Which factors increase the risk of mortality and morbidity from hypopituitarism (panhypopituitarism)?

Updated: Jun 09, 2020
  • Author: Bernard Corenblum, MD, FRCPC; Chief Editor: Romesh Khardori, MD, PhD, FACP  more...
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Answer

Four retrospective studies from the United Kingdom and Sweden showed that mortality is increased by 1.3- to 2.2-fold in patients with hypopituitarism, compared with age- and sex-matched cohorts. [14] Morbidity is variable and may result from hormone deficiency, from the underlying disease, or from inadequate long-term replacement therapy. The systemic effects of pituitary hormone deficiencies vary depending on the extent of pituitary involvement. Given that the pituitary acts on numerous endocrine sites, the consequences of pituitary dysfunction range from subclinical disease to panhypopituitarism. Underlying disorders, such as tumors, intracranial lesions, or systemic disease, may be asymptomatic or may cause morbidity that masks the hormone deficiency. Note the following:

  • Deficiency of ACTH with adrenal crisis or TSH with myxedema may be life threatening

  • GH deficiency causes more morbidity in children than in adults

  • There is a suggestion of increased cardiovascular disease resulting from GH deficiency

  • Sudden compromise of ACTH production may result in more profound morbidity than slowly progressive deficiency

  • Gonadotropin deficiency with hypogonadism may insidiously cause morbidity

  • Morbidity is more profound in congenital hypopituitarism

  • Inappropriate replacement therapy with thyroxin, glucocorticoids, or sex steroids may be associated with long-term morbidity

A study by O’Reilly et al indicated that in patients with hypopituitarism resulting from nonfunctioning pituitary adenomas, deficiencies of ACTH and gonadotropin increase mortality rates, as do excessive doses of hydrocortisone and suboptimal replacement of levothyroxine. The study included 519 patients, with a median followup of 7.0 years. [15]


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