Hypopituitarism

What is hypopituitarism?

Hypopituitarism is a rare condition in which there’s a lack (deficiency) of one, multiple or all of the hormones made by your pituitary gland. Hormones are chemicals that coordinate different functions in your body by carrying messages through your blood to your organs, muscles and other tissues. These signals tell your body what to do and when to do it.

The pituitary hormones are in charge of important functions in your body, such as metabolism, growth and development and reproduction. Your pituitary gland is a pea-sized gland located at the base of your brain below your hypothalamus (the part of your brain that controls your autonomic nervous system). It’s a part of your endocrine system.

Your pituitary gland is connected to your hypothalamus through a stalk of blood vessels and nerves. This is called the pituitary stalk. Through the stalk, your hypothalamus communicates with your pituitary gland and tells it to release certain hormones. Your hypothalamus is the part of your brain that controls functions like blood pressure, heart rate, body temperature and digestion.

Hypopituitarism can occur from disorders of or damage to your pituitary gland or hypothalamus.

What hormones do the pituitary gland make?

Your pituitary gland makes the following hormones:

• Adrenocorticotropic hormone (ACTH or corticotropin): This hormone stimulates your adrenal glands to produce cortisol (stress hormone), which helps maintain blood pressure and blood glucose (blood sugar) levels.
• Antidiuretic hormone (ADH or vasopressin): This hormone regulates water balance and sodium levels in your body.
• Follicle-stimulating hormone (FSH): This hormone stimulates sperm production in people assigned male at birth and stimulates the ovaries to produce estrogen and egg development in people assigned female at birth.
• Growth hormone (GH): In children, growth hormone stimulates growth. In adults, growth hormone helps maintain healthy muscles and bones and impacts fat distribution. GH also impacts your metabolism (how your body turns the food you eat into energy).
• Luteinizing hormone (LH): This hormone stimulates ovulation in people assigned female at birth and testosterone production in people assigned male at birth.
• Oxytocin: In people assigned female at birth, oxytocin helps labor to progress during childbirth and causes breast milk (chest milk) to flow. It also and influences the bonding between parent and baby.
• Prolactin: This hormone stimulates breast milk production after giving birth and can affect menstrual periods in people assigned female at birth. It can affect fertility and sexual functions in adults.
• Thyroid-stimulating hormone (TSH): This hormone stimulates your thyroid to produce hormones that manage metabolism, energy and your nervous system.

What are the different kinds of hypopituitarism?

There are three different kinds of hypopituitarism based on the number of hormones that are lacking (deficient):

• Isolated pituitary deficiency: One pituitary hormone is affected and lacking.
• Multiple pituitary hormone deficiency: Two or more pituitary hormones are affected and lacking.
• Panhypopituitarism: All pituitary hormones are affected and lacking.

There are three kinds of hypopituitarism based on the cause of it and how your pituitary gland and its hormones are affected:

• Primary hypopituitarism: Caused by damage to or disorders of your pituitary gland.
• Secondary hypopituitarism: Caused by damage to or disorders of your hypothalamus. Your pituitary gland is connected to your hypothalamus through the pituitary stalk. Since your hypothalamus signals your pituitary to release certain hormones, issues with your hypothalamus can cause hypopituitarism.
• Idiopathic hypopituitarism: The cause can’t be determined.

Who does hypopituitarism affect?

Hypopituitarism can affect anyone at any age, though it’s a rare condition.

How common is hypopituitarism?

Hypopituitarism is a rare condition. There are approximately 10 to 40 new cases per one million people a year.

What are the symptoms of hypopituitarism?

The symptoms of hypopituitarism depend on which pituitary hormone(s) are affected and deficient (lacking). The following factors also affect what kind of symptoms you’ll experience:

• Your sex.
• Your age when hypopituitarism begins (the onset of hypopituitarism).
• The cause of hypopituitarism.
• How fast the affected hormones are decreasing.

