Hypopituitarism: Symptoms, Causes, and Treatment

If you’re feeling “off” with no obvious cause, it’s possible your hormone levels might not be in balance. Hypopituitarism is one potential cause of many types of hormone imbalances. 

“Hypo” means below normal, and “pituitarism” refers to your pituitary gland. Your pituitary gland is an important endocrine gland that produces eight important hormones that influence almost all aspects of your health.

Hypopituitarism can cause a range of signs and symptoms depending on which hormones your body is underproducing. The severity of your hormonal deficiency can be mild or severe.

Pituitary Hormones

Doctors divide your pituitary gland into posterior and anterior lobes because each part of the gland has its own unique functions.

Your anterior pituitary gland produces:

• Human growth hormone. Human growth hormone (HGH) stimulates the growth and repair of tissues throughout the body.

• Prolactin. Prolactin promotes milk production in women after childbirth. In men, it’s thought to play arole in maintaining testosterone levels and the development of sperm. Prolactin levels are generally low in males; high levels can cause problems. 

• Follicle-stimulating hormone. Follicle-stimulating hormone (FSH) regulates the development of eggs in the ovaries of females and sperm in the testes of males.

• Luteinizing hormone. Luteinizing hormone (LH) stimulates the release of estrogen in females and testosterone in males.

• Adrenocorticotropic hormone. Adrenocorticotropic hormone (ACTH) stimulates your adrenal glands to produce cortisol to help combat stress.

• Thyroid-stimulating hormone. Thyroid-stimulating hormone (TSH) stimulates the thyroid gland to produce thyroid hormones that regulate your metabolism.

Your posterior pituitary gland produces:

• Vasopressin. Vasopressin helps regulate water balance in your body. Higher levels reduce urine output and constrict your blood vessels. This hormone is also called anti-diuretic hormone (ADH).

• Oxytocin. In females, oxytocin stimulates uterine contractions during childbirth and promotes milk ejection during breastfeeding. It plays an important role in bonding between individuals, such as romantic partners, in everyone.

Symptoms of Hypopituitarism

Hypopituitarism symptoms depend on which hormone deficiencies you develop. You may be deficient in one hormone or many. Being deficient in all the pituitary hormones, called panhypopituitarism,  is rare.

Here’s a breakdown of potential symptoms by deficiency type.

Human Growth Hormone Deficiency Symptoms

In children:

• Short stature or failure to grow

• Increased body fat

• Smaller penis than expected

• Delayed puberty

• Low energy or fatigue

• Poor bone density, leading to an increased risk of fractures

• Decreased muscle mass and strength

In adults:

• Fatigue and reduced stamina

• Decreased muscle mass and strength

• Increased body fat, especially around the waist

• Reduced bone density

• Depression or mood swings

• Memory problems or difficulty concentrating

• Sleep disturbances or insomnia

• Increased cardiovascular disease risk

Prolactin Deficiency Symptoms

In females, the main sign of prolactin deficiency is an inability to produce breast milk after childbirth.

Symptoms of prolactin deficiency in males are still being studied. Generally, high levels are of more concern to doctors because it can cause problems such as headaches or low sex drive. 

Follicle-Stimulating Hormone Deficiency Symptoms

FSH deficiency is a rare cause of infertility for men and women. FSH deficiency alone generally doesn’t cause symptoms other than infertility and low sperm quality in men.

Luteinizing Hormone Deficiency Symptoms

In men, LH deficiency can lead to reduced testosterone and associated symptoms including:

• Low sex drive

• Erectile dysfunction

• Decreased muscle mass and bone density

• Decreased body hair growth

• Fatigue

• Mood changes

• Infertility

Adrenocorticotropic Hormone Deficiency

ACTH deficiency can lead to a reduction in cortisol production. The insufficient production of cortisol by your adrenal glands is known as adrenal insufficiency. 

