Hypopituitarism

What is hypopituitarism?

• Hypopituitarism is a condition where your pituitary gland does not make enough hormones for your body. The pituitary gland is an almond-shaped organ found under the middle part of your brain. Your pituitary gland makes and releases hormones such as prolactin, growth hormone, and thyroid stimulating hormone. Hormones are special chemicals that flow through your blood and control functions of your organs. An area of your brain called the hypothalamus is found above your pituitary gland. It sends signals to your pituitary gland telling it which hormones to release, and how much. Hormones from your pituitary gland then control the amount of hormones your other glands make and release.
  
  
• Your body needs certain amounts of each different hormone to function well. With hypopituitarism, your pituitary gland makes only small amounts of these hormones, or none at all. When you lack hormones, you may have mood and mind problems, and problems with your organs and tissues. Treating your hypopituitarism may help your body function normally again. Your symptoms may be relieved quickly, and you may prevent any further problems.

What causes hypopituitarism?

Your condition may be caused by any of the following:

• Abnormal genes: Genes are little pieces of information that tell your body how to grow and what to do. Being born with abnormal genes can cause your pituitary gland to make abnormal amounts of needed hormones.
  
  
• Brain trauma (injury): Trauma from accidents, blows to the head, or a stroke can damage your brain tissue and pituitary gland. A stroke is a condition where you have blocked blood vessels, or bleeding inside your brain. Parts of your pituitary gland may die if it does not get enough blood.
  
  
• Head tumors: A tumor is a lump of abnormal cells which can grow very quickly. Tumors inside your head can press on your pituitary gland and damage it. Tumors may pinch blood vessels and nerves around the pituitary gland and block the flow of blood. Tumors may also pinch the pituitary stalk and block signals from your hypothalamus to your pituitary gland. The pituitary stalk is a small tube that connects the hypothalamus to your pituitary gland. Without signals from the hypothalamus, your pituitary gland will not make the right amounts of hormones.
  
  
• Other medical conditions: Autoimmune diseases can damage your pituitary gland, brain tissues, and other organs. Your immune system protects your body from infection and harmful materials. If you have an autoimmune disease, your immune system can harm even your normal cells and tissues. Inflammation (swelling) and infections can damage brain tissues and your pituitary gland. Too much swelling can pinch your blood vessels and block the flow of blood to your pituitary gland. Parts of your pituitary gland may die, and it will not function properly.
  
  
• Radiation therapy or radiosurgery: These treatments use powerful x-ray beams to shrink or remove tumors in your head. Radiation may also damage healthy cells in your pituitary gland.
  
  
• Surgery: Surgery is used to remove tumors, or decrease their size. During surgery, your pituitary gland may get damaged causing it not to function correctly.

Which hormones are decreased during hypopituitarism?

Your pituitary gland has two main areas that make different kinds of hormones. The anterior pituitary gland is found at the front, and is the larger of the two. The posterior pituitary gland stores (keeps) hormones that are made by the hypothalamus.

• Anterior pituitary gland hormones:
  
  
  • Adrenocorticotropic hormone: This is also called ACTH. ACTH gets your body ready for hard or stressful activities. ACTH helps your body use energy for different body functions.
    
    
  • Gonadotropin hormones: These control the amount of hormones the male and female sex organs make. These hormones are needed for females to become pregnant and have babies. In males, these hormones make it possible for them to get their female partner pregnant.
    
    
  • Growth hormone: This hormone controls how your body grows and develops.
    
    
  • Prolactin: This hormone controls how much breastmilk the female body makes. This helps prepare females for pregnancy and breastfeeding.
    
    
  • Thyroid stimulating hormone: This hormone controls your body's metabolism. Metabolism includes all the processes in your body that make energy.
  
  

• Posterior pituitary gland hormones:
  
  
  • Anti-diuretic hormone: This is also called ADH. This hormone controls how much urine your body makes.
    
    
  • Oxytocin: This hormone controls the muscles of a female's uterus (womb) during child birth. This hormone also controls the flow of milk when females breastfeed.
  
  

What are the signs and symptoms of hypopituitarism?

You may have any of the following:

• Gastrointestinal:
  
  
  • Constipation (hard, dry stools).
    
    
  • Nausea (upset stomach).
    
    
  • Vomiting (throwing up).
  
  
• Musculoskeletal:
  
  
  • Feeling slow or weak.
    
    
  • Getting tired easily while exercising or doing other activities.
    
    
  • Not growing to be as tall as what is expected for you.
    
    
  • Weak bones which may break easily.
  
  
• Psychological:
  
  
  • Feeling very sad most of the time.
    
    
  • Losing interest in activities you enjoy.
    
    
  • Sudden mood changes.
  
  
• Reproductive:
  
  
  • Decreased desire (need) for sex.
    
