Pituitary Disorders

Hypopituitary Syndromes (Lancet 2016;388:2403)

Etiologies

  • Primary: surgery, radiation (develops after avg 4–5 y), tumors (primary or metastatic), infection, infiltration (sarcoid, hemochromatosis), autoimmune, ischemia (including Sheehan’s syndrome caused by pituitary infarction intrapartum), carotid aneurysms, cavernous sinus thrombosis, trauma, medications (eg, ipilimumab), apoplexy
  • Secondary (hypothalamic dysfunction or stalk interruption): tumors (including craniopharyngioma), infection, infiltration, radiation, surgery, trauma

Clinical manifestations

  • Hormonal deficiencies: ACTH, TSH, FSH and LH, GH, prolactin, and ADH
  • Panhypopituitarism: deficiencies in multiple hormonal axes and including ADH
  • Mass effect: headache, visual field Δs, cranial nerve palsies, galactorrhea

Central adrenal insufficiency: ACTH