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Allergy & Immunology324 papers

Iatrogenic pituitary disorder

Last edited: 4/14/2026

Overview

Iatrogenic pituitary disorders refer to hormonal imbalances and functional impairments caused by medical interventions, particularly surgical procedures on the pituitary gland. These disorders can arise from damage to the gland or its stalk during surgery, leading to deficiencies in pituitary hormones.

Diagnosis

  • Imaging: MRI to identify structural abnormalities such as pituitary stalk interruption syndrome (PSIS) 1.
  • Hormonal Testing: Comprehensive assessment of pituitary hormones including TSH, ACTH, GH, FSH, LH, and prolactin to detect deficiencies or excesses 3.
  • Dynamic Testing: Utilize stimulation and suppression tests to evaluate pituitary function, though validation varies 5.
  • Clinical Evaluation: Assess for symptoms related to hormone deficiencies (e.g., growth issues, hypogonadism, hypothyroidism) 3.

    • Management

  • Hormone Replacement Therapy: Replace deficient hormones based on specific deficiencies identified (e.g., levothyroxine for hypothyroidism, recombinant GH for growth hormone deficiency) 3.
  • Multidisciplinary Approach: Involvement of endocrinologists, neurosurgeons, and other specialists for comprehensive care 3.
  • Monitoring: Regular follow-up with hormonal assessments to adjust replacement therapy as needed 3.

    • Special Populations

  • Pediatrics: Unique developmental considerations; dynamic testing validation is limited 5.
  • Postoperative Care: Special attention to pediatric patients post-surgery due to developmental impacts 5.

    • Key Recommendations

  • Comprehensive Hormonal Assessment Post-Surgery: Conduct thorough hormonal evaluations to identify iatrogenic deficiencies (Evidence: Moderate 3).
  • Multidisciplinary Team Involvement: Engage a multidisciplinary team for optimal management of pituitary disorders (Evidence: Moderate 3).
  • Regular Monitoring and Adjustment of Hormone Therapy: Implement routine follow-up and adjust hormone replacement therapy based on clinical and hormonal parameters (Evidence: Moderate 3).

