We searched Medline with the main search term “hypopituitarism” in combination with “epidemiology”, “diagnosis”, or “treatment”. We further combined these terms with “hypocortisolism”, “hypothyroidism”, “hypogonadism”, or “growth hormone deficiency”. We largely selected articles from 1998 to 2006 but did not exclude frequently referenced and highly regarded older publications. We also searched the reference lists of articles identified by this search strategy and selected those we judged
SeminarHypopituitarism
Section snippets
Causes and epidemiology
As far as we know, only one population-based study has assessed the incidence and prevalence of hypopituitarism.6 These researchers noted a prevalence of 45·5 cases per 100 000 in a Spanish population. Incidence was 4·2 cases per 100 000 per year and increased with age. The causes of hypopituitarism were pituitary tumorous (61%), non-pituitary lesions (9%), and non-cancerous causes (30%), including 11% idiopathic cases.6 Other disorders that classically have been regarded as rare causes of
Pathophysiology
The pituitary gland is supplied with blood by branches of the internal carotid artery. These vessels form a capillary plexus in the region of the median eminence of the hypothalamus. Blood from this area reaches the anterior pituitary by means of long and short portal veins via the pituitary stalk. The middle and inferior hypophyseal arteries supply the pituitary stalk and neurohypophysis with arterial blood. However, the anterior lobe is not included in this arterial blood supply; it is
Clinical presentation
Sometimes, signs and symptoms of underlying diseases accompany hypopituitarism. Tumoral masses in the sellar region with suprasellar extension can become manifest with visual impairment that is slowly progressive in most cases. Visual-field defects can present not only as classic bitemporal hemianopsia but also unilaterally in many cases. Usually, such defects remain unrecognised by patients until diagnosed by a doctor. Headaches can be an unspecific symptom of tumour masses. In case of lateral
Screening for hypopituitarism
Endocrine assessment of pituitary function is usually prompted by presence of ophthalmological, neurological, or other symptoms, leading to suspicion of pituitary disease. In some disorders, however, pituitary dysfunction should be actively searched for. After pituitary surgery, glucocorticoid replacement should be given to avoid undetected hypoadrenalism until deficits of ACTH and other pituitary hormones are excluded about 4 weeks after surgery.44 In patients with traumatic brain injury or
Search strategy and selection criteria
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