Symptoms of ACTH deficiency include:

• Fatigue and weakness

• Loss of appetite and weight loss

• Low blood pressure, leading to dizziness or fainting

• Hypoglycemia (low blood sugar)

• Nausea and vomiting

• Depression or other mood changes

• Darkening of the skin

• Salt cravings

Thyroid-Stimulating Hormone Deficiency

TSH deficiency can lead to hypothyroidism, as TSH is responsible for stimulating the thyroid gland to produce thyroid hormones. Symptoms of TSH deficiency include:

• Fatigue

• Weight gain or difficulty losing weight

• Poor cold tolerance

• Joint and muscle pain

• Dry skin and brittle hair

• Depression or mood changes

• Slow heart rate

• Memory problems or difficulty concentrating

Vasopressin Deficiency

Vasopressin deficiency can cause diabetes insipidus, a condition characterized by large amounts of clear urine due to disruptions in your body’s water balance regulation. Key symptoms include:

• Excessive thirst

• Frequent urination, with large volumes of clear urine

• Dehydration 

• Fatigue 

• Weakness

• Headaches and dizziness

• Low blood pressure

• Dizziness, especially when standing up 

• Frequent need to pee at night

Oxytocin Deficiency

Oxytocin deficiency can affect various physiological and emotional processes and may cause:

• Weight gain

• Increased anxiety and depression

• Mood swings

• Osteoporosis

Causes of Hypopituitarism

Hypopituitarism can develop due to problems with your pituitary gland or your hypothalamus. Your hypothalamus is part of your brain that plays a role in coordinating the release of many types of hormones. 

Specific causes of hypopituitarism may include the following:

• Pituitary tumors, such as craniopharyngioma or pituitary adenoma. Pituitary tumors are thought to make up more than 60 percent of cases of hypopituitarism.

• Traumatic brain injury

• Pituitary apoplexy, or sudden loss of blood supply to your pituitary gland

• Brain surgery or radiation complications

• Infections, such as meningitis

• Autoimmune inflammation, which may cause pituitary or hypothalamic dysfunction

• Genetic mutations present from birth (idiopathic)

• Underlying diseases, such as sarcoidosis or hemochromatosis

• Sheehan syndrome, a complication of childbirth

Risk Factors for Hypopituitarism

Risk factors for hypopituitarism include:

• Genetic mutations. Some genetic conditions, such as multiple endocrine neoplasia, type I, can predispose people to pituitary dysfunction and tumors.

• Age. The risk of developing pituitary adenomas (the most common type of pituitary tumor) seems to increase with age.

• Family history. Some pituitary tumors run in families, but most aren’t linked to a family history.

• Head trauma. Injury to your head or brain can damage your pituitary gland. Not wearing a helmet during contact sports or activities like cycling may increase your risk.

• Brain surgery or radiation. Receiving surgery or radiation treatments for brain tumors or other head or neck tumors can potentially harm the pituitary gland. 

• Autoimmune diseases. Conditions like lymphocytic hypophysitis can lead to inflammation of the pituitary. The average age at which this condition develops in men is approximately 45. 

• Taking dopamine agonists. The most common cause of low prolactin without abnormal levels of other pituitary hormones is taking medications called dopamine agonists. These medications are used to treat Parkinson’s, restless legs syndrome, and other conditions having to do with dopamine levels in the brain.

Diagnosis of Hypopituitarism

Getting a diagnosis for hypopituitarism often starts by seeing your primary healthcare provider. They’ll perform initial tests such as:

• Considering your symptoms

• Reviewing your personal medical history

• Reviewing your family medical history

• Performing a physical exam

If they suspect you may have a hormonal problem, they may send you to a specialist in endocrinology for additional testing.

Tests used to diagnose a hormone imbalance include:

• Blood tests. These can help your doctor examine your hormone levels to identify deficiencies in specific pituitary hormones. Blood tests are also used to differentiate between pituitary problems and other problems, such as issues stemming from your hypothalamus, testicles, thyroid, or adrenal glands. 

