Materiały źródłowe

• #1 Diagnosis and Treatment of Hypopituitarism

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4722397/

  Hypopituitarism can be easily diagnosed by measuring basal pituitary and target hormone levels except growth hormone (GH) and adrenocorticotropic hormone (ACTH) deficiency. […] Therefore, early diagnosis and prompt treatment is necessary. […] Hormone replacement therapy should be individualized according to the specific needs of each patient, taking into account possible interactions. […] Long-term endocrinological follow-up of hypopituitary patients is important to monitor hormonal replacement regimes and avoid under- or overtreatment. […] The treatment of hypopituitarism typically involves a replacement of the deficient hormone but care must be taken because several studies have reported an increased incidence of cardiovascular disorders and number of deaths among these patients.

• #2 Diagnosis and Treatment of Hypopituitarism

  https://www.e-enm.org/journal/view.php?doi=10.3803/enm.2015.30.4.443

  Hypopituitarism can be easily diagnosed by measuring basal pituitary and target hormone levels except growth hormone (GH) and adrenocorticotropic hormone (ACTH) deficiency. […] Therefore, early diagnosis and prompt treatment is necessary. […] Hormone replacement therapy should be individualized according to the specific needs of each patient, taking into account possible interactions. […] Long-term endocrinological follow-up of hypopituitary patients is important to monitor hormonal replacement regimes and avoid under- or overtreatment. […] The treatment of hypopituitarism typically involves a replacement of the deficient hormone but care must be taken because several studies have reported an increased incidence of cardiovascular disorders and number of deaths among these patients.

• #3 Hypopituitarism – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/hypopituitarism/diagnosis-treatment/drc-20351648

  Hypopituitarism is treated with medicines that raise hormone levels. This is called hormone replacement. Doses are set to match the amount of hormones that the body would make if it didn’t have a pituitary problem. In some cases, people with hypopituitarism may need to take this medicine for the rest of their lives. […] Sometimes, treatment of a condition causing hypopituitarism may restore the body’s ability to make pituitary hormones, either fully or in part. […] A specialist in endocrine disorders, called an endocrinologist, may keep an eye on symptoms and hormone levels in the blood. This is to ensure that the right amount of medicine is given. […] If a tumor in or around the pituitary gland is the cause of hypopituitarism, surgery might be needed to remove the growth. Some tumors also can be treated with medicines or radiation therapy.

• #4 Hypopituitarism: What It Is, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/22102-hypopituitarism

  Theres no cure, but hypopituitarism is treatable. Treatment depends on which pituitary hormone(s) are deficient and what caused your condition. Your healthcare team will work with you to customize the right treatment plan. Common treatment options for hypopituitarism include: […] Hormone replacement therapy: This aims to restore the deficient pituitary hormone(s) to normal levels. You typically remain on medication for the rest of your life. […] Surgery: People who have pituitary adenomas may need surgery to remove them. […] Radiation therapy: Radiation therapy can help shrink pituitary adenomas.

• #5 Hormone replacement in patients with hypopituitarism: a practical approach | Endocrinology Today

  https://endocrinology.medicinetoday.com.au/et/2023/november/feature-article/hormone-replacement-patients-hypopituitarism-practical-approach

  Hypopituitarism affects about one in 2000 people and requires long-term, often lifelong, management. Implementing a practical, stepwise approach to hormone assessment and replacement is important for all clinicians and can prevent life-threatening complications. This includes an understanding of the sequence and method of central adrenal insufficiency, central hypothyroidism and hypogonadism treatment, but also extends more broadly to cardiovascular and bone health. […] The sequence of anterior pituitary hormone replacement is an important consideration. Cortisol should be replaced first, followed by thyroxine, sex hormones and, lastly, growth hormone. This avoids the onset of a life-threatening adrenal crisis and incorrect interpretation of hormone studies based on other untreated deficiencies.

• #6 Treatment of hypopituitarism – UpToDate

  https://www.uptodate.com/contents/treatment-of-hypopituitarism

  Treatment of patients with hypopituitarism is the sum of the treatments of each of the individual pituitary hormonal deficiencies detected in a patient with pituitary or hypothalamic disease. The specifics of therapy for hypopituitarism will be reviewed here. […] The primary consequence of lack of corticotropin (ACTH) is cortisol deficiency. As a result, treatment consists of the administration of hydrocortisone in an amount and timing to mimic the normal pattern of cortisol secretion. […] Most authorities recommend replacement with hydrocortisone because that is the hormone the adrenal glands make normally (hydrocortisone and cortisol are different names for the same chemical structure). […] Most authorities recommend hydrocortisone doses of 15 to 25 mg/day because those doses are similar to daily production rates.

