Treatment of hypopituitarism
- Peter J Snyder, MD
Peter J Snyder, MD
- Editor-in-Chief — Endocrinology
- Section Editor — Pituitary Disease; Male Reproductive Endocrinology
- Professor of Medicine
- University of Pennsylvania School of Medicine
Treatment of patients with hypopituitarism is the sum of the treatments of each of the individual pituitary hormonal deficiencies detected in a patient with pituitary or hypothalamic disease. The treatments of corticotropin (ACTH), thyroid-stimulating hormone (TSH), and luteinizing hormone (LH) and follicle-stimulating hormone (FSH) deficiencies are in many ways the same as the treatments of primary deficiencies of the respective target glands, but in other ways they differ. Both the similarities and differences will be highlighted below. Treatment of growth hormone (GH) deficiency is unique to hypopituitarism.
The specifics of therapy for hypopituitarism will be reviewed here. The causes, clinical manifestations, and diagnosis of hypopituitarism, as well as GH deficiency in adults and the management of individual hormone deficiencies, are reviewed in more detail elsewhere. (See "Causes of hypopituitarism" and "Clinical manifestations of hypopituitarism" and "Diagnostic testing for hypopituitarism" and "Growth hormone deficiency in adults".)
The primary consequence of lack of corticotropin (ACTH) is cortisol deficiency. As a result, treatment consists of the administration of hydrocortisone in an amount and timing to mimic the normal pattern of cortisol secretion. Because there is no test to assess the adequacy of the replacement, the optimal doses are not known. Most authorities recommend replacement with hydrocortisone because that is the hormone the adrenal glands make normally (hydrocortisone and cortisol are different names for the same chemical structure).
Preparation and dose — Most authorities recommend hydrocortisone doses of 15 to 25 mg/day [1,2] because those doses are similar to daily production rates . Patients who are more severely deficient or weigh more tend to need doses at the upper end of this range and vice versa. Some patients, however, need even larger doses to avoid severely symptomatic adrenal insufficiency, and others can get by on smaller amounts. (See "Treatment of adrenal insufficiency in adults".)
Although dividing the total daily dose into two or even three doses (with the largest dose on arising in the morning) makes sense physiologically, many patients cannot remember to take doses in the middle of the day. For them, taking the entire dose in the morning is preferable to missing doses. Most patients feel well while taking the entire dose on arising.To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
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- ACTH DEFICIENCY
- Preparation and dose
- - Assessment of dose adequacy
- Subjective health status
- Unmasking diabetes insipidus
- Need for mineralocorticoid coverage
- Adrenal androgen replacement
- TSH DEFICIENCY
- LH AND FSH DEFICIENCY
- - Androgen replacement
- GROWTH HORMONE DEFICIENCY
- PROLACTIN DEFICIENCY
- INFORMATION FOR PATIENTS