• Imaging. Imaging tests such as MRI or CT scans can help healthcare professionals identify structural abnormalities in or around your pituitary gland, such as tumors or birth defects.

• Hormone stimulation tests. These involve taking a medication to stimulate the release of hormones from your pituitary gland. Your healthcare provider then measures the resulting levels of your hormones. For example, during the insulin tolerance test, you’ll receive insulin to temporarily drop your blood sugar levels to stimulate the release of ACTH and HGH. 

Treatment of Hypopituitarism

Treatment for pituitary hormone deficiency often involves hormone replacement to replenish your hormone levels.

Treatment may also involve treating an underlying tumor or condition with surgery. The most common surgery for pituitary tumors is a procedure called transsphenoidal surgery. This minimally invasive technique involves making an incision in your nasal passages to access your pituitary gland.

You may need to be on medication for hypopituitarism for the rest of your life, depending on the cause and your symptoms.

HGH Deficiency Treatment

Hormone replacement therapy is the main treatment for children with growth hormone deficiency to help support normal growth. Hormone replacement therapy involves taking daily injections.

Doctors usually also recommend these injections for adults with HGH deficiency. 

You may also need other treatments for complications, such as the development of osteoporosis. Your doctor may prescribe bisphosphonates to increase bone mineral density.

Prolactin Deficiency Treatment

Hyperprolactinemia often doesn’t require treatment. When treatment is administered, it usually addresses the underlying cause. For example, if dopamine agonists are causing your symptoms, your doctor may recommend adjusting your dose.

FSH and LH Deficiency Treatment

In males, testosterone replacement therapy (TRT) is often administered to help keep testosterone levels in a healthy range. These medications can be administered in forms such as:

• Gels

• Patches

• Oral medications

• Injections

If you’re trying to have children, you might receive human chorionic gonadotropin (HCG) to improve semen quality. 

ACTH Deficiency Treatment

A type of steroid called hydrocortisone is the main treatment for ACTH deficiency. This medication closely resembles the hormone cortisol in your body.

The medication hydrocortisone is typically recommended at a dose of 10 to 20 milligrams in the morning and 5 to 10 milligrams in the afternoon.

Your provider might also prescribe another type of steroid, called prednisone, once daily. Steroids can cause side effects if taken for the long term, so your doctor will likely want to limit the amount of time you spend on them. 

TSH Deficiency Treatment

Levothyroxine is usually prescribed for people with low thyroid hormone levels. This medication is a synthetic version of the hormone thyroxine produced by your thyroid.

Vasopression Deficiency Treatment

Low levels of vasopression can be treated with a synthetic version of the hormone called desmopressin. It can be administered:

• Orally

• Intranasally

• Subcutaneously (through injections)

• Intravenously

Oxytocin Deficiency

A synthetic form of oxytocin may be prescribed for people who are oxytocin-deficient.

Preventing Hypopituitarism

Preventing hypopituitarism is challenging because many of the underlying causes are largely out of your control. But it won’t hurt to take the following preventive steps. 

• Protect your head from injury. Wearing protective gear during sports or in environments where head injuries are possible can reduce the risk of trauma to your pituitary gland.

• Wear a seatbelt in motor vehicles. Buckling up in vehicles can help prevent traumatic injury to your head.

• Manage chronic health conditions. Proper treatment of autoimmune diseases, infections, and other underlying health concerns may reduce the risk of pituitary damage.

• Avoid radiation exposure. Minimizing unnecessary radiation treatments, particularly to your head, can reduce your risk of pituitary damage. Keep in mind this isn’t always under your control, as radiation therapy may be the best treatment for certain types of head or neck cancers.

• Seek out genetic counseling as needed. For people with a family history of genetic conditions that are linked with hypopituitarism, like Kallmann syndrome, genetic counseling may help identify risk factors and provide guidance on symptom prevention or treatment.

If you suspect you may have a hormonal problem, seeing your healthcare provider and attending all your scheduled follow-up appointments it’s critical for identifying the underlying cause and keeping your symptoms under control.