How is hypopituitarism (panhypopituitarism) treated?

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

Missed or delayed diagnosis of hypopituitarism could potentially lead to permanent disability or death. Medical care consists of hormone replacement as appropriate and treatment of the underlying cause. Glucocorticoids are required if the ACTH-adrenal axis is impaired. This is particularly important in sudden collapse due to pituitary apoplexy or acute obstetric hemorrhage with pituitary insufficiency. In such circumstances, do not delay initiation of a possibly lifesaving treatment pending a definitive diagnosis. Treat secondary hypothyroidism with thyroid hormone replacement. [5]

Treat gonadotropin deficiency with sex-appropriate hormones. In men, testosterone replacement is used and substituted with human chorionic gonadotropin (hCG) injections if the patient desires fertility. In women, estrogen replacement is used with or without progesterone as appropriate.

GH is replaced in children as appropriate. GH is not routinely replaced in adults unless the patient is symptomatic of GH deficiency, after all other pituitary hormones have been replaced. Then, a 6-month trial of replacement GH therapy may be considered.

Surgical care depends on the underlying cause and clinical state. In pituitary apoplexy, prompt surgical decompression may be lifesaving if head imaging reveals clinically significant tumor mass effect. Microadenomas do not need surgical treatment unless GH or ACTH hypersecretion is present. Prolactinomas, small and large, generally respond to medical therapy with tumor shrinkage and alleviation of mass symptoms. Debulk macroadenomas with mass symptoms that do not respond to medical therapy or are not expected to respond to medical therapy. Some asymptomatic nonsecreting macroadenomas may have an option of close clinical/radiologic observation. If radiotherapy is used, long-term new-onset hypopituitarism may occur and must be monitored.

The most common causes of nonsecreting pituitary adenomas are variants of gonadotropin-secreting tumors. In perhaps a third of these lesions, treatment with the potent dopamine agonist cabergoline may result in some decrease in mass or prevention of recurrence. [21]


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