Abstract
Hypopituitarism includes all clinical conditions that result in partial or complete failure of the anterior and posterior lobe of the pituitary gland’s ability to secrete hormones. The aim of management is usually to replace the target-hormone of hypothalamo-pituitary-endocrine gland axis with the exceptions of secondary hypogonadism when fertility is required, and growth hormone deficiency (GHD), and to safely minimise both symptoms and clinical signs. Adrenocorticotropic hormone deficiency replacement is best performed with the immediate-release oral glucocorticoid hydrocortisone (HC) in 2–3 divided doses. However, novel once-daily modified-release HC targets a more physiological exposure of glucocorticoids. GHD is treated currently with daily subcutaneous GH, but current research is focusing on the development of once-weekly administration of recombinant GH. Hypogonadism is targeted with testosterone replacement in men and on estrogen replacement therapy in women; when fertility is wanted, replacement targets secondary or tertiary levels of hormonal settings. Thyroid-stimulating hormone replacement therapy follows the rules of primary thyroid gland failure with L-thyroxine replacement. Central diabetes insipidus is nowadays replaced by desmopressin. Certain clinical scenarios may have to be promptly managed to avoid short-term or long-term sequelae such as pregnancy in patients with hypopituitarism, pituitary apoplexy, adrenal crisis, and pituitary metastases.
Highlights
Hypopituitarism or pituitary insufficiency includes all clinical conditions that result in partial or complete failure of the anterior and rarely of the posterior lobe of the pituitary gland to secrete hormones
In cases of post-surgical or other presumed transient hypopituitarism, secondary adrenal insufficiency (SAI) replacement with an modified-release HC (MRHC) is not recommended for the practical reasons that there are no commercially available low or intermediate dose MRHC formulations; a switch to MRHC may be tried when SAI lasts more than 12 months [38]
The first refers to the immediate clinical suspicion in situations of adrenocorticotropic hormone (ACTH) and thyroid-stimulating hormone (TSH)- insufficiency, since their lack that may be life-threatening
Summary
Hypopituitarism or pituitary insufficiency includes all clinical conditions that result in partial or complete failure of the anterior and rarely of the posterior lobe of the pituitary gland to secrete hormones. Pituitary apoplexy (PitAp) or adrenal crisis (AC) are characteristically life-threatening clinical entities [5,6]. These risks have mandated the need for evidence-based guideline for hormonal replacement in hypopituitary adults, either of isolated or combined hormonal insufficiency, and Endocrine Society Clinical Practice Guidelines have been recently issued for the management of hypopituitarism and for each target-hormone deficiency either at a primary or a secondary level of hypothalamo-pituitary target endocrine gland axis [7,8,9,10,11,12]. Many novel research studies do not focus on the hormonal replacement per se, but on ways of administration and delivery of the drug in order to achieve a better compliance from the patients’ point of view, and to most closely parallel the physiological circadian secretion of the deficient hormone, and to optimise quality of life (QoL)
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