• #7 Treatment of hypopituitarism – UpToDate

  https://www.uptodate.com/contents/treatment-of-hypopituitarism

  Although dividing the total daily dose into two or even three doses (with the largest dose on arising in the morning) makes sense physiologically, many patients cannot remember to take doses in the middle of the day. For them, taking the entire dose in the morning is preferable to missing doses. Most patients feel well while taking the entire dose on arising.

• #8 Management of Hypopituitarism

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6947162/

  The management of hypopituitarism as IHD or MPHD has recently been discussed as a Clinical Practice Guideline from the Endocrine Society. The aim of hypopituitarism management is usually to replace the target-hormone of the disturbed hypothalamo-pituitary-endocrine gland axis. However, there are exceptions to this rule, such as GHD and SHG when fertility is the primary concern. Moreover, while hypopituitarism is usually permanent it may be also transient in cases of compression, inflammation (hypophysitis), surgery or functional suppression. The aim of hormone replacement is to minimise both symptoms and clinical signs of specific hormone deficiencies with safety, minimise inconvenience, and to maximise QoL. […] The endogenous secretion of glucocorticoids (GCs) follows a 24-h circadian rhythm, with a morning peak at the point of sleep-to-waking and a nadir at midnight. This circadian rhythm parallels the activity of a primary circadian clock sited in the suprachiasmatic nucleus of the hypothalamus, this synchronising secondary circadian rhythms in other brain areas and in peripheral centers such as the adrenals, and indeed in all cells. For this reason, in patients with SAI the cortisol rhythm may retain some residual function as opposed to primary AI (PAI), where the cyclic secretion is completely lost. This latter fact, along with the fact that the physiological daily production of cortisol may be lower than previously believed, can readily result in overtreatment of patients with AI unless great care is taken. The GC most widely used for cortisol replacement therapy worldwide is immediate-release oral GC hydrocortisone (HC) in daily divided doses. The current recommendations suggest total daily replacement doses for HC of 1012 mg/m2 body surface area (BSA); in adults, the suggested HC dose is 1520 mg as a total daily dose with the highest HC dose (half or two-thirds of the total daily dose) given immediately on waking (morning) and the other 23 (and rarely 4) doses given later at lunch and then late afternoon (or an additional early afternoon), respectively.

• #9 Management of Hypopituitarism

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6947162/

  Once-daily modified-release HC (MRHC) formulation (Plenadren) has been recently introduced and it is composed of an immediate-release coating combined with an extended-release core. This formulation aims to model a more physiological cortisol secretion profile without troughs and peaks but with higher concentrations during the morning in the first 4 h of its administration and a period without cortisol-exposure at night, resulting in decreased 24-h exposure to cortisol. Plenadren results in less recurrent infections and a better metabolic profile along with a less impaired QoL. […] GH replacement is then administered to patients with no contraindications at a starting dose of 0.20.4 mg/day for patients younger than 60 years and 0.10.2 mg/day for patients older than 60 years. GH doses are titrating to maintain IGF-1 levels above the mean/median for that age and sex group, but below the upper limit of normal (ULN), reducing the dose if AEs appear.

• #10 Panhypopituitarism Treatment & Management: Medical Care, Surgical Care, Consultations

  https://emedicine.medscape.com/article/923789-treatment

  Cortisol deficiency requires prompt recognition and treatment. This is particularly true for the child who may be facing surgery or experiencing other significant stresses related to the cause of hypopituitarism. […] Oral replacement is usually with hydrocortisone, which is most often administered twice daily but can be administered 3 times daily. Prednisone may be considered advantageous because of twice-daily dosing (at about 20-25% of the dose for hydrocortisone). However, growth suppression is a more common problem with prednisone, which should generally be avoided. […] The dose of L-thyroxine (levothyroxine) replacement is age dependent. Monitor free T4 levels and adjust the dose of T4 to maintain reference-range levels. […] Evaluate and treat cortisol deficiency before starting T4 replacement, to avoid precipitating an adrenal crisis.

