Hypopituitarism natural history, complications and prognosis: Difference between revisions
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==Overview== | ==Overview== | ||
The [[Natural history of disease|natural history]] of hypopituitarism depends on the severity of damage leading to partial or complete [[hormonal]] deficiency. If left untreated, hypopituitarism can lead to critical consequences. Complications of hypopituitarism include [[adrenal crisis]], [[osteoporosis]], [[electrolyte]] abnormalities, and [[diabetes mellitus]]. Hypopituitarism is often associated with [[vascular]] conditions. Hypopituitarism has a good [[prognosis]] as long as the [[hormonal replacement therapy]] is given adequately. | |||
==Natural History== | ==Natural History== | ||
If left untreated, hypopituitarism may lead to the development of different [[symptoms]] according to the area/lobe of the [[pituitary gland]] affected and the deficient [[hormone]]. The [[Natural history of disease|natural history]] is variable and depends upon the severity of damage leading to partial or complete [[hormonal]] deficiency, age, rapidity of onset, and the underlying cause:<ref name="Vance1994">{{cite journal|last1=Vance|first1=Mary Lee|title=Hypopituitarism|journal=New England Journal of Medicine|volume=330|issue=23|year=1994|pages=1651–1662|issn=0028-4793|doi=10.1056/NEJM199406093302306}}</ref> | |||
'''[[Hypogonadism]]''' | |||
*In both genders, if left untreated, it will lead to a decrease in [[bone density]] and [[osteoporosis]].<ref name="KlibanskiNeer1980">{{cite journal|last1=Klibanski|first1=Anne|last2=Neer|first2=Robert M.|last3=Beitins|first3=Inese Z.|last4=Ridgway|first4=E. Chester|last5=Zervas|first5=Nicholas T.|last6=McArthur|first6=Janet W.|title=Decreased Bone Density in Hyperprolactinemic Women|journal=New England Journal of Medicine|volume=303|issue=26|year=1980|pages=1511–1514|issn=0028-4793|doi=10.1056/NEJM198012253032605}}</ref><ref name="pmid2923387">{{cite journal |vauthors=Greenspan SL, Oppenheim DS, Klibanski A |title=Importance of gonadal steroids to bone mass in men with hyperprolactinemic hypogonadism |journal=Ann. Intern. Med. |volume=110 |issue=7 |pages=526–31 |year=1989 |pmid=2923387 |doi= |url=}}</ref><ref name="pmid7432421">{{cite journal |vauthors=Klibanski A, Neer RM, Beitins IZ, Ridgway EC, Zervas NT, McArthur JW |title=Decreased bone density in hyperprolactinemic women |journal=N. Engl. J. Med. |volume=303 |issue=26 |pages=1511–4 |year=1980 |pmid=7432421 |doi=10.1056/NEJM198012253032605 |url=}}</ref> | |||
*In women, there may be an increased risk of [[Coronary heart disease|coronary artery disease]] due to a reduction [[estrogen]] levels.<ref name="MatthewsMeilahn1989">{{cite journal|last1=Matthews|first1=Karen A.|last2=Meilahn|first2=Elaine|last3=Kuller|first3=Lewis H.|last4=Kelsey|first4=Sheryl F.|last5=Caggiula|first5=Arlene W.|last6=Wing|first6=Rena R.|title=Menopause and Risk Factors for Coronary Heart Disease|journal=New England Journal of Medicine|volume=321|issue=10|year=1989|pages=641–646|issn=0028-4793|doi=10.1056/NEJM198909073211004}}</ref><ref name="pmid2488072">{{cite journal |vauthors=Matthews KA, Meilahn E, Kuller LH, Kelsey SF, Caggiula AW, Wing RR |title=Menopause and risk factors for coronary heart disease |journal=N. Engl. J. Med. |volume=321 |issue=10 |pages=641–6 |year=1989 |pmid=2488072 |doi=10.1056/NEJM198909073211004 |url=}}</ref> | |||
*In men, decreased [[muscle mass]] due to a reduction in [[Testosterone|testosterone hormone]] levels. | |||
'''[[Vasopressin]] deficiency''' | |||
* It may lead to [[dehydration]] and [[Electrolyte disturbance|electrolyte abnormalities]] such as [[hyponatremia|hypernatremia]]. | |||
