The signs and symptoms of hypopituitarism are usually progressive, and gradually develop over several months or years. However, some patients may report a more sudden presentation of symptoms.
The nature of the symptoms varies considerably from patient to patient, and also according to the pituitary hormones that are lacking. Some of the typical symptoms of the condition include:
- Weakness and fatigue
- Decreased appetite
- Weight loss
- Sensitivity to cold
- Swollen facial features or body
More specific symptoms according to the type of pituitary hormone deficiency are indicated below.
ACTH and Cortisol Deficiency
Adrenocorticotropic hormone (ACTH) is involved in the production of cortisol. A deficiency can lead to symptoms such as:
- Low blood pressure
- Low serum sodium levels
- Low hemoglobin levels leading to pallor
- Low blood glucose
In such patients, any crisis situation which puts increased stress on the body such as serious infections, or major surgery, may precipitate coma and even death due to the increased gap in need and supply of ACTH and cortisol.
Acute deficiency may present as:
- circulatory collapse
Children may manifest failure to thrive and poor growth.
TSH and Thyroid Hormone Deficiency
Thyroid stimulating hormone (TSH) for the pituitary gland usually stimulates the production of thyroxine (T4) and other thyroid hormones, which play a role in the metabolism of the body.
When there is a deficiency in these hormones, symptoms may include:
- generalized body puffiness
- sensitivity to cold
- impaired memory and concentration
Patients may also have dry skin and be more susceptible to anemia. Lethargy and weight gain, with low pulse rate and blood pressure are also characteristic of several patients. A severe deficiency in TSH also has the potential to cause hypothermia, coma and death in rare cases.
Children with abnormally low TSH levels are mentally and physically backward.
LH and FSH Deficiency
A deficiency in luteinizing hormone (LH) and follicle-stimulating hormone (FSH) can cause different symptoms for men and women.
In men, this may present as a reduction in libido, erectile dysfunction and infertility. In addition, hair over the face, scrotum and body may be lost, along with bone and muscle loss, and anemia.
In women, the symptoms may include:
- delayed menstrual periods
- reduction in libido
- vaginal dryness
- subfertility and infertility
Affected women are also more likely to develop osteoporosis and weak bone structures prone to fractures later in life.
Children who have gonadotrophin deficiency show delay in attaining puberty.
Growth Hormone Deficiency
Growth Hormone (GH) deficiency can cause slow growth and short stature in children, in addition to an increase in body fat. In adults, the deficiency is linked to fatiguability, increased body fat, low muscle mass and a higher risk for the development of cardiovascular disease.
Prolactin (PRL) hormone plays an essential role in the production of breast milk following childbirth. Women with prolactin deficiency may be unable to breastfeed as a result of the deficiency.
Antidiuretic Hormone Deficiency
Deficiency in antidiuretic hormone can lead to diabetes insipidus, which is characterized by symptoms such as increased thirst and urination, particularly at nighttime. The urine is very dilute, and the serum sodium levels are high due to the excessive loss of water.
Assessing the Signs and Symptoms of Hypopituitarism
The severity and presentation of symptoms linked to hypopituitarism depend on the type of hormone deficiency and the cause of the condition.
While general signs such as fatigue, sensitivity to cold and changes in appetite and weight may be evident in a deficiency of several hormones, specific symptoms are linked to particular hormone deficiencies. Other symptoms and signs evolve as a result of the condition that caused the pituitary failure. All these symptoms can help in the diagnosis of the condition, alongside blood tests, and will usually improve with treatment when the hormone levels become normalized.
Reviewed by Dr Liji Thomas, MD.