Panhypopituitarism

Learning objectives

A rare condition in which the pituitary there’s a deficiency in all of the hormones produced by the pituitary gland
The anterior lobe of the pituitary gland produces:
- Adrenocorticotropic hormone (ACTH or corticotropin)
- Follicle-stimulating hormone (FSH)
- Growth hormone (GH)
- Luteinizing hormone (LH)
- Prolactin (PRL)
- Thyroid stimulation hormone (TSH)
The posterior lobe of the pituitary gland produces:
- Antidiuretic hormone (ADH)/vasopressin
- Oxytocin
Can affect anyone at any age
It can be life-threatening, especially if significant deficiencies of ACTH are present, and affects 4 people per 100,000 people
Panhypopituitarism is a type of hypopituitarism
- A deficiency or lack in one or multiple of the hormones produced by the pituitary gland
Patients with hormonal deficiencies present with the following:
- ACTH deficiency – adrenal insufficiency
- TSH deficiency – hypothyroidism
- Gonadotropin deficiency – hypogonadism
- GH deficiency – difficult to thrive and short stature in children, adults are usually asymptomatic; however, they may feel fatigued and weak
- ADH deficiency – diabetes insipidus presenting with polydipsia and polyuria

Symptoms depend on the hormones depend on which hormone is deficient
- Growth problems (in children)
- Obesity
- Hair loss
- Bradycardia
- Hypoglycemia
- Hypotension
- Fatigue
- Nausea or dizziness
- Depression and/or anxiety
- Frequent infections
- Sensitivity to cold
- Unusually dry skin
- Unexplained weight loss or weight gain
- Dyslipidemia
- Tachycardia
- Excessive thirst and urination
- Female and male infertility
Additional symptoms specific to infants, children, or adolescents
- Prolonged jaundice in newborns
- Micropenis
- Slowed growth
- Delayed puberty

Pituitary-related	Hypothalamus-related
Pituitary adenoma Infection Injury Pituitary gland surgery Radiation therapy Pituitary apoplexy Congenital (related to midline craniofacial defects) Kallman syndrome Idiopathic	Traumatic brain injury Brain surgery Tumors such as craniopharyngiomas Secondary metastasis Pressure from hydrocephalus Stroke Tuberculous meningitis

Adrenal crisis (acute cortisol insufficiency) which is characterized by the following symptoms:
- Fever
- Weakness
- Confusion
- Hypotension
- Tachycardia
- Vomiting
- Diarrhea
- Hypoglycemia
Secondary diseases:
- Obesity
- Increased cholesterol
- Metabolic syndrome
- Estradiol deficiency potentially leads to osteoporosis