• #11 Diagnosis and Treatment of Hypopituitarism

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4722397/

  It is necessary for physicians to inform their patients that they may require lifetime treatment unless there are special circumstances, such as the discontinuation of estrogen replacement after menopause. […] The primary goals of treatment should be centered around the recuperation of the physiological health of the patient in terms of growth, reproduction, metabolism, and body composition. […] Although replacement with hypothalamic or pituitary hormones are physiologic (at least theoretically), we administrate target organ hormone due to the high cost and inconvenience of repeated injections. […] ACTH deficiency can be treated with either hydrocortisone or prednisolone, which is a synthetic corticosteroid drug. […] TSH deficiency is treated with L-thyroxine (T4). […] For patients with hypogonadotropic hypogonadism, it is important to consider both gonad steroid replacement treatment and fertility. […] In the past, GH replacement treatment is generally only utilized in children with growth disorder due to GH deficiency. […] Diabetes insipidus that results from ADH deficiency can be easily treated with a novel synthetic analogue of vasopressin known as desmopressin.

• #12 Hormone Replacement in Hypopituitarism Guideline Resources | Endocrine Society

  https://www.endocrine.org/clinical-practice-guidelines/hormone-replacement-in-hypopituitarism

  The 2016 guideline addresses: […] Treating a variety of hormone deficiencies […] Recommendations from the guideline include: […] People who have proven cases of growth hormone deficiency and no contraindications should be offered growth hormone replacement as a treatment option. […] Premenopausal women who have central hypogonadism, a condition where the sex glands produce minimal amounts or no hormones, can undergo hormone treatment, provided there are no contraindications. […] For patients who have low levels of glucocorticoid hormones, hydrocortisone can be given in a daily single or divided dose. […] All hypopituitarism patients should be instructed to obtain an emergency card, bracelet or necklace warning about the possibility of adrenal insufficiency. […] Patients who are suspected of having an adrenal crisis due to secondary adrenal insufficiency should receive an immediate injection of 50 to 100 milligrams of hydrocortisone.

• #12 Hormone Replacement in Hypopituitarism Guideline Resources | Endocrine Society

  https://www.endocrine.org/clinical-practice-guidelines/hormone-replacement-in-hypopituitarism

  People who have central adrenal insufficiency should receive the lowest tolerable dose of hydrocortisone replacement on a long-term basis to reduce the risk of metabolic and cardiovascular disease. […] Hormonal replacement in panhypopituitarism […] We recommend using HC, usually 1520 mg total daily dose in single or divided doses. […] We recommend L-T4 in doses sufficient to achieve serum fT4 levels in the mid to upper half of the reference range. […] We recommend offering GH replacement to those patients with proven GHD and no contraindications. […] We recommend gonadal hormone treatment in premenopausal women with central hypogonadism, provided there are no contraindications. […] When administering desmopressin (DDAVP) in diabetes insipidus (DI), we suggest individualized therapeutic schedules.

• #13 Hypopituitarism – UF Health

  https://ufhealth.org/conditions-and-treatments/hypopituitarism

  If hypopituitarism is caused by a tumor, you may need surgery to remove the tumor. Radiation therapy may also be needed. […] You will need lifelong hormone medicines to replace hormones that are no longer made by organs under the control of the pituitary gland. These may include: corticosteroids (cortisol), growth hormone, sex hormones (testosterone for men and estrogen for women), thyroid hormone, desmopressin. […] Medicines are also available to treat related infertility in men and women. […] If you take glucocorticoid medicines for pituitary ACTH deficiency, be sure you know when to take a stress dose of your medicine. Discuss this with your health care provider. […] Always carry a medical ID (card, bracelet, or necklace) that says you have adrenal insufficiency. The ID should also say the type of medicine and dosage you need in case of an emergency caused by adrenal insufficiency. […] Hypopituitarism is usually permanent. It requires lifelong treatment with one or more medicines. But you can expect a normal life span. […] Side effects of medicines to treat hypopituitarism can develop. However, do not stop any medicine on your own without talking with your provider first.

• #14 Hypopituitarism | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/23284

  Individuals at an advanced age or those with cardiac disease require the thyroid hormone, also called L-thyroxine, replacement therapy. Treatment initiation generally involves a low dose of 25 g/d of L-thyroxine, followed by gradual adjustments based on biochemical results and clinical indicators. […] In men, testosterone replacement can be delivered through various methods, including gels, patches, oral medications, or IM injections. […] In women, estrogen and progesterone hormone replacement therapy can be administered IM, orally, or transdermally. […] ADH replacement with intranasal or oral desmopressin, a synthetic analog of vasopressin, aids in stabilizing the water balance and addressing polyuria in patients. Maintaining sodium levels within the normal range is essential. Monitoring urine-specific gravity and osmolality helps validate the effectiveness of ADH replacement and ensures appropriate water regulation.