'''Growth hormone deficiency''' | |||
* It may lead to serious [[vascular]] conditions most likely due to increased [[serum]] [[cholesterol]] and [[triglyceride]] concentrations causing increased [[mortality]].<ref name="pmid1973979">{{cite journal| author=Rosén T, Bengtsson BA| title=Premature mortality due to cardiovascular disease in hypopituitarism. | journal=Lancet | year= 1990 | volume= 336 | issue= 8710 | pages= 285-8 | pmid=1973979 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1973979 }} </ref><ref name="pmid4342932">{{cite journal |vauthors=Merimee TJ, Hollander W, Fineberg SE |title=Studies of hyperlipidemia in the HGH-deficient state |journal=Metab. Clin. Exp. |volume=21 |issue=11 |pages=1053–61 |year=1972 |pmid=4342932 |doi= |url=}}</ref><ref name="pmid6804746">{{cite journal |vauthors=Blackett PR, Weech PK, McConathy WJ, Fesmire JD |title=Growth hormone in the regulation of hyperlipidemia |journal=Metab. Clin. Exp. |volume=31 |issue=2 |pages=117–20 |year=1982 |pmid=6804746 |doi= |url=}}</ref> | |||
==Complications== | ==Complications== | ||
[[Complications]] that can develop as a result of hypopituitarism are include: | |||
*[[Adrenal crisis|Adrenal crisis,]] the most serious complication of hypopituitarism. It occurs in case of improper [[glucocorticoids]] replacement therapy. | |||
* [[Osteoporosis]] | |||
* [[Electrolyte disturbance|Electrolyte abnormalities]] such as [[hypernatremia]] | |||
* [[Diabetes insipidus]] | |||
* [[Metabolic syndrome]] | |||
*[[Complication (medicine)|Complications]] of [[growth hormone]] replacement therapy:<ref name="pmid16456485">{{cite journal| author=Bowlby DA, Rapaport R| title=Safety and efficacy of growth hormone therapy in childhood. | journal=Pediatr Endocrinol Rev | year= 2004 | volume= 2 Suppl 1 | issue= | pages= 68-77 | pmid=16456485 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16456485 }} </ref> | |||
**[[Pseudotumor cerebri]] | |||
**[[Intracranial hypertension|Benign intracranial hypertension.]] | |||
**[[Slipped capital femoral epiphysis|Slipped capital femoral epiphyses]]. | |||
**[[Diabetes mellitus]] due to [[insulin resistance]]. | |||
==Prognosis== | ==Prognosis== | ||
*Hypopituitarism has a good [[prognosis]] as long as the patient is given optimum [[hormonal replacement therapy]].<ref name="Vance1994">{{cite journal|last1=Vance|first1=Mary Lee|title=Hypopituitarism|journal=New England Journal of Medicine|volume=330|issue=23|year=1994|pages=1651–1662|issn=0028-4793|doi=10.1056/NEJM199406093302306}}</ref> | |||
*Hypopituitarism is often associated with [[vascular]] conditions and has a high [[mortality rate]].<ref name="pmid16597813">{{cite journal| author=Prabhakar VK, Shalet SM| title=Aetiology, diagnosis, and management of hypopituitarism in adult life. | journal=Postgrad Med J | year= 2006 | volume= 82 | issue= 966 | pages= 259-66 | pmid=16597813 | doi=10.1136/pgmj.2005.039768 | pmc=2585697 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16597813 }} </ref> | |||
*There are 6 major [[retrospective]] studies done that have shown increased [[mortality]] in patients with hypopituitarism.