Hypopituitarism natural history, complications and prognosis
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Ahmed Elsaiey, MBBCH [2]
Overview
The natural history of hypopituitarism depends on the different clinical manifestations. If hypogonadism is left untreated, it will lead to decrease bone density and osteoporosis. Vasopressin deficiency will end up to dehydration and electrolyte imbalance. Complications of hypopituitarism include adrenal crisis, pseudotumor cerebri, and diabetes mellitus. Hypopituitarism has a good prognosis as long as the hormonal replacement therapy is given adequately.
Natural History
Hypopituitarism develops different symptoms according to the affected part of the pituitary gland and the deficient hormone. Leaving hypopituitarism without treatment can lead to critical consequences. The natural history depends on the different manifestations of the disease as the following:[1]
- Hypogonadism:
- In both genders, if left untreated, it will lead to decrease bone density and osteoporosis.[2][3][4]
- In women, there may be an increase risk of coronary artery disease due to depletion of the estrogen level in women.[5][6]
- In men, decrease muscle mass due to depletion of the testosterone hormone levels.
- Vasopressin deficiency: It will end up to dehydration and electrolyte abnormalities like hypernatremia.
- Growth hormone deficiency: It may lead to serious vascular conditions most likely due to increased serum cholesterol and triglyceride concentrations causing increased mortality.[7][8][9]
Complications
Complications that can develop as a result of hypopituitarism are:
- Adrenal crisis, the most serious complication of hypopituitarism. It occurs in case of improper glucocorticoids replacement therapy.
- Osteoporosis
- Electrolyte abnormalities such as hypernatremia
- Diabetes insipidus
- Complications of growth hormone replacement therapy:[10]
- Pseudotumor cerebri
- Benign intracranial hypertension.
- Slipped capital femoral epiphyses.
- Diabetes mellitus due to insulin resistance.
Prognosis
- Hypopituitarism prognosis is controversial as it depends on the treatment therapies.
- It has a good prognosis as long as the hormonal replacement therapy is performed properly.[1]
- Hypopituitarism is often associated with vascular conditions and has a high mortality rate.[11]
- There are 6 major retrospective studies done that have shown increased mortality in patients with hypopituitarism[7][12][13][14][15]
References
- ↑ 1.0 1.1 Vance, Mary Lee (1994). "Hypopituitarism". New England Journal of Medicine. 330 (23): 1651–1662. doi:10.1056/NEJM199406093302306. ISSN 0028-4793.
- ↑ Klibanski, Anne; Neer, Robert M.; Beitins, Inese Z.; Ridgway, E. Chester; Zervas, Nicholas T.; McArthur, Janet W. (1980). "Decreased Bone Density in Hyperprolactinemic Women". New England Journal of Medicine. 303 (26): 1511–1514. doi:10.1056/NEJM198012253032605. ISSN 0028-4793.
- ↑ Greenspan SL, Oppenheim DS, Klibanski A (1989). "Importance of gonadal steroids to bone mass in men with hyperprolactinemic hypogonadism". Ann. Intern. Med. 110 (7): 526–31. PMID 2923387.
- ↑ Klibanski A, Neer RM, Beitins IZ, Ridgway EC, Zervas NT, McArthur JW (1980). "Decreased bone density in hyperprolactinemic women". N. Engl. J. Med. 303 (26): 1511–4. doi:10.1056/NEJM198012253032605. PMID 7432421.
- ↑ Matthews, Karen A.; Meilahn, Elaine; Kuller, Lewis H.; Kelsey, Sheryl F.; Caggiula, Arlene W.; Wing, Rena R. (1989). "Menopause and Risk Factors for Coronary Heart Disease". New England Journal of Medicine. 321 (10): 641–646. doi:10.1056/NEJM198909073211004. ISSN 0028-4793.
- ↑ Matthews KA, Meilahn E, Kuller LH, Kelsey SF, Caggiula AW, Wing RR (1989). "Menopause and risk factors for coronary heart disease". N. Engl. J. Med. 321 (10): 641–6. doi:10.1056/NEJM198909073211004. PMID 2488072.
- ↑ 7.0 7.1 Rosén T, Bengtsson BA (1990). "Premature mortality due to cardiovascular disease in hypopituitarism". Lancet. 336 (8710): 285–8. PMID 1973979.
- ↑ Merimee TJ, Hollander W, Fineberg SE (1972). "Studies of hyperlipidemia in the HGH-deficient state". Metab. Clin. Exp. 21 (11): 1053–61. PMID 4342932.
- ↑ Blackett PR, Weech PK, McConathy WJ, Fesmire JD (1982). "Growth hormone in the regulation of hyperlipidemia". Metab. Clin. Exp. 31 (2): 117–20. PMID 6804746.
- ↑ Bowlby DA, Rapaport R (2004). "Safety and efficacy of growth hormone therapy in childhood". Pediatr Endocrinol Rev. 2 Suppl 1: 68–77. PMID 16456485.
- ↑ Prabhakar VK, Shalet SM (2006). "Aetiology, diagnosis, and management of hypopituitarism in adult life". Postgrad Med J. 82 (966): 259–66. doi:10.1136/pgmj.2005.039768. PMC 2585697. PMID 16597813.
- ↑ Bates AS, Van't Hoff W, Jones PJ, Clayton RN (1996). "The effect of hypopituitarism on life expectancy". J. Clin. Endocrinol. Metab. 81 (3): 1169–72. doi:10.1210/jcem.81.3.8772595. PMID 8772595.
- ↑ Bülow B, Hagmar L, Mikoczy Z, Nordström CH, Erfurth EM (1997). "Increased cerebrovascular mortality in patients with hypopituitarism". Clin. Endocrinol. (Oxf). 46 (1): 75–81. PMID 9059561.
- ↑ Nilsson B, Gustavasson-Kadaka E, Bengtsson BA, Jonsson B (2000). "Pituitary adenomas in Sweden between 1958 and 1991: incidence, survival, and mortality". J. Clin. Endocrinol. Metab. 85 (4): 1420–5. doi:10.1210/jcem.85.4.6498. PMID 10770176.
- ↑ Tomlinson JW, Holden N, Hills RK, Wheatley K, Clayton RN, Bates AS, Sheppard MC, Stewart PM (2001). "Association between premature mortality and hypopituitarism. West Midlands Prospective Hypopituitary Study Group". Lancet. 357 (9254): 425–31. PMID 11273062.