• #15 Management of Hypopituitarism

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6947162/

  The recent guidelines suggest measuring serum free T4 (fT4) and TSH to evaluate SHT. A fT4 level below the laboratory reference range in conjunction with a low, normal, or mildly elevated TSH (inappropriately low-TSH) in the setting of pituitary disease usually confirms a diagnosis of SHT. In general, levothyroxine (L-T4) replacement in SHT is similar to that in primary hypothyroidism, but serum TSH cannot be used to assess adequacy of replacement.

• #16 Hormone replacement in patients with hypopituitarism: a practical approach | Endocrinology Today

  https://endocrinology.medicinetoday.com.au/et/2023/november/feature-article/hormone-replacement-patients-hypopituitarism-practical-approach

  Adrenal insufficiency must be excluded before starting thyroid hormone replacement. Starting thyroxine in the setting of untreated adrenal insufficiency can accelerate the metabolism of the low residual cortisol and precipitate adrenal crises. […] Thyroid hormone replacement is similar to hormone replacement for primary hypothyroidism (e.g. associated with Hashimotos thyroiditis), using an estimated dose of 1.6mcg/kg/day of levothyroxine. […] In the hypopituitary setting, transdermal oestrogen replacement is preferred, as first-pass metabolism of oral oestrogen attenuates GH and insulin-like growth factor-1 (IGF-1) action and metabolism. […] Current recommendations include the use of sex hormone replacement until the natural age of menopause. […] Both male and female fertility are impaired in central hypogonadism. Assisted reproductive treatments (i.e. ovulation induction or in vitro fertilisation) are often required for conception, with pregnancy rates ranging from 47 to 76% in small observational studies.

• #17 Hypopituitarism (Panhypopituitarism) Treatment & Management: Approach Considerations, Prevention, Long-Term Monitoring

  https://emedicine.medscape.com/article/122287-treatment

  A missed or delayed diagnosis of hypopituitarism could potentially lead to permanent disability or death. Medical care consists of hormone replacement as appropriate and treatment of the underlying cause. Glucocorticoid (cortisol) is required if the ACTH-adrenal axis is impaired. This is particularly important in sudden collapse due to pituitary apoplexy or acute obstetric hemorrhage with pituitary insufficiency. In such circumstances, do not delay initiation of a possibly lifesaving treatment pending a definitive diagnosis. Treat secondary hypothyroidism with thyroid hormone replacement. […] Treat gonadotropin deficiency with gender-appropriate hormones. In men, testosterone replacement is used and substituted with human chorionic gonadotropin (hCG) injections if the patient desires fertility. In women, estrogen replacement is used with or without progesterone as appropriate.

• #18 Management of Hypopituitarism

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6947162/

  Testosterone replacement is similar to male patients with primary hypogonadism (PHG) and is suggested for adult males with clear biochemical deficiency when they do not have any contraindications in order to prevent testosterone deficiency signs and symptoms. […] Hormonal replacement therapy (HRT) as oral oestrogen (unopposed oestrogens only for women who have undergone hysterectomy), or combined oestrogen and progestogen therapy (women with an intact uterus to prevent endometrial hyperplasia) is recommended, assuming that no contraindications (particularly related to breast carcinoma or thrombosis) are present. The goals of treatment differ according to age: in older women the indication is the control of hot flushes and not to prevent the harm that the oestrogen deficiency carries as in the case of young women.

• #19 Hypopituitarism – Wikipedia

  https://en.wikipedia.org/wiki/Hypopituitarism

  Most pituitary hormones can be replaced indirectly by administering the products of the effector glands: hydrocortisone (cortisol) for adrenal insufficiency, levothyroxine for hypothyroidism, testosterone for male hypogonadism, and estradiol for female hypogonadism (usually with a progestogen to inhibit unwanted effects on the uterus). […] Long-term follow up by specialists in endocrinology is generally needed for people with known hypopituitarism. Apart from ensuring the right treatment is being used and at the right doses, this also provides an opportunity to deal with new symptoms and to address complications of treatment. […] Difficult situations arise in deficiencies of the hypothalamus-pituitary-gonadal axis in people (both men and women) who experience infertility; infertility in hypopituitarism may be treated with subcutaneous infusions of FSH, human chorionic gonadotropin—which mimics the action of LH—and occasionally GnRH.

