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Panhypopituitarism

Authors:
  • Diana Kohnle
Publication Type:

Condition

Panhypopituitarism

(PHP; Underactive Pituitary Gland)

Definition

The pituitary gland is found at the base of the brain. It makes many key hormones that control the production of other hormones made by glands in the body. In panhypopituitarism, the gland does not make enough hormones.

Pituitary Gland.

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Causes

This is most often caused by damage to the gland. In adults, it is often a result of pituitary surgery. In children, damage to the pituitary gland may be caused by:

  • Infection
  • Stroke
  • Genetic factors
  • Tumor on or near the pituitary gland
  • Cancer that has spread
  • Injury

Sometimes the cause is not known.

Risk Factors

Things that may raise the risk of panhypopituitarism include:

Symptoms

Diagnosis

The doctor will ask about symptoms and medical history. A physical exam will be done.

Tests may include:

  • Blood tests—to measure hormone levels
  • Stimulation tests—to test how much the endocrine glands, usually the pituitary gland
  • Semen analysis—in males who may have infertility
  • MRI scan —to look at the glands

Treatment

The goal of treatment is to get hormones that are low back to the normal level. How this is done depends on what caused the panhypopituitarism.

Treatment options include:

  • Hormone replacement therapy to make up for the missing hormones
  • Surgery to remove a tumor if that is causing the damage
  • Radiation therapy—done if the cause of the damage is a cancer or a tumor that cannot be removed with surgery

Prevention

Most of the time panhypopituitarism cannot be prevented.

Compression of the Tumor

If there is a tumor pressing on the gland or the structures near it a person could have:

  • Blurred vision
  • Loss of visual field
  • Poor temperature control

Insufficient Hormones

  • Low levels of gonadotropins can cause:
    • In premenopausal women—missed menstrual cycles, infertility, osteoporosis, vaginal dryness, loss or reduction in female characteristics
    • In men—erectile dysfunction, reduced testes size, decreased production of sperm, infertility, breast enlargement, reduced muscle mass, loss or reduction in male characteristics like beard growth
  • Low levels of growth hormone can cause:
    • In children—stunted growth
    • In adults—weakness, obesity, low blood sugar levels, and reduced exercise tolerance
  • Low levels of thyroid-stimulating hormones can lead to:
    • Underactive thyroid, which causes confusion, hair loss, weakness, slow heart rate, muscle stiffness, intolerance to cold, constipation, weight gain, and dry skin
  • Low corticotrophic levels can lead to:
    • Underactive adrenal gland, which causes low blood pressure, low blood sugar, fatigue, weight loss, vomiting, and low stress tolerance—this can be life-threatening
  • Low prolactin levels can cause:
    • In women—missed periods, infertility, and milk secretion
    • In men—reduced facial and body hair, small testes
  • Low levels of antidiuretic hormone can cause:
    • Feeling very thirsty and having to urinate often
    • Nighttime urination
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References

  • Fleseriu, M., Hashim, I.A., et al. Hormonal replacement in hypopituitarism in adults: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab, 2016; 101 (11): 3888-921.
  • Higham, C.E., Johannsson, G., et al. Hypopituitarism. Lancet, 2016; 388 (10058): 2403-15.
  • Hypopituitarism in children. Stanford Children's Health website. Available at: http://www.stanfordchildrens.org/en/topic/default?id=hypopituitarism-in-children-90-P01962.
  • Schneider, H.J., Aimaretti, G., et al. Hypopituitarism. Lancet, 2007; 269 (9571): 1461-1470.
  • What is a growth disorder? Nemours Kids Health website. Available at: http://kidshealth.org/parent/medical/endocrine/growth_disorder.html.
Last Updated:
2023-06-01

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This content is reviewed regularly and is updated when new and relevant evidence is made available. This information is neither intended nor implied to be a substitute for professional medical advice. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with questions regarding a medical condition.