Symptoms of a lack of growth hormone (GH)

Symptoms of growth hormone deficiency in newborns include:

• Hypoglycemia (low blood sugar).
• An abnormally small penis (micropenis) in babies assigned male at birth.

Symptoms of growth hormone deficiency in children include:

• Slow growth or no growth.
• Short height (stature).
• Missing or delayed sexual development during puberty.

Symptoms of growth hormone deficiency in adults include:

• Fatigue.
• Reduced sense of wellbeing.
• Decreased sexual function and sexual interest.
• Higher amount of body fat, particularly around the waist.
• Sensitivity to heat and cold.
• Decreased muscle mass.
• Decreased strength and stamina when exercising.

Symptoms of a lack of thyroid-stimulating hormone (TSH)

Symptoms of thyroid-stimulating hormone deficiency in newborns include:

• Decreased muscle tone.
• Low body temperature (hypothermia).
• A bulging belly.
• A hoarse cry.

Symptoms of thyroid-stimulating hormone deficiency in children and adults are similar to symptoms of hypothyroidism, an underactive thyroid. This is because TSH stimulates your thyroid to produce its own hormones.

Symptoms of hypothyroidism include:

• Fatigue.
• Dry skin and thinning hair.
• Constipation.
• Weight gain.
• Muscle weakness.
• Sensitivity to cold temperatures.
• Depression.
• For people assigned female at birth, experiencing heavier-than-normal menstrual periods or irregular periods.

Symptoms of a lack of follicle-stimulating hormone (FSH) and/or luteinizing hormone (LH)

FSH and LH are called gonadotropins and affect your reproductive system.

Symptoms of FSH deficiency and/or LH deficiency in newborns assigned male at birth include:

• An abnormally small penis (micropenis).
• Undescended testicles (cryptorchidism).

Symptoms of FSH deficiency and/or LH deficiency in children include:

• Absent breast development in children assigned female at birth during puberty.
• Absent testicular enlargement in children assigned male at birth during puberty.
• Lack of growth spurt during puberty.

Symptoms of FSH deficiency and/or LH deficiency in adults assigned male at birth include:

• Loss of interest in sex (low sex drive).
• Fatigue.
• Infertility.
• Erectile dysfunction.
• Decreased facial or body hair.

Symptoms of FSH deficiency and/or LH deficiency in adult assigned female at birth can include:

• Loss of interest in sex (low sex drive).
• Fatigue.
• Infertility.
• Hot flashes.
• Irregular periods or no menstrual periods (amenorrhea).
• Decreased pubic hair.
• Lack of breast milk production after giving birth.

Symptoms of a lack of adrenocorticotropic hormone (ACTH or corticotropin)

Symptoms of ACTH deficiency in newborns include:

• Hypoglycemia (low blood sugar).
• The rate of weight gain is significantly lower than average (failure to thrive).
• Seizures.
• Yellowing skin (jaundice).

Symptoms of ACTH deficiency in children and adults include:

• Fatigue.
• Unexplained weight loss.
• Low blood pressure (hypotension).
• Nausea and vomiting.
• Hypoglycemia (low blood sugar).
• Confusion.

Symptoms of a lack of prolactin

The main symptom of prolactin deficiency is a lack of breast milk production after giving birth.

Symptoms of a lack of oxytocin

Symptoms of oxytocin deficiency include:

• Breast milk flow issues after childbirth.
• Difficulty bonding with your baby after birth.
• Lack of empathy.
• Difficulty interacting with others.

Symptoms of a lack of antidiuretic hormone (ADH or vasopressin or arginine vasopressin)

Symptoms of ADH deficiency in newborns include:

• Vomiting.
• Unexplained episodes of fever.
• Excessive crying.
• Weight loss.
• Constipation.
• Very wet diapers.

Symptoms of ADH deficiency in children include:

• Difficulty with toilet training.
• Bedwetting.
• Getting tired easily.