• #20 Hormone Replacement in Hypopituitarism Guideline Resources | Endocrine Society

  https://www.endocrine.org/clinical-practice-guidelines/hormone-replacement-in-hypopituitarism

  People who have central adrenal insufficiency should receive the lowest tolerable dose of hydrocortisone replacement on a long-term basis to reduce the risk of metabolic and cardiovascular disease. […] Hormonal replacement in panhypopituitarism […] We recommend using HC, usually 1520 mg total daily dose in single or divided doses. […] We recommend L-T4 in doses sufficient to achieve serum fT4 levels in the mid to upper half of the reference range. […] We recommend offering GH replacement to those patients with proven GHD and no contraindications. […] We recommend gonadal hormone treatment in premenopausal women with central hypogonadism, provided there are no contraindications. […] When administering desmopressin (DDAVP) in diabetes insipidus (DI), we suggest individualized therapeutic schedules.

• #21 Management of Hypopituitarism

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6947162/

  Hypopituitarism includes all clinical conditions that result in partial or complete failure of the anterior and posterior lobe of the pituitary glands 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 23 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.

• #22 Diagnosis and Treatment of Hypopituitarism

  https://www.e-enm.org/journal/view.php?doi=10.3803/enm.2015.30.4.443

  For patients with hypogonadotropic hypogonadism, it is important to consider both gonad steroid replacement treatment and fertility. […] In the past, GH replacement treatment is generally only utilized in children with growth disorder due to GH deficiency. However, the recent development of recombinant human GH has made it possible to use GH to treat adults with hypopituitarism or reduced GH secretion. […] Diabetes insipidus that results from ADH deficiency can be easily treated with a novel synthetic analogue of vasopressin known as desmopressin.

• #23 Hormone Replacement in Hypopituitarism Guideline Resources | Endocrine Society

  https://www.endocrine.org/clinical-practice-guidelines/hormone-replacement-in-hypopituitarism

  We suggest that all patients with DI wear an emergency bracelet or necklace to inform clinicians of the patients health problem if incapacitated. […] We suggest that clinicians monitor euthyroid patients with GHD who begin GH therapy for the risk of developing CH, and if fT4 levels decrease below the reference range, these patients should begin L-T4 therapy. […] We recommend that clinicians monitor fT4 or total T4 levels every 46 weeks for women with CH who become pregnant, and that these women may require increased L-T4 doses to maintain levels within target ranges for pregnancy. […] We recommend GC replacement until full HPA axis recovery after surgically resecting ACTH-secreting tumors. […] We recommend using stress doses of steroids in AI before surgery and tapered doses after surgery before repeating testing.

• #24 Hormone replacement in patients with hypopituitarism: a practical approach | Endocrinology Today

  https://endocrinology.medicinetoday.com.au/et/2023/november/feature-article/hormone-replacement-patients-hypopituitarism-practical-approach

  GH replacement consists of daily subcutaneous injections of recombinant human GH. […] The treatment of AVP-D involves the use of desmopressin, which is a synthetic analogue of vasopressin with a longer half-life. The aim of treatment is to provide relief from the excessive urination and thirst, which otherwise interfere with daily activities and sleep. […] Hypopituitarism affects a broad range of physiological systems and necessitates stepwise investigation and management. Identification and treatment of central adrenal insufficiency prior to starting other therapies is key, as is recognising the differences between primary and central hormone deficiencies.

• #25 Azthena logo with the word Azthena

  https://www.news-medical.net/health/Hypopituitarism-Treatment.aspx

  Adults with low GH levels are rarely symptomatic and often do not require treatment. However, if other hormone levels are low, and they experience symptoms, growth hormone replacement may be required. […] Surgical procedures may be needed in the treatment of hypopituitarism for some patients. […] It is important that patients being treated for hypopituitarism receive adequate follow-up care and support. […] As hormone replacement therapy is given on a lifelong basis, frequent monitoring is needed to monitor the hormone replacement and to ensure that the patient is receiving the right dosage. […] Both under-replacement and over-replacement of hormones can result in disturbing and even dangerous symptoms. This should be avoided by having ones blood tested regularly, and adjusting the hormone dose accordingly.