    
  • Difficulty getting pregnant or having babies for females.
    
    
  • Infertility (unable to get your female partner pregnant) or erection problems in males.
    
    
  • Irregular or absent menstruation (monthly period) in females.
  
  
• Skin and hair:
  
  
  • Dry or pale skin.
    
    
  • Losing hair from many areas of your body.
  
  
• Other signs and symptoms:
  
  
  • A hoarse (rough) voice, or losing your voice completely.
    
    
  • Blurry vision, or having blind spots.
    
    
  • Getting cold very easily.
    
    
  • Headaches, dizziness, and trouble thinking.
    
    
  • Losing or gaining weight without trying.
    
    
  • Slow heartbeats or low blood pressure.
    
    
  • Urinating more than usual, and feeling thirsty most of the time.

How is hypopituitarism diagnosed?

Your caregiver will ask about any health problems, accidents, or injuries you may have had in the past. He may also ask about your family's health history. He will ask what symptoms you feel and how bad they are. He will do a physical exam to check your health, and you may need any of the following:

• Urine testing: This test measures the hormone levels in your body.
  
  
• Blood tests: You may need blood taken for tests. This can tell caregivers how much of each hormone you have in your body. Blood tests may also give your caregivers information about your health. The blood can be taken from a blood vessel in your hand, arm, or the bend in your elbow. You may need to have blood drawn more than once.
  
  
• Computed tomography scan: This is also called a CT scan. A special x-ray machine with a computer takes pictures of your brain. It can show your tissues, blood vessels, and any tumors inside your brain. A CT scan can also tell if there is bleeding or other problems in your brain.
  
  
• Hormone challenge tests: This test is done to check if your hypothalamus, pituitary, and other glands are working properly. You will be given a certain amount of hormones or medicines such as insulin or steroids. Caregivers will then check how these hormones or medicines act in your body. Your caregiver will check for other health conditions before giving you hormone challenge tests. Tell your caregiver if you have heart problems or epilepsy.
  
  
• Magnetic resonance imaging: This is also called an MRI. The MRI shows pictures of the inside of your head. This can show your caregiver if you have any brain tumors or other problems. You will need to lay still and relax during an MRI. Never enter the MRI room with an oxygen tank, watch, or other metal objects. This can cause serious injury.
  
  
• Water deprivation test: This test measures how much ACTH or ADH you have in your body. You will be told not to drink liquids for a certain amount of time. Your urine will be measured every 2 hours and your blood will be checked every hour.

How is hypopituitarism treated?

You may need any of the following:

• Fluid replacements: Certain hormones help control your blood pressure. When these hormone levels are too low, your blood pressure may be low and cause dizziness or other problems. IV fluids may be given to increase your blood pressure and correct your body's fluid balance. An IV is a tube placed in your vein for giving medicine or liquids. This tube is capped or connected to tubing and liquid.
  
  
• Hormone replacements: Caregivers may give you certain hormones to correct your blood levels. These hormones may be given as pills, injections, or skin patches. Certain hormones must be taken at certain times for them to work properly. Some may need to be taken several times a day, every day. You may need to take these hormones for the rest of your life.
  
  
• Treatments for other causes: Your caregiver may need to treat other health conditions that may be causing your hypopituitarism. Caregivers will treat brain trauma caused by accidents or blows to your head. Caregivers may use medicines, radiotherapy, or surgery to shrink or remove any brain tumors.

When should I call my caregiver?

Call your caregiver if:

• You are female and your menstrual period stops or becomes irregular.
  
  
• You get tired very easily.
  
  
• You have gained or lost weight without trying.
  
  
• Your mood often changes quickly from being happy to being very sad.
  
  
• You have questions or concerns about your condition, treatment, or care.

When should I seek immediate help?

Seek care immediately or call 911 if:

• You cannot feel or move some parts of your body.
  
  
• You feel confused, or have a hard time speaking.
  
  
• You feel dizzy, have a bad headache, or you are throwing up.
  
  
• You have chest pain and trouble breathing.
  
  
• You lose consciousness.
  
  
• Your vision suddenly becomes blurred.

Where can I find support and more information?

Contact any of the following for more information:

• Endocrine and Metabolic Diseases Information Service
  National Institutes of Health
  6 Information Way
  Bethesda , MD 20892-3569
  Phone: 1- 888 - 828-0904
  Web Address: http://www.endocrine.niddk.nih.gov
  

• National Institute of Neurological Disorders and Stroke
  P.O. Box 5801
  Bethesda , MD 20824
  Phone: 1- 301 - 496-5751
  Phone: 1- 800 - 352-9424
  Web Address: http://www.ninds.nih.gov
  

Care Agreement

You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your caregivers to decide what care you want to receive. You always have the right to refuse treatment.

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The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

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