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Hypopituitarism

Last edited: 4/14/2026

Overview

Hypopituitarism is a condition characterized by insufficient secretion of one or more pituitary hormones, leading to various endocrine deficiencies including growth hormone, thyroid-stimulating hormone, adrenocorticotropic hormone, and gonadotropins 4511.

Diagnosis

  • Clinical Presentation: Symptoms vary based on deficient hormones; common include fatigue, hypoglycemia, growth retardation, and reproductive issues 14.
  • Laboratory Tests: Measure hormone levels (e.g., TSH, free T4, cortisol, IGF-1) and perform dynamic tests (e.g., TRH stimulation, ACTH stimulation) 4.
  • Imaging: MRI of the pituitary gland to identify structural abnormalities such as tumors, inflammation, or stalk interruption 1822.
  • Genetic Testing: Consider in cases with congenital hypopituitarism or familial patterns 615.

    • Management

  • Hormonal Replacement: Tailored to deficient hormones; examples include levothyroxine for hypothyroidism, glucocorticoids for adrenal insufficiency, sex steroids for gonadal deficiencies, and growth hormone for growth hormone deficiency 9.
  • Monitoring: Regular follow-up to adjust hormone replacement doses and monitor for complications 9.
  • Supportive Care: Address symptoms like myalgias with thyroid hormone and glucocorticoids 34.
  • Transition Care: Coordinated care between pediatric and adult endocrinologists for adolescents 18.

    • Special Populations

  • Pediatrics: Early diagnosis crucial for growth and development; consider genetic causes 1615.
  • Elderly: Increased risk of comorbidities affecting management; careful monitoring of multiple hormone deficiencies 220.
  • Comorbidities: Iron overload can complicate management; monitor ferritin levels and consider iron chelation if necessary 214.

    • Key Recommendations

  • Comprehensive Hormonal Assessment: Perform thorough endocrine evaluations including dynamic tests to identify specific deficiencies (Evidence: Moderate 4).
  • Personalized Hormone Replacement Therapy: Initiate and adjust hormone replacement based on individual deficiencies and clinical response (Evidence: Strong 9).
  • Regular Monitoring and Follow-Up: Schedule frequent follow-ups to manage hormone levels and address emerging complications (Evidence: Moderate 4).
  • Coordinated Care Transitions: Ensure seamless transition of care from pediatric to adult endocrinology services (Evidence: Expert opinion 18).
  • Consider Genetic Causes in Congenital Cases: Evaluate genetic factors in neonates and infants presenting with hypopituitarism (Evidence: Moderate 615).

