Panhypopituitarism

(PHP; Underactive Pituitary Gland)

Pronounced: Pan-HI-po-pah-TWO-ah-ta-ree-sm

by Diana Kohnle

Definition

The pituitary gland is found at the base of the brain. It produces several important hormones that control the production of other hormones made by glands in the body. In panhypopituitarism, the gland produces an insufficient amount of hormones.

Pituitary Gland

Causes

This condition is most often caused by damage to the gland. In adults, it is usually a result of pituitary surgery. In children, damage to the pituitary gland may be caused by:

Infection
Stroke
Genetic factors
Tumor on or near the pituitary gland
Cancer that has spread
Injury
No known cause

Risk Factors TOP

These risk factors increase your chance of developing panhypopituitarism. Tell your doctor if you have any of these risk factors:

Damage to the pituitary gland (eg, trauma, radiation, cancer spread, postpartum hemorrhage)
Tumor on the pituitary gland

Symptoms TOP

Compression of the Tumor

Compression of the tumor on local structures, especially the nerves of the eyes, can cause:

Blurred vision
Loss of visual field
Poor temperature control

Insufficient Hormones

Insufficient levels of gonadotropins can cause:
- In premenopausal women: missed menstrual cycles, infertility, osteoporosis, vaginal dryness, loss or reduction in female characteristics
- In men: impotence, reduced size of testes, decreased production of sperm, infertility, breast enlargement, reduced muscle mass, loss or reduction in male characteristics (eg, beard growth)
Insufficient levels of growth hormone can cause:
- In children: stunted growth or dwarfism
- In adults: weakness, obesity, reduced cardiac output, low blood sugar levels, and reduced exercise tolerance
Insufficient levels of thyroid-stimulating hormones can lead to:
- Underactive thyroid, which causes confusion, hair loss, weakness, slow heart rate, muscle stiffness, intolerance to cold, constipation, weight gain, and dry skin
Insufficient corticotrophic levels can lead to:
- Underactive adrenal gland, which causes low blood pressure, low blood sugar, fatigue, weight loss, vomiting, and low stress tolerance—This can be life-threatening.
Excessive prolactin levels can cause:
- In women: missed periods, infertility, and milk secretion
- In men: reduced facial and body hair, small testes

Diagnosis TOP

Your doctor will ask about your symptoms and medical history. A physical exam will be done.

Tests may include the following:

MRI scan —a test that uses magnetic waves to make pictures of structures inside the body
Blood tests—Blood tests—to measure pituitary, as well as target gland hormone levels
Stimulation tests—to test the maximum capacity of the endocrine glands, usually of the pituitary gland
Semen analysis—in males suspected of infertility

Treatment TOP

Talk with your doctor about the best plan for you. Treatment depends on the cause of the condition. The goal of treatment is to restore normal blood hormone levels of thyroid, adrenal, estrogen or testosterone, and sometimes growth hormone.

Treatment options include:

Hormone replacement therapy—based on what types of hormones are missing
Tumor removal—done if the cause of the damage is a tumor
Radiation therapy —done if the cause of the damage is a cancer or tumor

Prevention TOP

The majority of causes are not preventable. Injury prevention can prevent some cases.

RESOURCES:

The Hormone Foundation
http://www.hormone.org/

The Pituitary Network
http://www.pituitary.org/

CANADIAN RESOURCES:

About Kids Health
http://www.aboutkidshealth.ca/

Health Canada
http://www.hc-sc.gc.ca/index_e.html

References:

Bhasin S, Cunningham GR, Hayes FJ, et al. Testosterone therapy in adult men with androgen deficiency syndromes: an endocrine society clinical practice guideline. J Clin Endocrinol Metab. 2006;91:1995-2010.

Diabetes & other endocrine and metabolic disorders: hypopituitarism. Lucile Packard Children's Hospital website. Available at: http://www.lpch.or... . Accessed May 30, 2007.

Geffner M. Panhypopituitarism. The Magic Foundation website. Available at: http://64.233.167.... . Accessed May 30, 2007.

Randeva HS, Schoebel J, Byrne J, et al. Classical pituitary apoplexy: clinical features, management and outcome. Clin Endocrinol (Oxf) . 1999;51:181-188.

Schneider HJ, Aimaretti G, Kreitschmann-Andermahr I, et al. Hypopituitarism. Lancet. 2007;269:1461-1470.

Toogood AA, Stewart PM. Hypopituitarism: clinical features, diagnosis, and management. Endocrinol Metab Clin North Am. 1998;37:235-261

What is a growth disorder? Nemours Foundation website. Available at: http://kidshealth.... . Accessed May 30, 2007.

Last reviewed April 2012 by Konda Mohan Reddy, MD, FAAP
Last Updated: 04/04/2012