Expanding the cause of hypopituitarism

Abstract

Hypopituitarism is defined as one or more pituitary hormone deficits due to a lesion in the hypothalamic-pituitary region. By far, the most common cause of hypopituitarism associated with sellar mass is pituitary adenoma. The less common and unusual causes of hypopituitarism are always challenging, and there is a long delay in arriving at the diagnosis. However, a high index of suspicion is needed when patients present with a history of cranial irradiation, head trauma, vascular injury, cancer treated with specific immune therapy causing hypophysitis, history of systemic diseases and bacterial, tuberculosis, viral, fungal and parasitic infections. Once suspected, the diagnosis can be confirmed with pituitary function tests and imaging. The pattern of pituitary hormone deficiencies depends on the nature of the underlying pathological process. Hypopituitarism may be permanent in some instances or transitory in other necessitating repeated assessment. It is unclear who and how often to screen, but certainly, a lengthy follow-up is needed. Identification of population at risk of hypopituitarism is important because many in the community may have untreated hypopituitarism with increased uncapacitation while optimal hormonal replacement may significantly improve their quality of life and life expectancy.