    • References

    1 Winkler I, Steichen E, Kapelari K, Wöckinger P, Neubauer V, Kiechl-Kohlendorfer U et al.. Pituitary Stalk Interruption Syndrome – clinical Presentation and Management of a Potentially Life-threatening Disease in Newborns. Journal of clinical research in pediatric endocrinology 2025. link 2 Zhu W, Vanderhaeghen T, Timmermans S, Vandewalle J, Eggermont M, Verhoog NJD et al.. Modulation of glucocorticoid receptor function under iron overload. Frontiers in immunology 2025. link 3 Arda BE, Sipahi H. Disproportionality analysis of data from VigiBase and other global product safety databases on toxicity of iron chelating agents. Expert opinion on drug safety 2025. link 4 Garmes HM, Boguszewski CL, Miranda PAC, Martins MRA, da Silva SRC, Abucham JZ et al.. Management of hypopituitarism: a perspective from the Brazilian Society of Endocrinology and Metabolism. Archives of endocrinology and metabolism 2021. link 5 Takahashi Y. MECHANISMS IN ENDOCRINOLOGY: Autoimmune hypopituitarism: novel mechanistic insights. European journal of endocrinology 2020. link 6 Martín-Rivada Á, Rodríguez-Contreras FJ, Muñoz-Calvo MT, Güemes M, González-Casado I, Del Pozo JS et al.. A novel GLI2 mutation responsible for congenital hypopituitarism and polymalformation syndrome. Growth hormone & IGF research : official journal of the Growth Hormone Research Society and the International IGF Research Society 2019. link 7 Zhou C, Lai S, Xie Y, Zhang S, Lu Y. Rhabdomyolysis in a patient complicated with hypopituitarism and multiple organ dysfunction syndrome and the literature review. The American journal of emergency medicine 2018. link 8 Boueilh T, Bassi C, Rouleau S, Le Crugel S, Moal V, Boux de Casson F et al.. Pituitary stalk interruption syndrome: a rare and severe cause of pituitary deficiency Laboratory diagnosis of a newborn case. Annales de biologie clinique 2017. link 9 Fleseriu M, Hashim IA, Karavitaki N, Melmed S, Murad MH, Salvatori R et al.. Hormonal Replacement in Hypopituitarism in Adults: An Endocrine Society Clinical Practice Guideline. The Journal of clinical endocrinology and metabolism 2016. link 10 Burrows AD, Jurcic M, Mahon MF, Pierrat S, Roffe GW, Windle HJ et al.. Bismuth coordination networks containing deferiprone: synthesis, characterisation, stability and antibacterial activity. Dalton transactions (Cambridge, England : 2003) 2015. link 11 Bancalari RE, Gregory LC, McCabe MJ, Dattani MT. Pituitary gland development: an update. Endocrine development 2012. link 12 Tebbi CK, Steffensen TS, Thorkelsson T, Gudmundsson JA, Gilbert-Barness E. Clinicopathologic conference: multiple fetal demises, lactic acidosis and hepatic iron accumulation. Fetal and pediatric pathology 2011. link 13 Kaiser L, Davis JM, Patterson J, Johnson AL, Bohart G, Olivier NB et al.. Iron sufficient to cause hepatic fibrosis and ascites does not cause cardiac arrhythmias in the gerbil. Translational research : the journal of laboratory and clinical medicine 2009. link 14 Raphael JL, Bernhardt MB, Mahoney DH, Mueller BU. Oral iron chelation and the treatment of iron overload in a pediatric hematology center. Pediatric blood & cancer 2009. link 15 Alatzoglou KS, Dattani MT. Genetic forms of hypopituitarism and their manifestation in the neonatal period. Early human development 2009. link 16 Mehndiratta MM, Phul P, Singh AK, Garg S, Bali R. Granulomatous hypophysitis--an interesting and rare cause mimicking pituitary mass. The Journal of the Association of Physicians of India 2007. link 17 Goddard DS, Liang MG, Chamlin SL, Svoren BM, Spack NP, Mulliken JB. Hypopituitarism in PHACES Association. Pediatric dermatology 2006. link 18 Stanhope R. Transition from paediatric to adult endocrinology: hypopituitarism. Growth hormone & IGF research : official journal of the Growth Hormone Research Society and the International IGF Research Society 2004. link 19 van Gelder W, Huijskes-Heins MI, Klepper D, van Noort WL, Cleton-Soeteman MI, van Eijk HG. Isolation and partial characterization of two porcine spleen ferritin fractions with different electrophoretic mobility. Comparative biochemistry and physiology. Part