Hypopituitarism

Diagnosis

Several tests can check hormone levels in the body and look for the cause of problems with the way the pituitary is working. These include:

• Blood tests. These tests measure levels of the hormones made in the pituitary gland and those made in glands that the pituitary controls, such as the thyroid gland. Blood tests can show if low hormone levels are due to the pituitary not working as it should.
• Stimulation or dynamic testing. A clinic that specializes in endocrine conditions can run these tests to measure hormone levels. These tests check the body's hormone levels before and after taking medicines that cause the body to make hormones.
• Brain imaging. MRI or CT scans of the brain can show a pituitary tumor or other pituitary gland problems.

Treatment

Hypopituitarism is treated with medicines that raise hormone levels. This is called hormone replacement. Doses are set to match the amount of hormones that the body would make if it didn't have a pituitary problem. In some cases, people with hypopituitarism may need to take this medicine for the rest of their lives.

Sometimes, treatment of a condition causing hypopituitarism may restore the body's ability to make pituitary hormones, either fully or in part.

Medications

Hormone replacement medicines might include:

• Cortisol replacement. These medicines include hydrocortisone (Cortef) or prednisone (Rayos). Taken by mouth, they replace the adrenal hormones needed because of a lack of adrenocorticotropic hormone (ACTH).
• Levothyroxine (Levoxyl, Synthroid, others). This medicine treats the low thyroid hormone levels, known as hypothyroidism, from a lack of thyroid-stimulating hormone (TSH).
• Sex hormones. These include testosterone, estrogen and progesterone. Testosterone is given by a shot, pills, patch or gel. Estrogen and progesterone usually are given in pills, gels or patches.
• Growth hormone. Also called somatropin (Genotropin, Humatrope, others), growth hormone is given by a shot under the skin. It promotes growth, which helps children grow taller. Adults who lack growth hormone also can benefit from growth hormone, but they won't get taller.
• Fertility hormones. Gonadotropins can be given by a shot to help ovulation and sperm production.

Monitoring hormone replacement

A specialist in endocrine disorders, called an endocrinologist, may keep an eye on symptoms and hormone levels in the blood. This is to ensure that the right amount of medicine is given.

People who take cortisol replacement need to work with a health care provider to adjust the dose during times of major stress. Under stress, the body usually makes extra cortisol to help manage the stress.

Having the flu, diarrhea or vomiting, or having surgery or dental work might mean the dose needs to be changed. The same might be true during pregnancy or with big changes in body weight.

Surgery or other procedures

If a tumor in or around the pituitary gland is the cause of hypopituitarism, surgery might be needed to remove the growth. Some tumors also can be treated with medicines or radiation therapy.

In case of emergency

People with hypopituitarism need to wear a medical alert bracelet or necklace and carry a card telling others of the condition. This is especially important for those taking cortisol replacement for a lack of ACTH.

Preparing for your appointment

You're likely to start by seeing your primary care provider. Sometimes, you might be referred to a specialist in endocrine disorders, known as an endocrinologist.

Here's some information to help you get ready for your appointment.

What you can do

• Be aware of any pre-appointment restrictions. When you make the appointment, ask if there's anything you need to do to get ready for tests you may need.
• Write down all symptoms you have, even if they seem not to be linked to each other. Note when they began.
• Write down key personal information, including any recent life changes or a change in your ability to cope with stress.
• Make a list of your key medical information, including recent surgeries and any other conditions for which you've been treated. Write down the names of all medicines you take, including doses. List injuries to your head or problems during childbirth.
• Take a family member or friend along, if possible. Someone who accompanies you can help you remember what your care provider tells you.
• Write down questions to ask your care provider.

Create a list of questions before your appointment so that you can make the most of your time with your provider. For hypopituitarism, some basic questions to ask include:

• What is likely causing my symptoms?
• What are other possible causes?
• What tests do I need?
• Is my condition likely to be short-term or long-term?
• What treatment do you recommend?
• How long will I need to take medicines?
• How will you know if my treatment is working?
• I have other health conditions. How can I best manage them together?
• Are there restrictions I need to follow?
• Do you have brochures or other printed material I can have? What websites do you recommend?

Be sure to ask all the questions you have.

What to expect from your doctor

Your care provider might ask questions, such as:

• How have your symptoms changed over time?
• Has your vision changed?
• Do you have bad headaches?
• Has your weight or the amount of your body hair changed? Are there other changes in how you look?
• Have you lost interest in sex? Has your menstrual cycle changed?
• Have you recently had a baby?
• Have you had a head injury or neurosurgery?
• Have you ever had radiation treatment for a head or neck tumor?
• Have any of your family members been diagnosed with pituitary or hormonal conditions?
• What, if anything, seems to improve your symptoms?
• What, if anything, appears to worsen your symptoms?