Hypopituitarism
Signs and Symptoms
Hypopituitarism is often progressive. Although the signs and symptoms can occur suddenly, usually they tend to develop gradually. They’re sometimes vague and subtle, and may be overlooked for many months or even years.
Signs and symptoms of hypopituitarism also vary, depending on which pituitary hormones are deficient. The signs and symptoms may include:
- Fatigue
- Decline in energy
- Muscle weakness
- Nausea
- Constipation
- Weight loss or gain
- Decline in appetite
- Abdominal discomfort
- Sensitivity to cold or difficulty staying warm
- Visual disturbances
- Loss of underarm and pubic hair
- Joint stiffness
- Hoarseness
- Facial puffiness
- Thirst and excess urination
- Low blood pressure
- Headaches
- Loss of interest in sexual activity
- Erectile dysfunction
- Decrease in facial or body hair
- Irregular or stopped menstrual periods
- Infertility
- Inability to produce milk for breast-feeding
- Children: stunted growth, short stature, and slowed sexual development
Medical History
The cause of hypopituitarism can also be other diseases and events that damage the pituitary, such as: - Head injuries
- Brain tumor
- Brain surgery
- Radiation treatment
- Autoimmune inflammation (hypophysitis)
- Stroke
- Infections of the brain, such as meningitis
- Tuberculosis
- Sarcoidosis (inflammatory disease occurring in various organs)
- Histiocytosis X (abnormal cells cause scarring in numerous parts of the body, such as the lungs and bones)
- Diseases of the hypothalamus, located just above the pituitary, also can cause hypopituitarism. The hypothalamus produces hormones of its own that directly affect the activity of the pituitary.
Laboratory Tests
- Assessment of anterior pituitary hormone
- Radiographic imaging by computed tomography or magnetic resonance imaging to assess anatomy
- Formal visual fields
- Serum levels of testosterone for men and estradiol for women, LH, FSH, T4, TSH, prolactin, GH (for children), and cortisol. The cortisol test is usually done before and after an ACTH administration test.
- Symptoms of nocturia and polyuria may warrant a test for ADH adequacy. Secretion of ADH can be analyzed using a water deprivation test.
Therapeutics
Pituitary Insufficiency Hormones, Botanicals, and Nutraceuticals
The long-term medical management of pituitary insufficiency would include some of the following prescriptions.
| Deficiency | Replacement Regimen |
| Adrenal Insufficiency | Hydrocortisone: 20 mg AM, 10 mg PMDHEA: 100 mgGlycerrhiza glabra (licorice): solid extract ½-1 tsp q.d. Smilax officinalis (sarsparilla): solid extract 1 tsp q.d. |
| Hypothyroidism | Levothyroxine: 100-125 mg T4 or T3 5-45 mcg b.i.d. Armour: 1-6 grains q.d. |
| Hypogonadism, men | Depo-testosterone: 300 mg intramuscularly every 3 wks orTestosterone patch: 6 mg q.d.Full spectrum light, daylight sunlightGNRH |
| Hypogonadism, women | Conjugated estrogens: 0.625-1.25 mg on days 1-25 of each month or Estradiol patch: .05-.1 twice weeklyFull spectrum light, daylight sunlight GNRH Medroxyprogesterone acetate: 5-10 mg on days 13-25 of each month |
| Diabetes insipidus | Desmopressin: 0.1 ml intranasally 1-2 q.d. |
| Growth Hormone Insufficiency | GH injectionsRegular exerciseArginine: 3-20 g q.d.Ornithine: 3-20 g q.d. |
| Zinc 15-100 mg q.d.High protein dietDeep sleep: Melatonin 3 mg at bedGABA: 500 mg 2-3 times per day |
Prognosis
If the pituitary insufficiency is functional treatment to support and nourish the gland may restult in complete reversal. If, however, hormone deficiencies persist after naturopathic treatment, then one or more hormone replacement medications is indicated. These treatments are considered as “replacement”, as the dosages are set to match the amounts that the body would normally manufacture (“physiologic dose”). This type of hormone treatment is usually lifelong.