B, Biochemistry & molecular biology 1996. link00076-4) 20 Nomoto J, Kuramitsu K, Kinoshita A, Saku K, Sasaki J, Arakawa K. A case of hypopituitarism and type V hyperlipidemia. Japanese journal of medicine 1989. link 21 Newman NM, Welch E, Challis DR. Adrenal hypoplasia and pituitary agenesis in a normocephalic infant, with a review of the literature. Australian paediatric journal 1988. link 22 Hausmann K, Wedekind I, Tenner-Racz K, Grosschupf G, Kuse R, Niecke M et al.. Sulfide silver amplification of ferritin iron cores in blood and bone marrow cells. Methods, adaptations to microphysical analyses, and the impact of advanced iron overload. Blut 1988. link 23 Hosokawa M, Satoh T. Effects of hypophysectomy and pituitary hormones on hepatic microsomal carboxylesterase isozymes in male rats. Research communications in chemical pathology and pharmacology 1988. link 24 Starzec A, Counis R, Jutisz M. Several intermediate forms in the processing of rat lutropin subunits as shown by sodium dodecyl sulphate polyacrylamide gel electrophoresis. Journal of chromatography 1988. link94538-2) 25 Andrews SC, Brady MC, Treffry A, Williams JM, Mann S, Cleton MI et al.. Studies on haemosiderin and ferritin from iron-loaded rat liver. Biology of metals 1988. link 26 Carr D, Thornes HM, Rutter AC, Finney RD, Turner PR. Sheehan's syndrome presenting with type III hyperlipoproteinaemia. Postgraduate medical journal 1987. link 27 Querci F, Cattaneo O, Sileo F, Nosari I, Lepore G, Corbellini A et al.. Empty sella syndrome and growth deficiency in childhood. Helvetica paediatrica acta 1987. link 28 Miśkowiak B. Studies on hypothalamo-pituitary corticoliberin system. I. Localization of corticotropin-releasing factor (CRF)- and neurophysin-immunoreactive neurons in the Mongolian gerbil (Meriones unguiculatus). Acta anatomica 1987. link 29 Stachura ME, Bernardis LL, Tyler JM, Kent PG. Differential spontaneous and stimulated in vitro release of newly synthesized or stored rGH and rPRL by pituitaries from rats with hypothalamic lesions. Neuroendocrinology 1986. link 30 Blethen SL, Weldon VV. Hypopituitarism and septooptic "dysplasia" in first cousins. American journal of medical genetics 1985. link 31 Lengvári I, Liposits Z, Vigh S, Schally AV, Flerkó B. The origin and ultrastructural characteristics of corticotropin-releasing factor (CRF)-immunoreactive nerve fibers in the posterior pituitary of the rat. Cell and tissue research 1985. link 32 Kawamoto K, Kawashima S. Changes of vasopressin- and oxytocin-immunoreactive neurons after hypophysectomy in young and old mice. Experimental gerontology 1985. link90056-7) 33 Martin W. Do we get too much iron?. Medical hypotheses 1984. link90136-1) 34 Horowitz M, Byrne E, Burnet R. Hypopituitarism associated with myalgia. Postgraduate medical journal 1984. link 35 Ozgen T, Bertan V, Kansu T, Akalin S. Intrasellar hydatid cyst. Case report. Journal of neurosurgery 1984. link 36 Martin W. Do we get too much iron?. Medical hypotheses 1984. link90050-1) 37 Dreyfuss F, Burlet A, Tonon MC, Vaudry H. Comparative immunoelectron microscopic localization of corticotropin-releasing factor (CRF-41) and oxytocin in the rat median eminence. Neuroendocrinology 1984. link 38 Oliven A, Harel D, Rosenfeld T, Spindel A, Gidron E. Hypopituitarism after aseptic cavernous sinus thrombosis. Neurology 1980. link 39 MacPhail AP, Derman DP, Bothwell TH, Torrance JD, Charlton RW, du Plessis JP et al.. Serum ferritin concentrations in black miners. South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde 1979. link 40 Mitchell DM, Webb SC, Hoffbrand BI. Pituitary coma with continuing menstruation. Postgraduate medical journal 1978. link 41 Piret L, Duvivier E, Beckers C, Crabbé J. Unusual features of thyroid function in anterior pituitary failure. Annales d'endocrinologie 1978. link 42 Rozario R, Hammerschlag SB, Post KD, Wolpert SM, Jackson I. Diagnosis of empty sella with CT scan. Neuroradiology 1977. link 43 Pelletier G, Dubé D, Puviani R. Somatostatin: electron microscope immunohistochemical localization in secretory neurons of rat hypothalamus. Science (New York, N.Y.) 1977. link

