Nav: Home

Endocrine Society experts issue clinical practice guideline on hypopituitarism

October 13, 2016

Washington, DC--The Endocrine Society today issued a Clinical Practice Guideline that recommends treating insufficient hormone levels in individuals with hypopituitarism by replacing hormones at levels as close to the body's natural patterns as possible.

The guideline, titled "Hormonal Replacement in Hypopituitarism in Adults: An Endocrine Society Clinical Practice Guideline," was published online and will appear in the November 2016 print issue of The Journal of Clinical Endocrinology & Metabolism (JCEM), a publication of the Endocrine Society.

Hypopituitarism, or pituitary insufficiency, occurs when the pituitary gland does not produce sufficient amounts of hormones--the chemical signals that regulate respiration, reproduction, growth, metabolism, sexual function and other important biological functions. The pituitary gland is often called the master gland because the hormones it produces impact many bodily functions. As a result, hypopituitarism can cause a range of symptoms, according to the Hormone Health Network.

The rare disorder can occur due to abnormal development or later in life as a result of a tumor, traumatic brain injury, hemorrhage or autoimmune condition, according to the Society's Endocrine Facts and Figures Report. Hypopituitarism affects about 45 people in every 100,000, according to the guideline.

"Hypopituitarism can manifest as low levels of a variety of hormones, including cortisol, thyroid hormone, estrogen, testosterone and growth hormone," said Maria Fleseriu, MD, FACE, of Oregon Health & Science University in Portland, OR. Fleseriu chaired the task force that developed the guideline. "The goal of treatment should be to restore hormone levels as close to healthy levels as possible The interactions between these hormones also are very important, and patients might require dose changes of one or more of the replacement hormones after starting or discontinuing another one."

In recommending treatment options, the guideline task force followed the overriding principle of using hormone replacement therapy dose size and timing to mimic the body's natural functioning as closely as possible.

Accurate and reliable measurements of hormones play a central role in diagnosing hypopituitarism and monitoring the effectiveness of treatments, Fleseriu said. Healthcare providers need to keep in mind technical considerations to ensure the testing procedure is as accurate as possible.

The guideline addresses special circumstances that may affect the treatment of patients with hypopituitarism, including pregnancy care, post-surgical care following pituitary or other operations, treatment in combination with anti-epilepsy medication, and care following pituitary apoplexy--a serious condition that occurs when there is bleeding into the gland or blood flow to it is blocked.

Recommendations from the guideline include:

  • Measurements of both free thyroxine and thyroid-stimulating hormone are needed to evaluate central hypothyroidism, a condition where the thyroid gland does not produce enough hormones because it isn't stimulated by the pituitary gland.

  • People who have central hypothyroidism should be treated with levothyroxine in doses sufficient to raise levels of the thyroid hormone free thyroxine to the upper half of the reference range.

  • Growth hormone stimulation testing should be used to diagnose patients with suspected growth hormone deficiency.

  • People who have proven cases of growth hormone deficiency and no contraindications should be offered growth hormone replacement as a treatment option.

  • Premenopausal women who have central hypogonadism, a condition where the sex glands produce minimal amounts or no hormones, can undergo hormone treatment, provided there are no contraindications.

  • People producing abnormally large volumes of dilute urine should be tested for central diabetes insipidus--a rare condition that leads to frequent urination--by analyzing the concentration of their blood and urine.

  • For patients who have low levels of glucocorticoid hormones, hydrocortisone can be given in a daily single or divided dose.

  • All hypopituitarism patients should be instructed to obtain an emergency card, bracelet or necklace warning about the possibility of adrenal insufficiency.

  • Patients who are suspected of having an adrenal crisis due to secondary adrenal insufficiency should receive an immediate injection of 50 to 100 milligrams of hydrocortisone.

  • People who have central adrenal insufficiency should receive the lowest tolerable dose of hydrocortisone replacement on a long-term basis to reduce the risk of metabolic and cardiovascular disease.

The Hormone Health Network offers resources on hypopituitarism at http://www.hormone.org/diseases-and-conditions/pituitary/hypopituitarism.

Other members of the Endocrine Society task force that developed this guideline include: Ibrahim A. Hashim of UT Southwestern Medical Center in Dallas, TX; Niki Karavitaki of the University of Birmingham and Birmingham Health Partners in Birmingham, U.K.; Shlomo Melmed of Cedars-Sinai Medical Center in Los Angeles, CA; M. Hassan Murad of the Mayo Clinic in Rochester, MN; Roberto Salvatori of Johns Hopkins University School of Medicine in Baltimore, MD; and Mary H. Samuels of Oregon Health & Science University in Portland, OR.