Symptoms of ADH deficiency in adults can include:

• Frequent urination.
• Extreme thirst.
• Having electrolyte imbalances.

What causes hypopituitarism?

Many conditions and situations can cause hypopituitarism. In some cases, healthcare providers can’t determine the cause. This is called idiopathic hypopituitarism. In general, these three main factors can cause hypopituitarism:

• Something is putting pressure on (compressing) your pituitary gland or hypothalamus.
• There’s damage to your pituitary gland or hypothalamus.
• You have a rare condition or a condition that rarely causes hypopituitarism.

Conditions that can put pressure on your pituitary or hypothalamus

Examples of conditions that can cause pressure on your pituitary gland or hypothalamus include:

• Pituitary adenomas: One of the most common causes of primary hypopituitarism is a pituitary adenoma (a benign, or noncancerous, tumor). If the adenoma is of a certain size or is growing, it can cause pressure on your pituitary or block blood flow to it.
• Brain tumors: Certain brain tumors near your hypothalamus and/or pituitary gland can cause hypopituitarism.
• Lymphocytic hypophysitis (LH): This is a rare condition in which your pituitary gland becomes invaded by lymphocytes (cells of your immune system), causing your pituitary gland to become enlarged and not function properly.
• Pituitary or hypothalamus sarcoidosis: Sarcoidosis is a disease that causes inflammation to the affected organ(s) and/or gland(s).

Situations that can cause pituitary or hypothalamus damage

Examples of situations that can cause pituitary or hypothalamus damage include:

• Surgery: One common cause of primary hypopituitarism is complications from the surgery that was used to remove a pituitary adenoma or certain kinds of brain surgery.
• Radiation therapy: Prior cancer radiation therapy or radiation used to treat a pituitary adenoma can cause damage to your pituitary gland or hypothalamus.
• Brain or head trauma (also called traumatic brain injury, or TBI): Situations such as a vehicle accident, a fall or contact sports can cause head trauma and brain injuries, which can cause damage to your pituitary gland or hypothalamus.
• Pituitary apoplexy: Pituitary apoplexy happens when there’s sudden destruction of pituitary gland tissue that happens from a lack of blood supply (infarction) to the pituitary or bleeding into the pituitary (hemorrhage). A sudden loss of blood can damage your pituitary gland (known as necrosis). This can happen with Sheehan syndrome (severe blood loss after childbirth), sickle cell anemia and diabetes. A subarachnoid hemorrhage (SAH), a kind of stroke usually from a head injury, can also cause pituitary apoplexy.

Rare conditions that can cause hypopituitarism

Examples of rare conditions that can cause hypopituitarism include:

• Hereditary hemochromatosis: This genetic condition causes too much iron in your bloodstream. It can damage your pituitary gland.
• Bacterial meningitis: Although it’s rare, hypopituitarism can be a complication of bacterial meningitis.
• Genetic mutations: Some rare genetic mutations can cause hypopituitarism.

What tests will be done to diagnose hypopituitarism?

Your healthcare provider may order any of the following tests to diagnose hypopituitarism:

• Hormone level blood tests: Your provider may order different blood tests that measure the levels of certain hormones in your blood depending on your symptoms.
• Hormone stimulation tests: For this test, your provider uses medicine to stimulate your pituitary gland to release the hormone that they’re testing. They then take samples of your blood and send them to a lab for testing.
• Insulin tolerance test: An insulin tolerance test can diagnose growth hormone (GH) and adrenocorticotropic hormone (ACTH or corticotropin) deficiencies.
• Osmolality tests for blood and urine: This test checks for antidiuretic hormone (ADH) deficiency. It requires blood and urine (pee) samples.
• MRI (magnetic resonance imaging) scans: MRI scans use radio waves and strong magnets to create detailed images of inside your body. Brain MRIs are considered the best way to find pituitary tumors that could be causing hypopituitarism.
• Brain CT (computed tomography) scan: Your provider may use this test to see if you have a brain tumor or pituitary adenoma (noncancerous tumor) that’s causing hypopituitarism. A brain CT scan uses X-rays to create detailed images of your brain and pituitary gland.