    Original source

    1. [1]
      Pituitary Stalk Interruption Syndrome – clinical Presentation and Management of a Potentially Life-threatening Disease in Newborns. — Winkler I, Steichen E, Kapelari K, Wöckinger P, Neubauer V, Kiechl-Kohlendorfer U et al. Journal of clinical research in pediatric endocrinology (2025)
    2. [2]
      Modulation of glucocorticoid receptor function under iron overload. — Zhu W, Vanderhaeghen T, Timmermans S, Vandewalle J, Eggermont M, Verhoog NJD et al. Frontiers in immunology (2025)
    3. [3]
      Disproportionality analysis of data from VigiBase and other global product safety databases on toxicity of iron chelating agents. — Arda BE, Sipahi H Expert opinion on drug safety (2025)
    4. [4]
      Management of hypopituitarism: a perspective from the Brazilian Society of Endocrinology and Metabolism. — Garmes HM, Boguszewski CL, Miranda PAC, Martins MRA, da Silva SRC, Abucham JZ et al. Archives of endocrinology and metabolism (2021)
    5. [5]
      MECHANISMS IN ENDOCRINOLOGY: Autoimmune hypopituitarism: novel mechanistic insights. — Takahashi Y European journal of endocrinology (2020)
    6. [6]
      A novel GLI2 mutation responsible for congenital hypopituitarism and polymalformation syndrome. — Martín-Rivada Á, Rodríguez-Contreras FJ, Muñoz-Calvo MT, Güemes M, González-Casado I, Del Pozo JS et al. Growth hormone & IGF research : official journal of the Growth Hormone Research Society and the International IGF Research Society (2019)
    7. [7]
      Rhabdomyolysis in a patient complicated with hypopituitarism and multiple organ dysfunction syndrome and the literature review. — Zhou C, Lai S, Xie Y, Zhang S, Lu Y The American journal of emergency medicine (2018)
    8. [8]
      Pituitary stalk interruption syndrome: a rare and severe cause of pituitary deficiency Laboratory diagnosis of a newborn case. — Boueilh T, Bassi C, Rouleau S, Le Crugel S, Moal V, Boux de Casson F et al. Annales de biologie clinique (2017)
    9. [9]
      Hormonal Replacement in Hypopituitarism in Adults: An Endocrine Society Clinical Practice Guideline. — Fleseriu M, Hashim IA, Karavitaki N, Melmed S, Murad MH, Salvatori R et al. The Journal of clinical endocrinology and metabolism (2016)
    10. [10]
      Bismuth coordination networks containing deferiprone: synthesis, characterisation, stability and antibacterial activity. — Burrows AD, Jurcic M, Mahon MF, Pierrat S, Roffe GW, Windle HJ et al. Dalton transactions (Cambridge, England : 2003) (2015)
    11. [11]
      Pituitary gland development: an update. — Bancalari RE, Gregory LC, McCabe MJ, Dattani MT Endocrine development (2012)
    12. [12]
      Clinicopathologic conference: multiple fetal demises, lactic acidosis and hepatic iron accumulation. — Tebbi CK, Steffensen TS, Thorkelsson T, Gudmundsson JA, Gilbert-Barness E Fetal and pediatric pathology (2011)
    13. [13]
      Iron sufficient to cause hepatic fibrosis and ascites does not cause cardiac arrhythmias in the gerbil. — Kaiser L, Davis JM, Patterson J, Johnson AL, Bohart G, Olivier NB et al. Translational research : the journal of laboratory and clinical medicine (2009)
    14. [14]
      Oral iron chelation and the treatment of iron overload in a pediatric hematology center. — Raphael JL, Bernhardt MB, Mahoney DH, Mueller BU Pediatric blood & cancer (2009)
    15. [15]
      Genetic forms of hypopituitarism and their manifestation in the neonatal period. — Alatzoglou KS, Dattani MT Early human development (2009)
    16. [16]
      Granulomatous hypophysitis--an interesting and rare cause mimicking pituitary mass. — Mehndiratta MM, Phul P, Singh AK, Garg S, Bali R The Journal of the Association of Physicians of India (2007)
    17. [17]
      Hypopituitarism in PHACES Association. — Goddard DS, Liang MG, Chamlin SL, Svoren BM, Spack NP, Mulliken JB Pediatric dermatology (2006)
    18. [18]
      Transition from paediatric to adult endocrinology: hypopituitarism. — Stanhope R Growth hormone & IGF research : official journal of the Growth Hormone Research Society and the International IGF Research Society (2004)
    19. [19]
      Isolation and partial characterization of two porcine spleen ferritin fractions with different electrophoretic mobility. — van Gelder W, Huijskes-Heins MI, Klepper D, van Noort WL, Cleton-Soeteman MI, van Eijk HG Comparative biochemistry and physiology. Part B, Biochemistry & molecular biology (1996)