<ref name="pmid1973979">{{cite journal |vauthors=Rosén T, Bengtsson BA |title=Premature mortality due to cardiovascular disease in hypopituitarism |journal=Lancet |volume=336 |issue=8710 |pages=285–8 |year=1990 |pmid=1973979 |doi= |url=}}</ref><ref name="pmid8772595">{{cite journal |vauthors=Bates AS, Van't Hoff W, Jones PJ, Clayton RN |title=The effect of hypopituitarism on life expectancy |journal=J. Clin. Endocrinol. Metab. |volume=81 |issue=3 |pages=1169–72 |year=1996 |pmid=8772595 |doi=10.1210/jcem.81.3.8772595 |url=}}</ref><ref name="pmid9059561">{{cite journal |vauthors=Bülow B, Hagmar L, Mikoczy Z, Nordström CH, Erfurth EM |title=Increased cerebrovascular mortality in patients with hypopituitarism |journal=Clin. Endocrinol. (Oxf) |volume=46 |issue=1 |pages=75–81 |year=1997 |pmid=9059561 |doi= |url=}}</ref><ref name="pmid10770176">{{cite journal |vauthors=Nilsson B, Gustavasson-Kadaka E, Bengtsson BA, Jonsson B |title=Pituitary adenomas in Sweden between 1958 and 1991: incidence, survival, and mortality |journal=J. Clin. Endocrinol. Metab. |volume=85 |issue=4 |pages=1420–5 |year=2000 |pmid=10770176 |doi=10.1210/jcem.85.4.6498 |url=}}</ref><ref name="pmid11273062">{{cite journal |vauthors=Tomlinson JW, Holden N, Hills RK, Wheatley K, Clayton RN, Bates AS, Sheppard MC, Stewart PM |title=Association between premature mortality and hypopituitarism. West Midlands Prospective Hypopituitary Study Group |journal=Lancet |volume=357 |issue=9254 |pages=425–31 |year=2001 |pmid=11273062 |doi= |url=}}</ref> | |||
==References== | ==References== | ||
{{Reflist|2}} | {{Reflist|2}} | ||
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{{WH}} | {{WH}} | ||
{{WS}} | {{WS}} | ||
[[Category:Medicine]] | |||
[[Category:Endocrinology]] | |||
[[Category:Up-To-Date]] | |||
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Ahmed Elsaiey, MBBCH [2]
Overview
The natural history of hypopituitarism depends on the severity of damage leading to partial or complete hormonal deficiency. If left untreated, hypopituitarism can lead to critical consequences. Complications of hypopituitarism include adrenal crisis, osteoporosis, electrolyte abnormalities, and diabetes mellitus. Hypopituitarism is often associated with vascular conditions. Hypopituitarism has a good prognosis as long as the hormonal replacement therapy is given adequately.
Natural History
If left untreated, hypopituitarism may lead to the development of different symptoms according to the area/lobe of the pituitary gland affected and the deficient hormone. The natural history is variable and depends upon the severity of damage leading to partial or complete hormonal deficiency, age, rapidity of onset, and the underlying cause:[1]
- In both genders, if left untreated, it will lead to a decrease in bone density and osteoporosis.[2][3][4]
- In women, there may be an increased risk of coronary artery disease due to a reduction estrogen levels.[5][6]
- In men, decreased muscle mass due to a reduction in testosterone hormone levels.
Vasopressin deficiency
- It may lead to dehydration and electrolyte abnormalities such as hypernatremia.
Growth hormone deficiency
- It may lead to serious vascular conditions most likely due to increased serum cholesterol and triglyceride concentrations causing increased mortality.[7][8][9]
Complications
Complications that can develop as a result of hypopituitarism are include:
- Adrenal crisis, the most serious complication of hypopituitarism. It occurs in case of improper glucocorticoids replacement therapy.
- Complications of growth hormone replacement therapy:[10]
Prognosis
- Hypopituitarism has a good prognosis as long as the patient is given optimum hormonal replacement therapy.[1]
- Hypopituitarism is often associated with vascular conditions and has a high mortality rate.[11]
- There are 6 major retrospective studies done that have shown increased mortality in patients with hypopituitarism.[7][12][13][14][15]
References
- ↑ 1.0 1.1 Vance, Mary Lee (1994). "Hypopituitarism". New England Journal of Medicine. 330 (23): 1651–1662. doi:10.1056/NEJM199406093302306. ISSN 0028-4793.
