Sign Up for a Free Account
  • Updated 08.19.2021
  • Released 10.30.1994
  • Expires For CME 08.19.2024

Hypopituitarism

Introduction

Overview

The pituitary gland sits in the sella turcica and is divided into 2 parts, the anterior and posterior. Hypopituitarism results from the partial or complete loss of 1 or more of 6 hormones made and released by the anterior pituitary gland. Non-tumoral causes constitute a major group of childhood hypopituitarism. Once fully established and prolonged (greater than 6 months), hypopituitarism is generally permanent, although spontaneous recovery can rarely occur. There are many causes of hypopituitarism, including tumors in or around the pituitary gland, whole brain radiation therapy or focused radiation therapy that includes the sella turcica in the treatment field, chemotherapy, operative damage, major head trauma, subarachnoid hemorrhage, infections, and perinatal and prenatal causes.

Key points

• Hypopituitarism results from the partial or complete loss of 1 or more of 6 hormones made and released by the anterior pituitary gland.

• Non-tumoral causes constitute a major group of childhood hypopituitarism.

• Once fully established and prolonged (greater than 6 months), hypopituitarism is generally permanent, although spontaneous recovery can rarely occur.

• Not all intrasellar enhancing lesions causing hypopituitarism are pituitary adenomas.

• A pituitary abscess is an intrasellar infection; it responds to antibiotic therapy and surgery, and although the abscess resolves eventually, protracted hypopituitarism often remains protracted, requiring prolonged hormone replacement therapy.

• After traumatic brain injury, anterior pituitary hormonal function should be assessed to attain maximal improvement in cognitive and physical function as well as quality of life.

Historical note and terminology

Hypopituitarism results from the partial or complete loss of 1 or more of the 6 hormones made and released by the anterior pituitary gland: growth hormone, adrenocorticotropic hormone, prolactin, thyroid stimulating hormone, luteinizing hormone, and follicle-stimulating hormone. The posterior pituitary is the storage gland for the hypothalamic hormones, antidiuretic hormone, and oxytocin. Although complete deficiency of anterior pituitary hormones is often called "panhypopituitarism," this term should be reserved for complete loss of anterior and posterior pituitary hormones, including the neuropeptides vasopressin and oxytocin.

The crucial physiologic roles of the pituitary gland were not suspected until the late 19th century and were not clearly defined until the first third of the 20th century. In the second century, Galen of Pergamum taught that the hypophysis acted as a funnel or drain for secreted mucus (pituita) made by the brain to pass into the nasopharynx. In the 16th century, Vesalius claimed that phlegm from the cerebral ventricles passed down the infundibulum into the gland and finally out the nose. Acromegaly was described by various authors from the 16th through 19th centuries, but when pituitary pathology was recognized in such cases, it was initially unclear if the pituitary enlargement was the cause or consequence of the disease (23). The first clear evidence suggesting a more important role for the pituitary gland was published in 1886. French neurologist Pierre Marie (1853-1940) described (and named) the disease of acromegaly, which was associated in his case with the replacement of the pituitary bodygland by a tumor (46).

Pierre Marie, French neurologist (1853-1940)

Photograph taken around 1900 by French photographer Louis Eugène Pirou (1841-1909). Marie described the relationship between a pituitary adenoma and acromegaly in 1886. (Courtesy of Wikimedia Commons. Public domain.)

American neurosurgeon Harvey Cushing (1869-1939) had suspected that a clinical disorder was associated with pituitary destruction (21), but in 1914 German physician Morris Simmonds (1855-1925) provided the first clear description of pituitary insufficiency, which he termed "pituitary cachexia" (68).

Harvey Williams Cushing, American neurosurgeon (1869-1939)

Photograph taken in 1938. Cropped from a picture of Cushing and English neurophysiologist Sir Charles Scott Sherrington (1857-1952). (Courtesy of the Wellcome Institution. Creative Commons Attribution 4.0 International license....

Simmonds detailed the necroscopic findings of a 46-year-old woman whose illness began after childbirth and was complicated by severe puerperal fever. The clinical findings included marked weight loss, premature aging, marked muscular weakness, and anemia. Subsequent reports stressed a common relationship between childbirth and the clinical syndrome, which led Reye to speculate in 1926 and 1928 that pituitary destruction was caused by thrombosis in the setting of pituitary hyperplasia during pregnancy (59; 60). This view was fully confirmed by the 1937 report of British pathologist Harold Leeming Sheehan (1900-1988) in his classic article on ischemic postpartum necrosis of the pituitary (66). Ischemic pituitary necrosis is now often variously named eponymically as Reye-Sheehan syndrome or Sheehan syndrome.

This is an article preview.
Start a Free Account
to access the full version.

  • Nearly 3,000 illustrations, 
including video clips of 
neurologic disorders.

  • Every article is reviewed by our esteemed Editorial Board for accuracy and currency.

  • Full spectrum of 
neurology in 1,200 
comprehensive articles.

Questions or Comment?

MedLink, LLC

3525 Del Mar Heights Rd, Ste 304
San Diego, CA 92130-2122

Toll Free (U.S. + Canada): 800-452-2400

US Number: +1-619-640-4660

Support: service@medlink.com

Editor: editor@medlink.com