• #26 Hypopituitarism – Wikipedia

  https://en.wikipedia.org/wiki/Hypopituitarism

  Treatment of hypopituitarism is threefold: removing the underlying cause, treating the hormone deficiencies, and addressing any other repercussions that arise from the hormone deficiencies. […] Pituitary tumors require treatment when they are causing specific symptoms, such as headaches, visual field defects or excessive hormone secretion. Transsphenoidal surgery (removal of the tumor by an operation through the nose and the sphenoidal sinuses) may, apart from addressing symptoms related to the tumor, also improve pituitary function, although the gland is sometimes damaged further as a result of the surgery. […] Prolactinomas may respond to dopamine agonist treatment—medication that mimics the action of dopamine on the lactrotrope cells, usually bromocriptine or cabergoline. This approach may improve pituitary hormone secretion in more than half the cases, and make supplementary treatment unnecessary.

• #27 Hypopituitarism – Hormonal and Metabolic Disorders – Merck Manual Consumer Version

  https://www.merckmanuals.com/home/hormonal-and-metabolic-disorders/pituitary-gland-disorders/hypopituitarism

  Treatment focuses on replacing deficient hormones with synthetic ones but sometimes includes surgical removal or irradiation of any pituitary tumors. […] Treatment is directed at the cause of pituitary underactivity (when possible) and at replacing deficient hormones. […] When the cause of the pituitary hormone deficiency is a tumor, surgical removal of a tumor is often the most appropriate first treatment. […] Supervoltage or proton beam irradiation of the pituitary gland can be used to destroy a tumor. […] Tumors that produce prolactin can be treated with medications that act like dopamine, such as bromocriptine or cabergoline. […] Treatment also focuses on replacing the deficient hormones, usually not by replacing pituitary hormones, but rather, by replacing their target hormones. […] Growth hormone is the only pituitary hormone that is replaced. Growth hormone treatment must be given by injection.

• #28 Hypopituitarism (Panhypopituitarism) Treatment & Management: Approach Considerations, Prevention, Long-Term Monitoring

  https://emedicine.medscape.com/article/122287-treatment

  GH is replaced in children as appropriate. GH is not routinely replaced in adults unless the patient is symptomatic of GH deficiency after all other pituitary hormones have been replaced. Then, a 6-month trial of replacement GH therapy may be considered. […] Surgical care depends on the underlying cause and clinical state. In pituitary apoplexy, prompt surgical decompression may be lifesaving if head imaging reveals a clinically significant tumor mass effect. Microadenomas do not need surgical treatment unless GH or ACTH hypersecretion is present. Prolactinomas, small and large, generally respond to medical therapy with tumor shrinkage and alleviation of mass symptoms. Debulk macroadenomas with mass symptoms that do not respond to medical therapy or are not expected to respond to medical therapy. Some asymptomatic, nonsecreting macroadenomas may have an option of close clinical/radiologic observation. If radiotherapy is used, long-term new-onset hypopituitarism may occur and must be monitored.

• #29 Hypopituitarism (Panhypopituitarism) Treatment & Management: Approach Considerations, Prevention, Long-Term Monitoring

  https://emedicine.medscape.com/article/122287-treatment

  The most common causes of nonsecreting pituitary adenomas are variants of gonadotropin-secreting tumors. In perhaps a third of these lesions, treatment with the potent dopamine agonist cabergoline may result in some decrease in mass or prevention of recurrence. […] A retrospective study by Graffeo et al indicated that in radiation-nave patients receiving single-fraction stereotactic radiosurgery for pituitary adenoma, a mean gland dose of less than 11.0 Gy may reduce the likelihood of posttreatment hypopituitarism. […] A study by Lee et al found that in patients with nonfunctioning pituitary adenomas, gross-total resection and/or adjuvant radiotherapy appear to prevent tumor recurrence or regrowth. […] A literature review by Li et al indicated that in the surgical treatment of pituitary adenomas, endoscopic transsphenoidal surgery is more successful than microscopic transsphenoidal surgery in gross tumor removal and, unlike the microscopic technique, does not significantly affect cerebrospinal fluid leak risk.

• #30 Diagnosis and Treatment of Hypopituitarism

  https://e-enm.org/DOIx.php?id=10.3803/enm.2015.30.4.443

  Given that there is a variety of causes underlying hypopituitarism as well as varying degrees of hormone deficiencies and types of deficient hormones, it is important to individualize hormone replacement therapy to the specific needs of a particular patient. […] The primary goals of treatment should be centered around the recuperation of the physiological health of the patient in terms of growth, reproduction, metabolism, and body composition. […] The pre- and postoperative incidence rates of hypopituitarism are similar because some hormone function can be recovered following the removal of a pituitary tumor whereas deficiencies in other pituitary hormones may develop after surgery. […] In clinical situations, prolactin and oxytocin deficiency are generally not treated. […] The administration of GH also seems to influence the metabolism rates of hydrocortisone and T4 such that the doses of these drugs need to be adjusted upward. […] Diabetes insipidus that results from ADH deficiency can be easily treated with a novel synthetic analogue of vasopressin known as desmopressin.