The Society established the Clinical Practice Guideline Program to provide endocrinologists and other clinicians with evidence-based recommendations in the diagnosis, treatment, and management of endocrine-related conditions. Each guideline is created by a task force of topic-related experts in the field. Task forces rely on evidence-based reviews of the literature in the development of guideline recommendations. The Endocrine Society does not solicit or accept corporate support for its guidelines. All Clinical Practice Guidelines are supported entirely by Society funds.

The Clinical Practice Guideline was co-sponsored by the American Association for Clinical Chemistry, The Pituitary Society and the European Society of Endocrinology.

The guideline will be published online at http://press.endocrine.org/doi/10.1210/jc.2016-2118, ahead of print.
-end-
Endocrinologists are at the core of solving the most pressing health problems of our time, from diabetes and obesity to infertility, bone health, and hormone-related cancers. The Endocrine Society is the world's oldest and largest organization of scientists devoted to hormone research and physicians who care for people with hormone-related conditions.

The Society, which is celebrating its centennial in 2016, has more than 18,000 members, including scientists, physicians, educators, nurses and students in 122 countries. To learn more about the Society and the field of endocrinology, visit our site at http://www.endocrine.org. Follow us on Twitter at @TheEndoSociety and @EndoMedia.

The Endocrine Society

Related Growth Hormone Articles:

FASEB Science Research Conference: Growth Hormone/Prolactin
This SRC will bring together international scientists from academia and industry for lively discussions on the latest developments in the growth hormone (GH)/prolactin (PRL) family of hormones and their clinical applications.
Low thyroid hormone before birth alters growth and development of fetal pancreas
Levels of thyroid hormone in babies influences insulin-secreting cells of the pancreas, according to a new study published in The Journal of Physiology.
When should doctors treat short children and teens with growth hormone?
When is it appropriate to treat short children with growth hormone?
Still no strong evidence that adjunctive treatment with human growth hormone in IVF improves results
Despite its occasional use as an adjunct in IVF, human growth hormone appears of little benefit to women having difficulty conceiving.
Aromatase inhibitors plus growth hormone may help short adolescent boys grow taller
Aromatase inhibitors, when used for up to three years in combination with growth hormone, may effectively and safely help very short adolescent boys grow taller, new research suggests.
Northern climes make a difference with growth hormone treatment
The rate of growth in children varies with the season while higher latitude and greater summer daylight exposure makes a significant difference in results for children treated with growth hormone, according to new research from the University of Manchester.
Growth hormone reduces risk of osteoporosis fractures in older women
For years after it was administered, growth hormone continued to reduce the risk of fractures and helped maintain bone density in postmenopausal women who had osteoporosis, according to a new study published in the Endocrine Society's Journal of Clinical Endocrinology & Metabolism.
Short boys are 2 to 3 times as likely as short girls to receive growth hormone
Short boys are three times more likely than short girls to receive recombinant human growth hormone treatment for idiopathic short stature (ISS), even though in a general pediatric population, equal proportions of both genders fall under the height threshold designating ISS.
Mark Cuban Foundation aids U-M research on growth hormone's impact on ACL recovery
Funding from the Mark Cuban Foundation, run by the well-known owner of the Dallas Mavericks, will allow University of Michigan researchers to study how human growth hormone may aid recovery from an ACL tear.
Marketing, prescribing testosterone and growth hormone for aging is disease mongering
The marketing, prescribing and selling of testosterone and growth hormone as panaceas for aging-associated problems is disease mongering.

Related Growth Hormone Reading:

Best Science Podcasts 2019

We have hand picked the best science podcasts for 2019. Sit back and enjoy new science podcasts updated daily from your favorite science news services and scientists.
Now Playing: TED Radio Hour

Anthropomorphic
Do animals grieve? Do they have language or consciousness? For a long time, scientists resisted the urge to look for human qualities in animals. This hour, TED speakers explore how that is changing. Guests include biological anthropologist Barbara King, dolphin researcher Denise Herzing, primatologist Frans de Waal, and ecologist Carl Safina.
Now Playing: Science for the People

#SB2 2019 Science Birthday Minisode: Mary Golda Ross
Our second annual Science Birthday is here, and this year we celebrate the wonderful Mary Golda Ross, born 9 August 1908. She died in 2008 at age 99, but left a lasting mark on the science of rocketry and space exploration as an early woman in engineering, and one of the first Native Americans in engineering. Join Rachelle and Bethany for this very special birthday minisode celebrating Mary and her achievements. Thanks to our Patreons who make this show possible! Read more about Mary G. Ross: Interview with Mary Ross on Lash Publications International, by Laurel Sheppard Meet Mary Golda...