    • References

    1 Voutetakis A. Pituitary stalk interruption syndrome. Handbook of clinical neurology 2021. link 2 Corsello A, Di Dalmazi G, Pani F, Chalan P, Salvatori R, Caturegli P. Walter E. Dandy: his contributions to pituitary surgery in the context of the overall Johns Hopkins Hospital experience. Pituitary 2017. link 3 Woodmansee WW, Carmichael J, Kelly D, Katznelson L. AMERICAN ASSOCIATION OF CLINICAL ENDOCRINOLOGISTS AND AMERICAN COLLEGE OF ENDOCRINOLOGY DISEASE STATE CLINICAL REVIEW: POSTOPERATIVE MANAGEMENT FOLLOWING PITUITARY SURGERY. Endocrine practice : official journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists 2015. link 4 Azurara L, Marçal M, Vieira F, Tuna ML. DPG-plus syndrome: new report of a rare entity. BMJ case reports 2015. link 5 Ching J, Lee PD. Brief review and commentary: diagnosis of pediatric pituitary disorders. Pituitary 2007. link 6 Gerver WJ, Neucker AV, Schrander-Stumpel CT. A patient with pituitary growth hormone deficiency and May-Hegglin anomaly: a distinct entity?. Genetic counseling (Geneva, Switzerland) 1994. link 7 Bjartell A, Sundler F, Ekman R. Extraction and immunochemical characterization of delta sleep-inducing peptide-like material from the porcine pituitary and adrenal gland. Peptides 1991. link90082-z) 8 Falke N, Martin R. Opiate binding differentially associated with oxytocin and vasopressin nerve endings from porcine neurohypophyses. Experimental brain research 1988. link 9 van der Sluis PJ, Pool CW, Sluiter AA. Immunochemical detection of peptides and proteins on press-blots after direct tissue gel isoelectric focusing. Electrophoresis 1988. link 10 Redecker P. Golgi-like immunostaining of pituicytes and tanycytes positive for glial fibrillary acidic protein in the neurohypophysis of the Mongolian gerbil (Meriones unguiculatus). Histochemistry 1987. link 11 May V, Wilber JF, U'Prichard DC, Childs GV. Persistence of immunoreactive TRH and GnRH in long-term primary anterior pituitary cultures. Peptides 1987. link90022-2) 12 Maldonado CA, Aoki A. Improvement of prolactin immunolabelling in osmium-fixed acrylic-embedded pituitary gland. Basic and applied histochemistry 1986. link 13 Loftus CM, Nilaver G, Beinfeld MC, Post KD. Motilin-related immunoreactivity in mammalian adenohypophysis. Neurosurgery 1986. link 14 Mulvogue HM, McMillen IC, Robinson PM, Perry RA. Immunocytochemical localization of pro gamma MSH, gamma MSH, ACTH and beta endorphin/beta lipotrophin in the fetal sheep pituitary: an ontogenetic study. Journal of developmental physiology 1986. link 15 Childs GV, Unabia G, Ellison D. Immunocytochemical studies of pituitary hormones with PAP, ABC, and immunogold techniques: evolution of technology to best fit the antigen. The American journal of anatomy 1986. link 16 Girod C, Trouillas J, Raccurt M, Dubois MP. Immunocytochemical localization of S-100 protein in stellate cells (folliculo-stellate cells) of the adenohypophysis in the monkeys Macaca irus and Cercopithecus aethiops. Cell and tissue research 1986. link 17 Powers CA. Anterior pituitary glandular kallikrein: trypsin activation and estrogen regulation. Molecular and cellular endocrinology 1986. link90095-x) 18 Dubourg P, Burzawa-Gerard E, Chambolle P, Kah O. Light and electron microscopic identification of gonadotrophic cells in the pituitary gland of the goldfish by means of immunocytochemistry. General and comparative endocrinology 1985. link90407-1) 19 Girod C, Lhéritier M, Trouillas J, Dubois MP. Cell types of the pars distalis of the hedgehog (Erinaceus europaeus L.) adenohypophysis: cytological, immunocytochemical and ultrastructural studies. 3. Opiocorticomelanotropic cells. Acta anatomica 1985. link 20 Hisano S, Adachi T, Daikoku S. Immunolabeling of adenohypophysial cells with protein A-colloidal gold--antibody complex for electron microscopy: use of the freeze-substitution technique in tissue preparation. The journal of histochemistry and cytochemistry : official journal of the Histochemistry Society 1984. link 21 Naito N, Takahashi A, Nakai Y, Kawauchi H. Immunocytochemical identification of the proopiocortin-producing cells in the chum salmon pituitary with antisera to endorphin and NH2-terminal peptide of salmon proopiocortin. General and comparative endocrinology 1984. link90029-7) 22 Gagel RF, O'Briain DS, Voelkel EF, Wolfe HJ, DeLellis RA, Lee AK et al.. Pituitary immunoreactive calcitonin-like material: lack of evidence for cross-reactivity with pro-opiomelanocortin. Metabolism: clinical and experimental 1983. link90125-7) 23 Martens GJ, Jenks BG, Van Overbeeke AP. Biosynthesis of a gamma 3-melanotropin-like peptide in the pars intermedia of the amphibian pituitary gland. European journal of biochemistry 1982. link 24 Coulter HD, Elde RP, Unverzagt SL. Co-localization of neurophysin- and enkephalin-like immunoreactivity in cat pituitary. Peptides 1981. link90055-3) 25 Nogami H, Yoshimura F. Prolactin immunoreactivity of acidophils of the small granule type. Cell and tissue research 1980. link 26 Kenan PD. The rhinologist and the management of pituitary disease. The Laryngoscope 1979. link 27 Bowie EP, Ishikawa H, Shiino M, Rennels EG. An immunocytochemical study of a rat pituitary multipotential clone. The journal of histochemistry and cytochemistry : official journal of the Histochemistry Society 1978. link 28 Silverman AJ, Knigge KM, Zimmerman EA. Ultrastructural immunocytochemical localization of neurophysin in freeze-substituted neurohypophysis. The American journal of anatomy 1975. link 29 Pakurar AS, Kahn RH, Conklin JL. Immunochemical staining of the rat adenohypophysis in organ culture. The Anatomical record 1975. link 30 Lewis PD. Neuromuscular involvement in pituitary gigantism. British medical journal 1972. link