How is hypopituitarism treated?

Treatment for hypopituitarism depends on which pituitary hormone(s) are deficient and the cause of the hypopituitarism. For that reason, treatment is very individualized. Your healthcare team will determine what the best treatment plan is for you. Common treatment options for hypopituitarism include:

• Hormone replacement therapy: Hormone replacement therapy aims to restore the deficient pituitary hormone(s) to normal levels.
• Surgery: Pituitary adenomas can cause hypopituitarism. People who have pituitary adenomas may undergo surgery to remove the adenoma.
• Radiation therapy: Some pituitary adenomas can be treated using radiation therapy.

Is there a cure for hypopituitarism?

Currently, there’s no known cure for hypopituitarism, but it is treatable.

What are the risk factors for hypopituitarism?

The following conditions or situations are considered risk factors for hypopituitarism:

• A history of cancer and radiation therapy: Some cancer treatments, such as radiation, can damage your pituitary gland.
• Head or brain trauma: Approximately 5% to 27% of individuals who experience a traumatic brain injury (TBI) develop hypopituitarism after five months to 12 years.
• Sickle cell anemia: Sickle cell anemia can cause a deficiency of pituitary hormones.
• Type 1 diabetes: Nerve and vascular damage that can result from poorly managed Type 1 diabetes can contribute to hypopituitarism.
• Genetic mutations: Certain genetic mutations can cause hypopituitarism. Talk to your healthcare provider if genetic mutations related to hypopituitarism run in your family.
• Pregnancy and giving birth: Lymphocytic hypophysitis, a rare condition that causes hypopituitarism, can occur in pregnant people. Severe blood loss (hemorrhaging) after childbirth can result in pituitary damage. This is known as Sheehan syndrome.

Can I prevent hypoparathyroidism?

Unfortunately, there are no known ways to prevent hypopituitarism.

What is the prognosis (outlook) for hypopituitarism?

The prognosis for hypopituitarism varies and depends on the following four factors:

• Your age at the onset (beginning) of your hypopituitarism.
• The cause of your hypopituitarism.
• How much your affected hormone(s) are lacking.
• How your body responds to treatment.

In most cases, people with hypopituitarism require close, lifelong monitoring of their hormones and symptoms. While many people with hypopituitarism lead healthy lives, long-term pituitary damage is associated with an increased risk of mortality (death) compared to people without hypopituitarism of the same age.

Can I die from hypopituitarism?

Although it is not as common, a sudden and severe onset of hypopituitarism can result in a medical emergency and death if it’s not treated. Be sure to call your healthcare provider or go to the nearest emergency room if you are experiencing symptoms.

When should I see my healthcare provider?

In most cases, hypopituitarism requires close, lifelong monitoring of the hormones affected. Be sure to see your healthcare provider regularly to make sure your treatment plan is working. If you’re experiencing new or concerning symptoms, contact your healthcare provider as soon as possible.

What questions should I ask my doctor?

If you’ve been diagnosed with hypopituitarism, you may want to ask your healthcare provider the following questions:

• What kind of hypopituitarism do I have?
• Which of my hormones are deficient?
• What is the cause of my hypopituitarism?
• What are my treatment options?
• Are there side effects of my treatment?
• How often do I have to take my medicine?
• Will my hypopituitarism affect my fertility?
• Will my hypopituitarism affect my pregnancy?
• Can I pass on hypopituitarism to my children?

A note from Cleveland Clinic:

A new diagnosis can be scary, but don’t be afraid to ask your healthcare provider questions about your hypopituitarism. Most cases of hypopituitarism require lifelong treatment and monitoring of your hormones, so it is important to see your provider regularly. Be sure to contact your provider if you have new or concerning symptoms. They’re there to help.