Hypopituitarism

Diagnosis

To diagnose hypopituitarism, several tests are used to check hormone levels and identify the cause of pituitary gland dysfunction. These tests help determine which hormones are affected and guide the most effective treatment plan.

Blood tests measure the levels of hormones made in the pituitary gland and in the glands that the pituitary controls, such as the thyroid gland. These results can show whether low hormone levels are due to the pituitary not functioning properly.

Stimulation or dynamic testing is performed in specialized endocrine clinics to evaluate how the body responds to medicines that stimulate hormone production. These tests measure hormone levels before and after stimulation to assess how well the pituitary and other glands are working.

Brain imaging, such as MRI or CT scans, helps detect pituitary tumors or other structural abnormalities in the gland that might be causing hormonal imbalances.

Treatment

Treatment for hypopituitarism focuses on restoring hormone balance through medication and managing any underlying causes, such as tumors or injuries to the pituitary gland. Most people require lifelong hormone replacement therapy to maintain healthy hormone levels.

Hormone replacement medicines may include:

• Cortisol replacement: Hydrocortisone (Cortef) or prednisone (Rayos) are taken orally to replace adrenal hormones that the body can’t make due to low ACTH levels.

• Levothyroxine: Medicines such as Levoxyl or Synthroid treat hypothyroidism caused by a lack of thyroid-stimulating hormone (TSH).

• Sex hormones: Testosterone (given as injections, gels, patches, or pills) and estrogen or progesterone (given as pills, gels, or patches) help restore normal sexual function and reproductive health.

• Growth hormone: Somatropin (Genotropin, Humatrope, others) is given by injection under the skin to promote growth in children and improve metabolism and body composition in adults.

• Fertility hormones: Gonadotropins can be administered by injection to stimulate ovulation in women and sperm production in men.

Monitoring hormone replacement

An endocrinologist monitors blood hormone levels and symptoms to ensure that the right doses of medicines are being used. Adjustments may be needed based on health status, age, or lifestyle changes.

People taking cortisol replacement need to increase their dosage during periods of physical stress such as illness, surgery, or significant emotional strain. Conditions like flu, vomiting, diarrhea, or pregnancy may also require temporary dose changes.

Surgery or other procedures

If a pituitary or nearby tumor is the cause of hypopituitarism, surgery may be required to remove the growth. In some cases, radiation therapy or medication can be used instead of or in addition to surgery to shrink or control the tumor.

Emergency preparedness

People living with hypopituitarism should wear a medical alert bracelet or necklace and carry an identification card describing their condition. This is especially important for those taking cortisol replacement therapy, as emergency medical personnel need to know about their hormone requirements in case of injury or illness.