Abstract
Hypopituitarism is a disorder characterized by insufficient secretion of one or more pituitary hormones. New etiologies of hypopituitarism have been recently described, including head trauma, cerebral hemorrhage, and drug-induced hypophysitis. The investigation of patients with these new disorders, in addition to advances in diagnosis and treatment of hypopituitarism, has increased the prevalence of this condition. Pituitary hormone deficiencies can induce significant clinical changes with consequent increased morbidity and mortality rates, while hormone replacement based on current guidelines protects these patients. In this review, we will first discuss the different etiologies of hypopituitarism and then address one by one the clinical aspects, diagnostic evaluation, and therapeutic options for deficiencies of TSH, ACTH, gonadotropin, and GH. Finally, we will detail the hormonal interactions that occur during replacement of pituitary hormones.
Highlights
Hypopituitarism is a heterogeneous disease characterized by insufficient secretion of one or more pituitary hormones due to genetic or acquired causes [1]
These numbers certainly underestimate the frequency of hypopituitarism, which has increased over the last years due to recognition of new etiologies, such as cerebral hemorrhage and head trauma, emergence of new etiologies, such as druginduced hypophysitis, and improvements in diagnostic tools [1]
In longitudinal follow-up, a decrease of more than 20% in free T4 (FT4) levels should alert for an increased risk of Central hypothyroidism (CH), even when the values remain within the low-normal range [35,36,37]
Summary
Hypopituitarism is a heterogeneous disease characterized by insufficient secretion of one or more pituitary hormones due to genetic or acquired causes [1]. New concepts in the pathophysiology of hormonal deficiencies, recent advances in diagnostic tools, and the emergence of new formulations for hormone replacement have significantly contributed to a reduction in morbidity and mortality rates in these patients [7,8,9,10] This narrative review provides a guide for the management of patients with hypopituitarism in Brazil, considering as much as possible regional differences and health care disparities. Sports-related TBI, comprising continuous or acute trauma in professional athletes, amateur sporting, or even during recreational activities, may result in pituitary dysfunction that is commonly neglected and undiagnosed [20] Hypophysitis, another frequently underdiagnosed cause of hypopituitarism, is related to an inflammatory process of the pituitary and may be classified as primary or secondary, depending on its etiology. Recognition and appropriate management of immune-mediated hypophysitis are important to initiate pituitary hormone replacement without interrupting cancer treatment (Tables 1 and 2) [28]
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