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Panhypopituitarism(PHP; Underactive Pituitary Gland)

Pronounced: Pan-HI-po-pah-TWO-ah-ta-ree-sm

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 Gland

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Causes

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:

  • Infection
  • Stroke
  • Genetic factors
  • Tumor on or near the pituitary gland
  • Cancer that has spread
  • Injury
  • No known cause
Risk Factors

These risk factors increase your chance of developing panhypopituitarism. Tell your doctor if you have any of these risk factors:

Symptoms
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: impotence , reduced size of testes, decreased production of sperm, infertility , breast enlargement, reduced muscle mass, loss or reduction in male characteristics (eg, 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.
  • Excessive prolactin levels can cause:
    • In women: missed periods, infertility, and milk secretion
    • In men: reduced facial and body hair, small testes
Diagnosis

Your doctor will ask about your symptoms and medical history. A physical exam will be done.

Tests may include the following:

  • MRI scan —a test that uses magnetic waves to make pictures of structures inside the body
  • Blood tests—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
Treatment

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 tumor
Prevention

The majority of causes are not preventable. Injury prevention can prevent some cases.

RESOURCES:

The Hormone Foundation
http://www.hormone.org/

The Pituitary Network
http://www.pituitary.org/

CANADIAN RESOURCES:

About Kids Health
http://www.aboutkidshealth.ca/

Health Canada
http://www.hc-sc.gc.ca/

References:

Bhasin S, Cunningham GR, Hayes FJ, et al. Testosterone therapy in adult men with androgen deficiency syndromes: an endocrine society clinical practice guideline. J Clin Endocrinol Metab. 2006;91:1995-2010.

Diabetes & other endocrine and metabolic disorders: hypopituitarism. Lucile Packard Children's Hospital website. Available at: http://www.lpch.org/DiseaseHealthInfo/HealthLibrary/diabetes/hypop.html . Accessed May 30, 2007.

Geffner M. Panhypopituitarism. The Magic Foundation website. Available at: http://64.233.167.104/search?q=cache:MHUYAhcYci8J:https://www.magicfoundation.org/downloads/PanPitpdf669.pdf+Panhypopituitarism&hl=en&ct=clnk&cd=8&gl=us . Accessed May 30, 2007.

Randeva HS, Schoebel J, Byrne J, et al. Classical pituitary apoplexy: clinical features, management and outcome. Clin Endocrinol (Oxf) . 1999;51:181-188.

Schneider HJ, Aimaretti G, Kreitschmann-Andermahr I, et al. Hypopituitarism. Lancet. 2007;269:1461-1470.

Toogood AA, Stewart PM. Hypopituitarism: clinical features, diagnosis, and management. Endocrinol Metab Clin North Am. 1998;37:235-261

What is a growth disorder? Nemours Foundation website. Available at: http://kidshealth.org/parent/medical/endocrine/growth_disorder.html . Accessed May 30, 2007.



Last reviewed March 2013 by Kim Carmichael, MD

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.

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