ABSTRACT

This chapter summarizes management of pituitary insufficiency, from a clinically practical point of view. It examines the importance of an individualized approach for each of the hormones to be replaced, together with the importance of considering different phases of the patient’s life in the overall management of patients with hypopituitarism. Hypopituitarism occurs when the pituitary gland is unable to produce its hormones, either due to a disease in the pituitary or due to inadequate stimulation of the pituitary from the hypothalamus. Patients with hypo-thalamic pituitary disease may develop anterior pituitary hormone deficiency due to the underlying disease or its treatment. The initial clinical presentation varies considerably due to the numerous underlying causes of hypopituitarism, the speed at which the pituitary insufficiency develops, and what hormones are lost. Thyroid-stimulating hormone deficiency or central hypothyroidism is considered to occur late in the development of hypopituitarism, in particular when the underlying lesion is a pituitary tumor or due to radiotherapy.