Hypopituitarism

Aetiology

• Congenital
• Kallmann's syndrome
• Infective
• Basal meningitis
• Encephalitis
• Syphilis
• Vascular
• Sheehan's syndrome
• Tumours
• Pituitary
• Hypothalamic
• Craniopharyngioma
• Meningioma
• Glioma
• Metastases (especially breast)
• Lymphoma
• Infiltration
• Sarcoidosis
• Langerhan's histiocytosis
• Haemochromatosis
• Others
• Radiation
• Anorexia nervosa
• Trauma or previous surgery

Clinical features

• Due to progressive loss of anterior pituitary hormones (listed in order of frequency)
• Growth hormone
• Growth failure
• Short stature
• Prolactin
• Failure of lactation
• Gonadotrophins
• Delayed puberty
• Infertility
• Amenorrhoea
• Loss of body hair
• TSH
• Hypothyroidism
• ACTH
• Adrenal failure (without pigmentation)

Investigations

• Determine hormone deficiencies
• Pituitary imaging, e.g. CT scan, MRI scan

Management

• Treat cause
• Hormone replacement