Hypopituitarism
Basics
Description
- Generalized condition caused by deficiency of anterior pituitary hormones: adrenocorticotropic hormone (ACTH), thyroid-stimulating hormone (TSH), luteinizing hormone (LH), follicle-stimulating hormone (FSH), growth hormone (GH), and prolactin. Less commonly, the posterior pituitary gland’s hormones can be affected: vasopressin (AVP) (antidiuretic hormone [ADH]) and oxytocin (1)[A].
- Generally, the order that hormone deficiencies develop is predictable, with decreased secretion of hormones least essential for life (GH, LH, and FSH) occurring earlier and more frequently than TSH and ACTH.
- System(s) affected: cardiovascular, endocrine/metabolic, gastrointestinal, musculoskeletal, nervous, reproductive, skin/exocrine
- Synonym(s): empty sella syndrome; Simmonds syndrome; panhypopituitarism; Sheehan syndrome (postpartum); pituitary apoplexy
Epidemiology
Incidence
- 40 new cases per million per year
- Adults and children. In children, it may cause short stature and pubertal delay.
- Predominant sex: male = female
Prevalence
- 46/100,000
- 61% due to pituitary tumors, 9% parapituitary lesions, 19% other causes, 11% idiopathic
Etiology and Pathophysiology
- Childhood
- Genetic disorders
- Perinatal asphyxia
- Developmental disorders/pituitary hypoplasia, aplasia
- Craniopharyngioma, other tumors
- Cranial irradiation
- Head trauma
- Adult
- Pituitary tumors: most common etiology; other intrasellar or parasellar tumors: meningiomas, gliomas, metastases, craniopharyngiomas, chordomas, ependymomas, suprasellar dysgerminomas, infundibulomas, astrocytomas, hamartomas
- Surgery on pituitary or adjacent structures, cranial irradiation
- Vascular: internal carotid artery aneurysm, subarachnoid hemorrhage, pituitary infarction, apoplexy, postpartum hemorrhage with hypotension (Sheehan syndrome)
- Head trauma
- Infection: abscess, hypophysitis, meningitis, encephalitis, tuberculosis, pneumocystic pneumonia, histoplasmosis, toxoplasmosis, aspergillosis, cytomegalovirus
- Infiltrative conditions: hemochromatosis, granulomatous disease, histiocytosis X, sarcoidosis
- Hypothalamic disease (secondary hypopituitarism)
- Autoimmune disease: lymphocytic hypophysitis
- Pituitary hemorrhage (apoplexy)
- Empty sella
Genetics
- Pituitary and hypothalamic hormone transcription factor defects cause the following congenital hormone deficiencies:
- AVP, diabetes insipidus
- DAX-1, congenital adrenal hypoplasia, hypogonadotropic hypogonadism
- GnRH-R and GPR54, loss-of-function mutations
- HESX-1, associated with septo-optic dysplasia
- KAL1 and FGFR1, Kallmann syndrome
- PROP1, LHX3, LHX4, combined pituitary hormone deficiency
- POMC, ACTH deficiency, obesity, red hair
- POU1F1 (Pit-1), combined pituitary hormone deficiency
- SF1, adrenal failure, 46,XY gonadal dysgenesis
- OTX2, orthodenticle family located on chromosome 14q23.1
- PITX2, associated with Rieger syndrome, which is characterized by anomalies of the anterior chamber of the eye in association with mental retardation, dental hypoplasia, and GHD
- Genetic defects in pituitary hormone receptors
- ACTH receptor defects: congenital insensitivity to ACTH
- GH receptor defects: Laron dwarfism
- LH/FSH receptor mutations
- TSH receptor loss-of-function mutation
Risk Factors
- Pituitary or parapituitary tumors
- Pregnancy and delivery
- Head trauma
- Pituitary or cranial radiation
- Pituitary surgery
- Vascular aneurysms and cerebrovascular accidents
- Lymphocytic hypophysitis
- Infiltrative diseases
- Infections
General Prevention
Commonly Associated Conditions
- Diabetes insipidus
- Kallmann syndrome
- Delayed puberty with growth delay
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Citation
Domino, Frank J., et al., editors. "Hypopituitarism." 5-Minute Clinical Consult, 33rd ed., Wolters Kluwer, 2025. Medicine Central, im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/816293/all/Hypopituitarism.
Hypopituitarism. In: Domino FJF, Baldor RAR, Golding JJ, et al, eds. 5-Minute Clinical Consult. Wolters Kluwer; 2025. https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/816293/all/Hypopituitarism. Accessed December 3, 2024.
Hypopituitarism. (2025). In Domino, F. J., Baldor, R. A., Golding, J., & Stephens, M. B. (Eds.), 5-Minute Clinical Consult (33rd ed.). Wolters Kluwer. https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/816293/all/Hypopituitarism
Hypopituitarism [Internet]. In: Domino FJF, Baldor RAR, Golding JJ, Stephens MBM, editors. 5-Minute Clinical Consult. Wolters Kluwer; 2025. [cited 2024 December 03]. Available from: https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/816293/all/Hypopituitarism.
* Article titles in AMA citation format should be in sentence-case
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T1 - Hypopituitarism
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ED - Baldor,Robert A,
ED - Golding,Jeremy,
ED - Stephens,Mark B,
BT - 5-Minute Clinical Consult, Updating
UR - https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/816293/all/Hypopituitarism
PB - Wolters Kluwer
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