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 GlandCopyright © Nucleus Medical Media, Inc. |
Causes TOP
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:
In some cases, the cause may be unknown.
Risk Factors TOP
Factors that may increase your chance of panhypopituitarism include:
- Damage to the pituitary gland, which may occur from trauma, radiation therapy, cancer spread, bleeding after childbirth (postpartum hemorrhage)
- Tumor of 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— erectile dysfunction, reduced size of testes, decreased production of sperm, infertility, breast enlargement, reduced muscle mass, loss or reduction in male characteristics like 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)
-
Decreased prolactin levels
can cause:
- In women—missed periods, infertility, and milk secretion
- In men—reduced facial and body hair, small testes
-
Insufficient antidiuretic hormone (rare) can cause:
- Excessive thirst and frequent urination
- Nighttime urination
Diagnosis TOP
You will be asked about your symptoms and medical history. A physical exam will be done.
Tests may include the following:
- 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
- MRI scan —imaging test used to assess internal structures
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 a tumor that cannot be removed with surgery
RESOURCES:
Hormone Health Network—Endocrine Society
http://www.hormone.org
The Pituitary Network Association
http://pituitary.org
CANADIAN RESOURCES:
About Kids Health—The Hospital for Sick Children
http://www.aboutkidshealth.ca
Health Canada
https://www.canada.ca
REFERENCES:
Bhasin S, Cunningham GR, et al. Testosterone therapy in adult men with androgen deficiency syndromes: an endocrine society clinical practice guideline. J Clin Endocrinol Metab. 2006;91(6):1995-2010.
Hypopituitarism in children. Stanford Children's Health website. Available at:
...(Click grey area to select URL)
Accessed March 6, 2018.
Randeva HS, Schoebel J, et al. Classical pituitary apoplexy: clinical features, management and outcome. Clin Endocrinol (Oxf). 1999;51(2):181-188.
Schneider HJ, Aimaretti G, Kreitschmann-Andermahr I, Stalla GK, Ghigo E. Hypopituitarism. Lancet. 2007;269(9571):1461-1470.
Toogood AA, Stewart PM. Hypopituitarism: clinical features, diagnosis, and management. Endocrinol Metab Clin North Am. 1998;37(1):235-261
What is a growth disorder? Nemours Kids Health website. Available at:
...(Click grey area to select URL)
Updated July 2014. Accessed March 6, 2018.
Last reviewed March 2018 by
EBSCO Medical Review Board
Alan Drabkin, MD
Last Updated: 3/1/2013