Hypopituitarism: Pathology review

On your rounds, you admit 28-year-old Regina who presents with an 8-month history of depression, cold intolerance, fatigue, and reduced libido.

History revealed she delivered a healthy baby eight months ago, and that the delivery was complicated by a severe postpartum hemorrhage.

She has also been unable to breastfeed and hasn’t had her menstruation since giving birth. Physical examination is remarkable for bradycardia, weight loss, and delayed relaxation of her reflexes.

Then you see Alexander, a 58-year-old male with difficulty seeing things in his peripheral vision. He also describes a loss of sex drive, erectile dysfunction, and significant weight gain, all starting approximately two years ago.

The examination revealed moderate obesity, bilateral gynecomastia, and bitemporal hemianopsia.

Basal serum hormone measurements were performed, showing decreased T4 levels in Regina and decreased FSH, LH, and testosterone levels in Alexander.

Both people have hypopituitarism. So hypopituitarism refers to the decreased secretion of one, some, or all of the anterior pituitary hormones.

These hormones are ACTH, or adrenocorticotropic hormone; TSH, or thyroid stimulating hormone; GH, or growth hormone; FSH, or follicle-stimulating hormone; LH, or luteinizing hormone, and prolactin.

Posterior pituitary hormone deficiency can also occur, but it’s extremely rare. This part of the pituitary gland releases oxytocin and antidiuretic hormone, or ADH.

Hypopituitarism typically occurs because of an acquired or congenital issue where the hypothalamus or pituitary is injured. Now, the clinical picture of hypopituitarism depends on which hormone is missing.

First, ACTH deficiency can present with symptoms such as orthostatic hypotension and tachycardia, weakness and lethargy, especially during periods of stress, like illness or during surgery.