Hypopituitarism natural history, complications and prognosis

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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

Natural History

Hypopituitarism develops different symptoms according to the affected part of the pituitary gland and the deficient hormone. Leaving hypopituitarism without treatment can lead to critical consequences. The natural history depends on the different manifestations of the disease as the following:^[1]

Hypogonadism:
- In both genders, if left untreated, it will lead to decrease bone density and osteoporosis.^[2]
- In women, there may be increase risk of coronary artery disease due to depletion of the estrogen level in women.^[3]
- In men, decrease muscle mass due to depletion of the testosterone hormone levels.
Vasopressin deficiency: It will end up to dehydration and electrolyte imbalance like hyponatremia.
Growth hormone deficiency: It may lead to serious vascular conditions and may lead to death.^[4]

Complications

Complications that can develop as a result of hypopituitarism are:

Adrenal crisis:
- The most acute and serious complication of hypopituitarism. It occurs in case of improper glucocorticoids replacement therapy.
Complications of growth hormone replacement therapy:^[5]
- Pseudotumor cerebii
- Benign intracranial hypertension.
- Slipped capital femoral epiphyses.
- Diabetes mellitus due to insulin resistance.

Prognosis

Hypopituitarism prognosis is controversial as it depends on the treatment therapies.
It has good prognosis as long as the hormonal replacement therapy is performed properly.^[1]
Hypopituitarism is often associated with vascular conditions and has high mortality rate.^[6]

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.
↑ 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.
↑ Rosén T, Bengtsson BA (1990). "Premature mortality due to cardiovascular disease in hypopituitarism". Lancet. 336 (8710): 285–8. PMID 1973979.
↑ 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.

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[Vance1994-1] 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.

[KlibanskiNeer1980-2] 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.

[MatthewsMeilahn1989-3] 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.

[pmid1973979-4] Rosén T, Bengtsson BA (1990). "Premature mortality due to cardiovascular disease in hypopituitarism". Lancet. 336 (8710): 285–8. PMID 1973979.

[pmid16456485-5] Bowlby DA, Rapaport R (2004). "Safety and efficacy of growth hormone therapy in childhood". Pediatr Endocrinol Rev. 2 Suppl 1: 68–77. PMID 16456485.

[pmid16597813-6] 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.

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