Panhypopituitarism: Definition, Causes, Symptoms, Diagnosis and Treatment

It is a rare disorder that results from decreased production of hormones from the pituitary gland.

The investigations of panhypopituitarism have been related to hypopituitarism , pituitary diseases, neoplasms, pituitary neoplasms and diabetes mellitus.

There are six hormones that are produced by the anterior lobe of the pituitary gland.

These include growth hormone, thyroid-stimulating hormone, follicle-stimulating hormone, leutenizing hormone, prolactin, and adrenocorticotropic hormone.

In addition, the posterior lobe of the pituitary gland releases antidiuretic hormone and oxytocin.

The antidiuretic hormone is responsible for maintaining the balance of water in the kidney .

Generalized effects are observed when these hormones are not present in their normal amounts.

The pituitary gland is located at the base of the brain and panhypopituitarism occurs when there is a deficient production of secretion in most pituitary hormones.

Causes

Hypopituitarism is usually caused by damage to the gland, conditions are observed that can lead to varying degrees in decreasing the function of the pituitary gland as:

  • The presence of a pituitary tumor that damages normal pituitary tissue as the tumor enlarges.
  • Surgery or pituitary radiation in the pituitary region can produce hypopituitarism.
  • The hypotension due to loss of blood may damage the pituitary gland.
  • The serious injuries in the head that affect the gland.
  • Presence of infections.
  • The existence of genetic factors.
  • The spread of cancer.
  • Damage to the pituitary gland by radiotherapy
  • Presence of postpartum hemorrhages.

Symptoms of panhypopituitarism

Panhypopituitarism can be a potentially fatal devastating situation, it can be partial and it can involve one or more hormones of the anterior pituitary.

The symptoms are often related to the deficiencies of the white gland hormones.

The symptoms will also be related to the cause that causes panhypopituitarism, such as:

Tumor compression:

Compression of the tumor in local structures, especially in the nerves of the eyes, can cause:

  • Blurry vision.
  • Loss of visual field.
  • Problems with temperature control.

Insufficient production of hormones:

Insufficient levels of gonadotropins can cause:
  • In premenopausal women: The omission of menstrual cycles, infertility, osteoporosis, vaginal dryness, loss or reduction of female characteristics.
  • In men ‘s erectile dysfunction a reduced testicular size , reduced sperm production, infertility, breast enlargement, reduced muscle mass, loss or reduction in male characteristics, such as growth of the beard.
Insufficient levels of growth hormone can cause:
  • In children and adolescents: A delay in growth or dwarfism.
  • In adults: Weakness, obesity, reduced cardiac output, low blood sugar levels and reduced tolerance to exercise.
Insufficient levels of thyroid stimulating hormones can lead to:
  • Underactive thyroid, which can cause confusion, hair loss, weakness, slow heart rate, muscle stiffness, cold intolerance, constipation , weight gain and dry skin.
Insufficient corticotrophic levels can lead to:
  • The underactive adrenal gland, which causes low blood pressure , low blood sugar levels, fatigue, weight loss, vomiting and low tolerance to stress.
Excessive levels of prolactin can cause:
  • In women: The loss of menstrual periods, infertility and the secretion of milk in the breasts.
  • In men: Reduction of facial and body hair and small testicles.
Insufficient antidiuretic hormone (rare) can cause:
  • Constant thirst and frequent urination.
  • Urinating during the night.

Other symptoms may occur such as nausea, vomiting, hoarseness may develop, constipation may occur secondary to some degree of dehydration.

Diagnosis

The diagnosis will be directed in addition to the differential diagnosis to the knowledge of the white gland.

A physical examination and tests must be performed that may include the following:

  • Blood tests: To measure the activity of the pituitary, as well as the levels of the hormone of the white gland, thyroid function tests, adrenal function tests among others.
  • Stimulation tests: To evaluate the maximum capacity of the endocrine glands, usually of the pituitary gland.
  • Analysis of semen in men suspected of infertility.
  • Magnetic resonance image: Image test used to evaluate internal structures.
  • Review of birth history: babies with hypopituitarism are usually normal or small for gestational age, in contrast to hyperinsulinemic babies, who are usually large for their gestational age.

Treatment

The treatment depends on the cause of the condition.

The goal of treatment is to restore normal levels of hormones in the thyroid blood, adrenal glands, estrogen or testosterone levels, and sometimes growth hormone .

Treatment options include:

  1. Hormone replacement therapy: Depending on the types of hormones that are not being produced in normal quantities, with drugs such as human growth hormone produced by recombinant DNA technology, desmopressin acetate among others.
  2. Tumor removal and radiation therapy: Performed if the tumor is interfering with the activity of the pituitary gland .