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For further information, see CMDT Part 26-01: Anterior Hypopituitarism

Key Features

Essentials of Diagnosis

  • Adrenocorticotropic hormone (ACTH) deficiency: reduced adrenal secretion of cortisol and epinephrine; aldosterone secretion remains intact

  • Growth hormone (GH) deficiency: in children, causes short stature; in adults, causes asthenia, obesity, and increased cardiovascular risk

  • Prolactin deficiency: postpartum lactation failure

  • Thyroid-stimulating hormone (TSH) deficiency: causes secondary hypothyroidism

  • Luteinizing hormone (LH) and follicle-stimulating hormone (FSH) deficiency: cause hypogonadism and infertility in men and women

General Considerations

  • Caused by hypothalamic or pituitary dysfunction, including mass lesions (eg, pituitary adenomas, granulomas, cleft cysts, apoplexy, metastatic carcinomas, aneurysms, and brain tumors)

  • May have single or multiple hormonal deficiencies of the anterior and posterior pituitary

  • Hypopituitarism without mass lesions may be due to

    • Cranial radiation

    • Surgery

    • Encephalitis

    • Hemochromatosis

    • Autoimmune (including ipilimumab therapy)

    • Stroke

    • Post-CABG

    • Long-term intrathecal opioid infusion

    • X-linked congenital adrenal hypoplasia

    • Moderate to severe traumatic brain injury (Glasgow coma scale ≤ 13/15)

    • Idiopathic

  • About 25–30% of survivors of moderate to severe traumatic brain injury have at least one pituitary hormone deficiency

  • About 55% of survivors of aneurysmal subarachnoid hemorrhage have at least one pituitary hormone deficiency

  • Some degree of hypopituitarism, most commonly GH deficiency and hypogonadotropic hypogonadism, occurs in one-third of patients who have had an ischemic stroke

  • Kallmann syndrome is the most common cause of congenital isolated gonadotropin deficiency

Clinical Findings

Symptoms and Signs

  • GH deficiency

    • Hypoglycemia in infancy and short stature in childhood

    • In adulthood, mild to moderate central obesity, increased systolic blood pressure, increased low-density lipoprotein (LDL) cholesterol, and reduced cardiac output

    • Reduced muscle and bone mass, reduced physical and mental energy, impaired concentration and memory, and depression

  • Gonadotropin deficiency

    • Also known as hypogonadotropic hypogonadism

    • Caused by insufficiencies in luteinizing hormone (LH) and follicle-stimulating hormone (FSH), which cause hypogonadism and infertility

  • Congenital gonadotropin deficiency

    • Characterized by partial or complete lack of pubertal development

      (See Amenorrhea, Primary)

  • Kallmann syndrome

    • Hypogonadism and anosmia or hyposmia

    • Renal anomalies (28%)

    • Midline craniofacial defects (50%): cleft lip, high-arched or cleft palate, absent nasal cartilage, dental agenesis, hypertelorism

    • Neurologic defects: cognitive problems, bimanual synkinesis, cerebellar ataxia, oculomotor dysfunction, color blindness, or neurosensory hearing loss (42%)

    • Musculoskeletal malformations: pectus excavatum, syndactyly, clinodactaly, camptodactyly

  • Congenital adrenal hypoplasia

    • Congenital normosmic idiopathic hypogonadotropic hypogonadism (IHH)

    • Lack of pubertal development in boys who survive beyond childhood

  • Prader-Willi syndrome

    • Variable features of gonadotropin deficiency and primary gondal dysfunction

    • Cryptorchidism

    • Mental retardation

    • Short stature

    • Hyperflexibility

    • Autonomic dysregulation

    • Cognitive impairment

    • Hyperphagia with obesity

    • Hypogonadotropic hypogonadism

    • Primary hypogonadism

  • Acquired gonadotropin deficiency

    • Loss of facial, axillary, pubic, and body hair

    • Diminished libido

    • Infertility

    • Osteopenia and muscle atrophy due to androgen deficiency

      (See Hypogonadism, Male and Amenorrhea, Secondary & Menopause)

  • TSH deficiency

  • ACTH deficiency

    • Weakness

    • Fatigue

    • Weight loss

    • Hypotension

    • Hyponatremia

  • Combined pituitary hormone deficiency and panhypopituitarism

    • Short stature

    • Lack of pubertal development

    • Dry, ...

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