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Feature Article

Hypopituitarism: recognising new causes and reducing complications

Arianne N Sweeting, Elizabeth L Chua

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Abstract

Hypopituitarism is becoming more common because of increasing recognition of novel causes of this condition. It is therefore essential that clinical practitioners are able to identify and manage this chronic disease to avoid life-threatening secondary adrenal insufficiency and maintain the patient’s quality of life.

Key Points

  • Hypopituitarism can be a life-threatening condition due to secondary adrenal insufficiency.
  • Hypopituitarism can present either acutely, with symptoms of sudden mass effect and secondary adrenal crisis, or more commonly as a subacute or chronic condition.
  • Pituitary adenoma is the most common cause of hypopituitarism; however, immune-modulating therapy for metastatic melanoma is an increasingly recognised cause of autoimmune hypophysitis, particularly in Australia.
  • Treatment involves adequate replacement of deficient hormones and long-term monitoring to prevent associated complications and improve quality of life.
  • Ongoing education of the patient and their family, as well as clinical practitioners, forms a crucial component of management. Education includes glucocorticoid replacement therapy, appropriate sick-day management, how to administer intramuscular hydrocortisone, when to present to the emergency department, and the importance of wearing a MedicAlert or equivalent identification at all times.

    Picture credit: © Phototake/Diomedia.com

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