The treatment for a patient with hypopituitarism depends on the cause and severity of the condition. Some etiologies, such as pituitary apoplexy or post-partum hemorrhage leading to pituitary insufficiency, require immediate treatment to reduce the risk of complications from acute adrenocortical collapse.
Others may not need such urgent treatment, or may not need treatment at all. For this reason, the likely causes should be established and addressed, followed by hormone replacement therapy, if required. Ongoing management is also important, because most patients will require lifelong therapy to control the condition.
Addressing the Underlying Cause
Once the cause of the condition is identified, it requires to be addressed as far as possible, to reduce the symptoms of the pituitary deficiency.
In some cases, appropriate management of the cause will result in a full or partial recovery of the pituitary function, and further treatment is unnecessary. However, most individuals will require some form of hormone replacement therapy in addition.
Hormone Replacement Therapy
Hormone replacement therapy is the standard treatment for hypopituitarism. The type of hormone replacement will depend on the specific hormone deficiency. In many cases, the therapy will be lifelong.
If there is impairment in the adrenocorticotropic hormone (ACTH) -adrenal axis function, glucocorticoid therapy such as hydrocortisone or prednisolone is required. These are available as oral treatments, to be taken daily.
Treatment should be commenced as early as possible, particularly for patients who have experienced the acute onset of symptoms due to pituitary insufficiency. In such cases, delaying treatment may have a fatal outcome.
For individuals with low levels of thyroid stimulating hormone, levothyroxine is needed to replace the function of the deficient thyroid hormone. This is available as an oral medication.
When the production of gonadotropin hormones is impaired, the appropriate sex hormones should be replaced to reduce symptoms and improve fertility. This usually involves testosterone replacement in men and estrogen (with or without progesterone) in women.
These hormones may be formulated as pills, gels or patches for daily use. Men who want to regain fertility may need HCG injections to increase sperm count.
For children with a deficiency of growth hormone (GH), injectable formulations are available and should be given throughout the growing years to achieve near-normal growth.
Adults with low GH levels are rarely symptomatic and often do not require treatment. However, if other hormone levels are low, and they experience symptoms, growth hormone replacement may be required.
Surgery and Radiotherapy
Surgical procedures may be needed in the treatment of hypopituitarism for some patients. For example, when the abnormal pituitary function is due to the growth of a tumor in the brain, the tumor may need to be removed.
Microadenomas of the pituitary rarely require removal, unless they are asso hypersecretion of GH or ACTH.
However, larger tumors may be associated with visual field restriction or other visual symptoms, and need to be removed. Either surgery or radiotherapy may be employed to bring about a good result.
Monitoring and Follow-Up
It is important that patients being treated for hypopituitarism receive adequate follow-up care and support.
As hormone replacement therapy is given on a lifelong basis, frequent monitoring is needed to monitor the hormone replacement and to ensure that the patient is receiving the right dosage.
Both under-replacement and over-replacement of hormones can result in disturbing and even dangerous symptoms. This should be avoided by having one’s blood tested regularly, and adjusting the hormone dose accordingly.
A special situation is when a patient on pituitary replacement therapy falls seriously sick or requires hospitalization for a major surgical procedure. in such cases, the body needs higher doses of the glucocorticoid hormones produced by the adrenal cortex.
The replacement doses should be increased accordingly to stress-dose levels, and reduced in a rapid step-wise manner when recovery is progressing. Other hormones do not need this kind of rapid raise in dosage.
Reviewed by Dr Liji Thomas, MD.