Elsevier

The Lancet

Volume 369, Issue 9571, 28 April–4 May 2007, Pages 1461-1470
The Lancet

Seminar
Hypopituitarism

https://doi.org/10.1016/S0140-6736(07)60673-4Get rights and content

Summary

Incidence and prevalence of hypopituitarism are estimated to be 4·2 per 100 000 per year and 45·5 per 100 000, respectively. Although the clinical symptoms of this disorder are usually unspecific, it can cause life-threatening events and lead to increased mortality. Current research has refined the diagnosis of hypopituitarism. Identification of growth hormone and corticotropin deficiency generally requires a stimulation test, whereas other deficiencies can be detected by basal hormones in combination with clinical judgment. Newly developed formulations of replacement hormones are convenient and physiological. Work has shown that many patients with brain damage—such as traumatic brain injury or aneurysmal subarachnoid haemorrhage—are at high risk of (sometimes unrecognised) hypopituitarism. Thus, a much increased true prevalence of this disorder needs to be assumed. As a result, hypopituitarism is not a rare disease and should be recognised by the general practitioner.

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

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

References (113)

  • M Simmonds

    Uber hypophysisschwund mit todlichem ausgang

    Dtsch Med Wschr

    (1914)
  • AS Bates et al.

    The effect of hypopituitarism on life expectancy

    J Clin Endocrinol Metab

    (1996)
  • M Regal et al.

    Prevalence and incidence of hypopituitarism in an adult Caucasian population in northwestern Spain

    Clin Endocrinol (Oxf)

    (2001)
  • S Benvenga et al.

    Clinical review 113: hypopituitarism secondary to head trauma

    J Clin Endocrinol Metab

    (2000)
  • M Bondanelli et al.

    Predictive value of circulating insulin-like growth factor i levels in ischemic stroke outcome

    J Clin Endocrinol Metab

    (2006)
  • HJ Schneider et al.

    Endocrine dysfunction in patients operated on for non-pituitary intracranial tumors

    Eur J Endocrinol

    (2006)
  • A Agha et al.

    Hypothalamic-pituitary dysfunction after irradiation of nonpituitary brain tumors in adults

    J Clin Endocrinol Metab

    (2005)
  • DF Kelly et al.

    Hypopituitarism following traumatic brain injury and aneurysmal subarachnoid hemorrhage: a preliminary report

    J Neurosurg

    (2000)
  • A Agha et al.

    Anterior pituitary dysfunction in survivors of traumatic brain injury

    J Clin Endocrinol Metab

    (2004)
  • G Aimaretti et al.

    Residual pituitary function after brain injury-induced hypopituitarism: a prospective 12-month study

    J Clin Endocrinol Metab

    (2005)
  • SA Lieberman et al.

    Prevalence of neuroendocrine dysfunction in patients recovering from traumatic brain injury

    J Clin Endocrinol Metab

    (2001)
  • M Bondanelli et al.

    Occurrence of pituitary dysfunction following traumatic brain injury

    J Neurotrauma

    (2004)
  • V Popovic et al.

    Hypopituitarism as a consequence of traumatic brain injury (TBI) and its possible relation with cognitive disabilities and mental distress

    J Endocrinol Invest

    (2004)
  • A Leal-Cerro et al.

    Prevalence of hypopituitarism and growth hormone deficiency in adults long-term after severe traumatic brain injury

    Clin Endocrinol (Oxf)

    (2005)
  • HJ Schneider et al.

    Prevalence of anterior pituitary insufficiency 3 and 12 months after traumatic brain injury

    Eur J Endocrinol

    (2006)
  • F Tanriverdi et al.

    High risk of hypopituitarism after traumatic brain injury: a prospective investigation of anterior pituitary function in the acute phase and 12 months after trauma

    J Clin Endocrinol Metab

    (2006)
  • BL Herrmann et al.

    Hypopituitarism following severe traumatic brain injury

    Exp Clin Endocrinol Diabetes

    (2006)
  • L Brandt et al.

    Fatigue after aneurysmal subarachnoid hemorrhage evaluated by pituitary function and 3D-CBF

    Acta Neurol Scand

    (2004)
  • I Dimopoulou et al.

    High incidence of neuroendocrine dysfunction in long-term survivors of aneurysmal subarachnoid hemorrhage

    Stroke

    (2004)
  • I Kreitschmann-Andermahr et al.

    Prevalence of pituitary deficiency in patients after aneurysmal subarachnoid hemorrhage

    J Clin Endocrinol Metab

    (2004)
  • G Aimaretti et al.

    Traumatic brain injury and subarachnoid haemorrhage are conditions at high risk for hypopituitarism: screening study at 3 months after the brain injury

    Clin Endocrinol (Oxf)

    (2004)
  • KH Darzy et al.

    Hypopituitarism after cranial irradiation

    J Endocrinol Invest

    (2005)
  • Incidence rates of hospitalization related to traumatic brain injury: 12 states, 2002

    MMWR Morb Mortal Wkly Rep

    (2006)
  • F Tagliaferri et al.

    A systematic review of brain injury epidemiology in Europe

    Acta Neurochir (Wien)

    (2006)
  • DJ Hellawell et al.

    Relatives' reports of long term problems following traumatic brain injury or subarachnoid haemorrhage

    Disabil Rehabil

    (2001)
  • M Schneider et al.

    Anterior pituitary hormone abnormalities following traumatic brain injury

    J Neurotrauma

    (2005)
  • E Ghigo et al.

    Consensus guidelines on screening for hypopituitarism following traumatic brain injury

    Brain Inj

    (2005)
  • S Reichlin

    Neuroendocrinology

  • BM Arafah

    Medical management of hypopituitarism in patients with pituitary adenomas

    Pituitary

    (2002)
  • L de Marinis et al.

    Primary empty sella

    J Clin Endocrinol Metab

    (2005)
  • PU Chieng et al.

    Reduced hypothalamic blood flow after radiation treatment of nasopharyngeal cancer: SPECT studies in 34 patients

    AJNR Am J Neuroradiol

    (1991)
  • EV Jorgensen et al.

    Neurotransmitter control of growth hormone secretion in children after cranial radiation therapy

    J Pediatr Endocrinol

    (1993)
  • R Ceballos

    Pituitary changes in head trauma (analysis of 102 consecutive cases of head injury)

    Ala J Med Sci

    (1966)
  • RN Kornblum et al.

    Pituitary lesions in craniocerebral injuries

    Arch Pathol

    (1969)
  • G Pierucci et al.

    [Pituitary changes especially necrotic–following cranio-cerebral injuries]

    Pathologica

    (1971)
  • MR Crompton

    Hypothalamic lesions following the rupture of cerebral berry aneurysms

    Brain

    (1963)
  • MR Crompton

    Hypothalamic lesions following closed head injury

    Brain

    (1971)
  • MT Dattani

    Growth hormone deficiency and combined pituitary hormone deficiency: does the genotype matter?

    Clin Endocrinol (Oxf)

    (2005)
  • T Murase et al.

    A survival case of myxedema coma of pituitary origin

    Endocrinol Jpn

    (1973)
  • G Finzi et al.

    [Myxedematous coma due to transitory secondary hypothyroidism: description of a case]

    Ann Ital Med Int

    (1991)
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