactin / deficiency
Radiotherapy / adverse effects
Thyrotropin / administration & dosage
Thyrotropin / deficiency
Thyroxine / administration & dosage
Thyroxine / deficiency
Vasopressins / administration & dosage
Vasopressins / deficiency

Substances

Gonadal Steroid Hormones
Gonadotropins, Pituitary
Pituitary Hormones, Anterior
Vasopressins
Human Growth Hormone
Adrenocorticotropic Hormone
Prolactin
Thyrotropin
Deamino Arginine Vasopressin
Thyroxine
Hydrocortisone