What is Hypopituitarism ?

Hypopituitarism is the loss of some or all functions of the anterior lobe of the pituitary gland.


CAUSE
Primary cause of which affect the pituitary gland (hypopituitarism primary):

Pituitary tumors
Decreased blood flow to the pituitary gland (due to severe bleeding, blood clots, anemia)
Infection and inflammation
Sarcoidosis or amyloidosis
Irradiation
Appointment of the pituitary gland surgically
Autoimmune diseases.


Primary cause of which affect the hypothalamus (secondary hypopituitarism):

Hypothalamic tumors
Inflammation
Head injury
Damage to the pituitary, blood vessels and nerves due to surgery.


SYMPTOMS
Hypopituitarism affect the function of endocrine glands are stimulated by the anterior pituitary hormones, because it's symptoms vary depending on the type of hormones what is lacking. The symptoms usually develop gradually and do not realize for some time, but sometimes occurs suddenly and dramatically.

Could be a shortage one, some or all of the anterior pituitary hormones. Gonadotropin deficiency (LH and FSH) in pre-menopausal women can cause:
- Cessation of the menstrual cycle (amenorrhea)
- Infertility
- Vaginal dryness
- Loss of some female sexual characteristics.
In men, gonadotropin deficiency causes:
- Impotence
- wrinkles in scrotum
- Reduced production of sperm resulting in infertility
- Loss of some male sexual characteristics (eg growth of body and facial hair).

Gonadotropin deficiency also occurs in Kallmann syndrome, which also suffer from:
- Cleft lip or cleft palate
- Color-blind
- Not able to smell anything.

Growth hormone deficiency in adults usually causes few symptoms or do not cause symptoms, but in children can cause slow growth, sometimes a midget (dwarfism).

TSH deficiency causes hypothyroidism, which cause symptoms such as:
- Confusion
- Not resistant to cold weather
- Weight gain
- Constipation
- Dry skin.

Corticotropin deficiency are rare; can cause the adrenal glands are less active, which would cause symptoms such as:
- Tired
- Low blood pressure
- Low blood sugar levels
- Low tolerance to stress (eg major trauma, surgery or infection).

Isolated prolactin deficiency is a rare condition, but it could explain why some women can not produce milk after childbirth. Sheehan's syndrome is a rare complication, where there is damage to some of the pituitary gland. Symptoms include fatigue, hair loss pubic and underarm hair, and inability to produce milk.


Diagnosis
To find structural abnormalities in the pituitary performed CT scan or MRI.

Blood tests done to determine levels of hormones following:
- LH (reduced)
- FSH (reduced)
- Testosterone (reduced)
- Estrogen (reduced)
- Cortisol (reduced)
- T4 (reduced)
- TSH (less)
- Growth hormone (reduced)
- IGF-1 (insulin-like growth factor 1) (reduced).

Angiography performed to assess the blood vessels leading to the pituitary.


TREATMENT
Treatment is intended to replace the target hormone deficiency, rather than the pituitary hormones. If there is a deficiency of thyroid hormone TSH is given, if there is a deficiency and adrenocortical hormone corticotropin given if there is a shortage of LH and FSH are given estrogen, progesterone or testosterone. Growth hormone is usually given to children.

If the cause is a pituitary tumor is small, then the removal of the tumor. Prolactin-producing tumors treated with bromocriptine administration. Irradiation with high power or with protons can also be used to destroy the pituitary tumor. Large tumors and has spread beyond the sella turcica may not only be corrected with surgery. After the surgery should be given high-powered radiation to kill the remaining tumor cells.

Radiation therapy is likely to cause loss of pituitary function slowly, in part or whole. Therefore the target gland function normally assessed every 3-6 months for the first year and then every year the following year.