• #31 Pituitary Health – Management Of Hypopituitarism

  https://pituitarysociety.org/hypopituitarism/

  Although there is no cure for hypopituitarism, it is treatable. Successful hormone replacement therapy can enable a patient to live a normal life, feel well, and not have the consequences of hormone deficiency. […] If the pituitary gland is permanently damaged, proper hormone replacement usually requires life-long treatment. […] When hormone replacement treatment is first started, it may take time to determine the patients response and to find the best dose. […] Fertility may be restored by lowering PRL levels with medication such as bromocriptine or cabergoline. […] If a woman with hypopituitarism becomes pregnant, she should be monitored closely. Doses of thyroid and steroid replacement may need to be adjusted.

• #32 Hormone Replacement in Hypopituitarism Guideline Resources | Endocrine Society

  https://www.endocrine.org/clinical-practice-guidelines/hormone-replacement-in-hypopituitarism

  We recommend HC stress dosing during the active phase of labor, similar to that used in major surgical stress. […] We recommend testing for acute pituitary insufficiency in all patients with pituitary apoplexy. […] We recommend GC therapy until a laboratory diagnosis is established and the patient maintains normal pituitary function. […] We suggest clinicians educate AI patients that are taking nondexamethasone GCs and who start enzyme-inducing antiepileptic drugs (AEDs) about the early signs and symptoms of AI.

• #33 Hypopituitarism – Hypothalamus and Pituitary Diseases – Endocrinology – Diseases – McMaster Textbook of Internal Medicine

  https://empendium.com/mcmtextbook/chapter/B31.II.8.3.

  GH replacement therapy is also suggested in adults with severe GH deficiency and no contraindications. […] Desmopressin/DDAVP, available as oral formulation, sublingual formulation, intranasal formulation, or IV/subcutaneous formulations can be used for inpatients. […] Surgical resection (transsphenoidal) is the first-line treatment for most pituitary adenomas. […] IV glucocorticoids: Hydrocortisone 100 mg qid to tid or dexamethasone ~4 mg bid at the early stages of pituitary apoplexy to correct the possible ACTH deficiency and reduce vasogenic edema.

• #34 Generalized Hypopituitarism – Endocrine and Metabolic Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/endocrine-and-metabolic-disorders/pituitary-disorders/generalized-hypopituitarism

  In pituitary apoplexy, immediate surgery is warranted if visual field disturbances or oculomotor palsies develop suddenly or if somnolence progresses to coma because of hypothalamic compression. Although management with high-dose corticosteroids and general support may suffice in a few cases, transsphenoidal decompression of the tumor should generally be undertaken promptly. […] In patients who have had surgery or radiation therapy to treat a pituitary tumor, treatment may be followed by the loss of other pituitary hormone functions. Patients treated with radiation may lose endocrine function slowly over years. Therefore, posttreatment hormonal status should be evaluated frequently, preferably at 3 and 6 months and yearly thereafter for at least 10 years and preferably up to 15 years after radiation therapy. Such evaluation should include at least assessment of thyroid and adrenal function.

• #35 Hypopituitarism (Panhypopituitarism) Treatment & Management: Approach Considerations, Prevention, Long-Term Monitoring

  https://emedicine.medscape.com/article/122287-treatment

  In very ill hospitalized patients or in patients undergoing major procedures, stress-dose steroids are required and are quickly tapered to a maintenance schedule after the procedure. Minor procedures or illnesses may not necessitate a change in steroid dose or may require a simple doubling of the usual daily dose until the illness resolves. Other hormone replacements are continued at their usual maintenance doses as appropriate. […] Good obstetric care has reduced the incidence of postpartum hypopituitarism. Radiation therapy that minimizes exposure of the pituitary reduces the time of onset of hypopituitarism. Experienced neurosurgeons employing high-resolution microscopic hypophyseal surgery may reduce the likelihood of subsequent hypopituitarism. […] Provide long-term follow-up care for complications of underreplacement or overreplacement. Stressful situations warrant an adjustment in therapy. Unlike adults, children require GH replacement.

