endocrine and metabolic disorders
Generalized Hypopituitarism
Treatment of Generalized Hypopituitarism
Hormone replacement Treatment of cause (eg, tumor) Treatment is replacement of the hormones of the hypofunctioning target glands, as discussed in the pertinent chapters in this section and elsewhere in THE MANUAL. Treatment of adults with GH deficiency is begun with a low, once daily dose of GH (0.3 mg subcutaneously for women, 0.2 mg for men, and 0.1 mg for older patients) and titrated to achieve a mid-normal serum IGF-I level. Benefits of treatment include improved energy and quality of life, improved lipid profile, decreased cardiovascular risk factors, increased body muscle mass, and decreased body fat mass. In men with panhypopituitarism treated with GH, mortality decreases to rates for age-matched individuals without hypopituitarism. In women with panhypopituitarism treated with GH, mortality declines but does not reach normal levels. In pituitary apoplexy, immediate surgery is warranted if visual field disturbances or oculomotor palsies develop suddenly or if somnolence progresses to coma because of hypothalamic compression. Although management with high-dose corticosteroids and general support may suffice in a few cases, transsphenoidal decompression of the tumor should generally be undertaken promptly. In patients who have had surgery or radiation therapy to treat a pituitary tumor, treatment may be followed by the loss of other pituitary hormone functions. Patients treated with radiation may lose endocrine function slowly over years. Therefore, posttreatment hormonal status should be evaluated frequently, preferably at 3 and 6 months and yearly thereafter for at least 10 years and preferably up to 15 years after radiation therapy. Such evaluation should include at least assessment of thyroid and adrenal function. Patients may also develop visual difficulties related to fibrosis of the optic chiasm. Sellar imaging and visual field assessment should be done at least every 2 years initially for about 10 years, particularly if residual tumor tissue is present. 