    20. [20]
      A case of hypopituitarism and type V hyperlipidemia. — Nomoto J, Kuramitsu K, Kinoshita A, Saku K, Sasaki J, Arakawa K Japanese journal of medicine (1989)
    21. [21]
      Adrenal hypoplasia and pituitary agenesis in a normocephalic infant, with a review of the literature. — Newman NM, Welch E, Challis DR Australian paediatric journal (1988)
    22. [22]
      Sulfide silver amplification of ferritin iron cores in blood and bone marrow cells. Methods, adaptations to microphysical analyses, and the impact of advanced iron overload. — Hausmann K, Wedekind I, Tenner-Racz K, Grosschupf G, Kuse R, Niecke M et al. Blut (1988)
    23. [23]
      Effects of hypophysectomy and pituitary hormones on hepatic microsomal carboxylesterase isozymes in male rats. — Hosokawa M, Satoh T Research communications in chemical pathology and pharmacology (1988)
    24. [24]
      Several intermediate forms in the processing of rat lutropin subunits as shown by sodium dodecyl sulphate polyacrylamide gel electrophoresis. — Starzec A, Counis R, Jutisz M Journal of chromatography (1988)
    25. [25]
      Studies on haemosiderin and ferritin from iron-loaded rat liver. — Andrews SC, Brady MC, Treffry A, Williams JM, Mann S, Cleton MI et al. Biology of metals (1988)
    26. [26]
      Sheehan's syndrome presenting with type III hyperlipoproteinaemia. — Carr D, Thornes HM, Rutter AC, Finney RD, Turner PR Postgraduate medical journal (1987)
    27. [27]
      Empty sella syndrome and growth deficiency in childhood. — Querci F, Cattaneo O, Sileo F, Nosari I, Lepore G, Corbellini A et al. Helvetica paediatrica acta (1987)
    28. [28]
      Studies on hypothalamo-pituitary corticoliberin system. I. Localization of corticotropin-releasing factor (CRF)- and neurophysin-immunoreactive neurons in the Mongolian gerbil (Meriones unguiculatus). — Miśkowiak B Acta anatomica (1987)
    29. [29]
      Differential spontaneous and stimulated in vitro release of newly synthesized or stored rGH and rPRL by pituitaries from rats with hypothalamic lesions. — Stachura ME, Bernardis LL, Tyler JM, Kent PG Neuroendocrinology (1986)
    30. [30]
      Hypopituitarism and septooptic "dysplasia" in first cousins. — Blethen SL, Weldon VV American journal of medical genetics (1985)
    31. [31]
      The origin and ultrastructural characteristics of corticotropin-releasing factor (CRF)-immunoreactive nerve fibers in the posterior pituitary of the rat. — Lengvári I, Liposits Z, Vigh S, Schally AV, Flerkó B Cell and tissue research (1985)
    32. [32]
      Changes of vasopressin- and oxytocin-immunoreactive neurons after hypophysectomy in young and old mice. — Kawamoto K, Kawashima S Experimental gerontology (1985)
    33. [33]
      Do we get too much iron? — Martin W Medical hypotheses (1984)
    34. [34]
      Hypopituitarism associated with myalgia. — Horowitz M, Byrne E, Burnet R Postgraduate medical journal (1984)
    35. [35]
      Intrasellar hydatid cyst. Case report. — Ozgen T, Bertan V, Kansu T, Akalin S Journal of neurosurgery (1984)
    36. [36]
      Do we get too much iron? — Martin W Medical hypotheses (1984)
    37. [37]
      Comparative immunoelectron microscopic localization of corticotropin-releasing factor (CRF-41) and oxytocin in the rat median eminence. — Dreyfuss F, Burlet A, Tonon MC, Vaudry H Neuroendocrinology (1984)
    38. [38]
      Hypopituitarism after aseptic cavernous sinus thrombosis. — Oliven A, Harel D, Rosenfeld T, Spindel A, Gidron E Neurology (1980)
    39. [39]
      Serum ferritin concentrations in black miners. — MacPhail AP, Derman DP, Bothwell TH, Torrance JD, Charlton RW, du Plessis JP et al. South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde (1979)
    40. [40]
      Pituitary coma with continuing menstruation. — Mitchell DM, Webb SC, Hoffbrand BI Postgraduate medical journal (1978)
    41. [41]
      Unusual features of thyroid function in anterior pituitary failure. — Piret L, Duvivier E, Beckers C, Crabbé J Annales d'endocrinologie (1978)
    42. [42]
      Diagnosis of empty sella with CT scan. — Rozario R, Hammerschlag SB, Post KD, Wolpert SM, Jackson I Neuroradiology (1977)
    43. [43]
      Somatostatin: electron microscope immunohistochemical localization in secretory neurons of rat hypothalamus. — Pelletier G, Dubé D, Puviani R Science (New York, N.Y.) (1977)
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