• #36 Hypopituitarism – Pituitary Foundation

  https://www.pituitary.org.uk/information/hypopituitarism/

  Once on replacement hormones further blood tests are required for most of these to make sure the levels of the hormones are appropriate as well as for safety markers. The latter to avoid problems associated with over-replacement of hormones. Monitoring of these is likely to be lifelong in most cases of hypopituitarism.

• #37 Hypopituitarism (Panhypopituitarism) Treatment & Management: Approach Considerations, Prevention, Long-Term Monitoring

  https://emedicine.medscape.com/article/122287-treatment

  Follow-up care also involves adjusting hormone replacement to physiologic maintenance levels using the lowest dose. Monitor the patient to avoid overreplacement. The incidence of new neoplasms is increased in young people treated with GH who had previous tumor treatment. […] Screening for hypopituitarism should be offered to patients with a history of TBI, SAH, pituitary microadenoma, pituitary radiation therapy, transsphenoidal surgery, or prolactinoma treatment and to GH-deficient children who have achieved their full height.

• #38 Hypopituitarism Treatment & Causes | Lurie Children’s

  https://www.luriechildrens.org/en/specialties-conditions/hypopituitarism/

  We treat the cause of the condition and replace the hormones the body isnt making. […] Hormone replacement therapy mimics the bodys natural production. The medicines can be continued as long as needed, during childhood and adulthood. These medications are tolerated very well when the right amounts of hormones are replaced. […] Some tumors respond to medicine that is swallowed. Other tumors need to be removed with surgery. Usually, the hormone deficiencies remain after a tumor is removed. Hormone therapy works for this. […] To be effective, hormone replacement must be supported with ongoing care. Throughout childhood, we need to adjust the hormone doses to accommodate the growing childs needs and changes in symptoms. […] We care for children with all forms of hypopituitarism. We treat each hormone deficiency to maintain the childs health and normal development. With the right care plan, children with hypopituitarism usually enjoy a normal life. We help the child to develop normally, interact with peers and feel well.

• #39 Panhypopituitarism in Children | Children’s Hospital of Philadelphia

  https://www.chop.edu/conditions-diseases/panhypopituitarism-children

  Even if the underlying cause of panhypopituitarism cannot be found or addressed, hormone replacement therapy works to return the body to a healthy rate of development and to normal metabolic function. […] When the cause is found to be a tumor, this can usually be controlled with surgery, medications or a combination of the two. Radiation therapy is sometimes used. […] Regular office visits with specialists are necessary to make sure medications are working and children are growing and developing as expected. […] When medication is needed to supplement hormone production, periodic follow-up tests are needed to ensure that the treatment continues to work effectively. […] Dosage levels and the combination of medications may need to be adjusted over time. […] Sometimes repeat imaging tests or additional blood tests may be recommended. If the treatment has eliminated or decreased the size of a tumor, follow-up tests and imaging will be needed periodically to make sure the tumor has not returned.

• #40 Hypopituitarism | Endocrine Society

  https://www.endocrine.org/patient-engagement/endocrine-library/hypopituitarism

  Treatment of the underlying cause of hypopituitarism is important. Endocrine treatment includes giving back the hormones missing, such as thyroid hormone, cortisol, testosterone in men and estrogen in women, DDAVP (synthetic ADH) and sometimes growth hormone. […] If a tumor is causing your hypopituitarism, you might need surgery to remove it and/or possibly radiation therapy. Sometimes, surgery to remove a tumor might help improve the pituitary gland function. You will need to get regular check-ups. It’s wise to wear medical identification, such as a bracelet or pendant, which provides information about your condition in case of an emergency. You can expect a normal life span, as long as you regularly take the medications recommended by your doctor. However, many patients with hypopituitarism do not feel completely well even when they take the recommended hormone therapy. Your doctor will help you adjust your hormone therapy to feel as well as possible.

• #41

  https://link.springer.com/article/10.1007/s11102-006-6039-z

  Diagnosis and treatment of patients with hypopituitarism needs careful clinical evaluation and individual optimization. […] Hormone replacement therapy should be individualized, taking into account possible interactions. Persisting symptoms and reduced quality of life are frequently reported, explained by, at least in part, intrinsic imperfections of hormone replacement strategies in mimicking normal hormone secretion. […] In the present overview, the principles of diagnosis and treatment of hypopituitarism are discussed.

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