- ↑ Klibanski, Anne; Neer, Robert M.; Beitins, Inese Z.; Ridgway, E. Chester; Zervas, Nicholas T.; McArthur, Janet W. (1980). "Decreased Bone Density in Hyperprolactinemic Women". New England Journal of Medicine. 303 (26): 1511–1514. doi:10.1056/NEJM198012253032605. ISSN 0028-4793.
- ↑ Greenspan SL, Oppenheim DS, Klibanski A (1989). "Importance of gonadal steroids to bone mass in men with hyperprolactinemic hypogonadism". Ann. Intern. Med. 110 (7): 526–31. PMID 2923387.
- ↑ Klibanski A, Neer RM, Beitins IZ, Ridgway EC, Zervas NT, McArthur JW (1980). "Decreased bone density in hyperprolactinemic women". N. Engl. J. Med. 303 (26): 1511–4. doi:10.1056/NEJM198012253032605. PMID 7432421.
- ↑ Matthews, Karen A.; Meilahn, Elaine; Kuller, Lewis H.; Kelsey, Sheryl F.; Caggiula, Arlene W.; Wing, Rena R. (1989). "Menopause and Risk Factors for Coronary Heart Disease". New England Journal of Medicine. 321 (10): 641–646. doi:10.1056/NEJM198909073211004. ISSN 0028-4793.
- ↑ Matthews KA, Meilahn E, Kuller LH, Kelsey SF, Caggiula AW, Wing RR (1989). "Menopause and risk factors for coronary heart disease". N. Engl. J. Med. 321 (10): 641–6. doi:10.1056/NEJM198909073211004. PMID 2488072.
- ↑ 7.0 7.1 Rosén T, Bengtsson BA (1990). "Premature mortality due to cardiovascular disease in hypopituitarism". Lancet. 336 (8710): 285–8. PMID 1973979.
- ↑ Merimee TJ, Hollander W, Fineberg SE (1972). "Studies of hyperlipidemia in the HGH-deficient state". Metab. Clin. Exp. 21 (11): 1053–61. PMID 4342932.
- ↑ Blackett PR, Weech PK, McConathy WJ, Fesmire JD (1982). "Growth hormone in the regulation of hyperlipidemia". Metab. Clin. Exp. 31 (2): 117–20. PMID 6804746.
- ↑ Bowlby DA, Rapaport R (2004). "Safety and efficacy of growth hormone therapy in childhood". Pediatr Endocrinol Rev. 2 Suppl 1: 68–77. PMID 16456485.
- ↑ Prabhakar VK, Shalet SM (2006). "Aetiology, diagnosis, and management of hypopituitarism in adult life". Postgrad Med J. 82 (966): 259–66. doi:10.1136/pgmj.2005.039768. PMC 2585697. PMID 16597813.
- ↑ Bates AS, Van't Hoff W, Jones PJ, Clayton RN (1996). "The effect of hypopituitarism on life expectancy". J. Clin. Endocrinol. Metab. 81 (3): 1169–72. doi:10.1210/jcem.81.3.8772595. PMID 8772595.
- ↑ Bülow B, Hagmar L, Mikoczy Z, Nordström CH, Erfurth EM (1997). "Increased cerebrovascular mortality in patients with hypopituitarism". Clin. Endocrinol. (Oxf). 46 (1): 75–81. PMID 9059561.
- ↑ Nilsson B, Gustavasson-Kadaka E, Bengtsson BA, Jonsson B (2000). "Pituitary adenomas in Sweden between 1958 and 1991: incidence, survival, and mortality". J. Clin. Endocrinol. Metab. 85 (4): 1420–5. doi:10.1210/jcem.85.4.6498. PMID 10770176.
- ↑ Tomlinson JW, Holden N, Hills RK, Wheatley K, Clayton RN, Bates AS, Sheppard MC, Stewart PM (2001). "Association between premature mortality and hypopituitarism. West Midlands Prospective Hypopituitary Study Group". Lancet. 357 (9254): 425–31. PMID 11273062.