    Original source

    1. [1]
      Pituitary stalk interruption syndrome. — Voutetakis A Handbook of clinical neurology (2021)
    2. [2]
      Walter E. Dandy: his contributions to pituitary surgery in the context of the overall Johns Hopkins Hospital experience. — Corsello A, Di Dalmazi G, Pani F, Chalan P, Salvatori R, Caturegli P Pituitary (2017)
    3. [3]
      AMERICAN ASSOCIATION OF CLINICAL ENDOCRINOLOGISTS AND AMERICAN COLLEGE OF ENDOCRINOLOGY DISEASE STATE CLINICAL REVIEW: POSTOPERATIVE MANAGEMENT FOLLOWING PITUITARY SURGERY. — Woodmansee WW, Carmichael J, Kelly D, Katznelson L Endocrine practice : official journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists (2015)
    4. [4]
      DPG-plus syndrome: new report of a rare entity. — Azurara L, Marçal M, Vieira F, Tuna ML BMJ case reports (2015)
    5. [5]
      Brief review and commentary: diagnosis of pediatric pituitary disorders. — Ching J, Lee PD Pituitary (2007)
    6. [6]
      A patient with pituitary growth hormone deficiency and May-Hegglin anomaly: a distinct entity? — Gerver WJ, Neucker AV, Schrander-Stumpel CT Genetic counseling (Geneva, Switzerland) (1994)
    7. [7]
      Extraction and immunochemical characterization of delta sleep-inducing peptide-like material from the porcine pituitary and adrenal gland. — Bjartell A, Sundler F, Ekman R Peptides (1991)
    8. [8]
      Opiate binding differentially associated with oxytocin and vasopressin nerve endings from porcine neurohypophyses. — Falke N, Martin R Experimental brain research (1988)
    9. [9]
      Immunochemical detection of peptides and proteins on press-blots after direct tissue gel isoelectric focusing. — van der Sluis PJ, Pool CW, Sluiter AA Electrophoresis (1988)
    10. [10]
      Golgi-like immunostaining of pituicytes and tanycytes positive for glial fibrillary acidic protein in the neurohypophysis of the Mongolian gerbil (Meriones unguiculatus). — Redecker P Histochemistry (1987)
    11. [11]
      Persistence of immunoreactive TRH and GnRH in long-term primary anterior pituitary cultures. — May V, Wilber JF, U'Prichard DC, Childs GV Peptides (1987)
    12. [12]
      Improvement of prolactin immunolabelling in osmium-fixed acrylic-embedded pituitary gland. — Maldonado CA, Aoki A Basic and applied histochemistry (1986)
    13. [13]
      Motilin-related immunoreactivity in mammalian adenohypophysis. — Loftus CM, Nilaver G, Beinfeld MC, Post KD Neurosurgery (1986)
    14. [14]
      Immunocytochemical localization of pro gamma MSH, gamma MSH, ACTH and beta endorphin/beta lipotrophin in the fetal sheep pituitary: an ontogenetic study. — Mulvogue HM, McMillen IC, Robinson PM, Perry RA Journal of developmental physiology (1986)
    15. [15]
      Immunocytochemical studies of pituitary hormones with PAP, ABC, and immunogold techniques: evolution of technology to best fit the antigen. — Childs GV, Unabia G, Ellison D The American journal of anatomy (1986)
    16. [16]
      Immunocytochemical localization of S-100 protein in stellate cells (folliculo-stellate cells) of the adenohypophysis in the monkeys Macaca irus and Cercopithecus aethiops. — Girod C, Trouillas J, Raccurt M, Dubois MP Cell and tissue research (1986)
    17. [17]
      Anterior pituitary glandular kallikrein: trypsin activation and estrogen regulation. — Powers CA Molecular and cellular endocrinology (1986)
    18. [18]
      Light and electron microscopic identification of gonadotrophic cells in the pituitary gland of the goldfish by means of immunocytochemistry. — Dubourg P, Burzawa-Gerard E, Chambolle P, Kah O General and comparative endocrinology (1985)
    19. [19]
      Cell types of the pars distalis of the hedgehog (Erinaceus europaeus L.) adenohypophysis: cytological, immunocytochemical and ultrastructural studies. 3. Opiocorticomelanotropic cells. — Girod C, Lhéritier M, Trouillas J, Dubois MP Acta anatomica (1985)
    20. [20]
      Immunolabeling of adenohypophysial cells with protein A-colloidal gold--antibody complex for electron microscopy: use of the freeze-substitution technique in tissue preparation. — Hisano S, Adachi T, Daikoku S The journal of histochemistry and cytochemistry : official journal of the Histochemistry Society (1984)
    21. [21]
      Immunocytochemical identification of the proopiocortin-producing cells in the chum salmon pituitary with antisera to endorphin and NH2-terminal peptide of salmon proopiocortin. — Naito N, Takahashi A, Nakai Y, Kawauchi H General and comparative endocrinology (1984)
    22. [22]
      Pituitary immunoreactive calcitonin-like material: lack of evidence for cross-reactivity with pro-opiomelanocortin. — Gagel RF, O'Briain DS, Voelkel EF, Wolfe HJ, DeLellis RA, Lee AK et al. Metabolism: clinical and experimental (1983)
    23. [23]
      Biosynthesis of a gamma 3-melanotropin-like peptide in the pars intermedia of the amphibian pituitary gland. — Martens GJ, Jenks BG, Van Overbeeke AP European journal of biochemistry (1982)
    24. [24]
      Co-localization of neurophysin- and enkephalin-like immunoreactivity in cat pituitary. — Coulter HD, Elde RP, Unverzagt SL Peptides (1981)
    25. [25]
      Prolactin immunoreactivity of acidophils of the small granule type. — Nogami H, Yoshimura F Cell and tissue research (1980)
    26. [26]
      The rhinologist and the management of pituitary disease. — Kenan PD The Laryngoscope (1979)
    27. [27]
      An immunocytochemical study of a rat pituitary multipotential clone. — Bowie EP, Ishikawa H, Shiino M, Rennels EG The journal of histochemistry and cytochemistry : official journal of the Histochemistry Society (1978)
    28. [28]
      Ultrastructural immunocytochemical localization of neurophysin in freeze-substituted neurohypophysis. — Silverman AJ, Knigge KM, Zimmerman EA The American journal of anatomy (1975)
    29. [29]
      Immunochemical staining of the rat adenohypophysis in organ culture. — Pakurar AS, Kahn RH, Conklin JL The Anatomical record (1975)
    30. [30]
      Neuromuscular involvement in pituitary gigantism. — Lewis PD British medical journal (1972)
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