Understanding hypopituitarism

The pituitary gland releases hormones, which regulate growth, metabolism, reproduction and homeostasis. Hypopituitarism is diagnosed when there is impaired secretion of one or more of these hormones. Depending on the severity and number of hormone deficiencies present, the clinical features of hypopituitarism can vary considerably. Infants with multiple pituitary hormone abnormalities are frequently unwell in the neonatal period whereas children with isolated growth hormone deficiency tend to present later in childhood with growth failure.Children with clinical features suggestive of a diagnosis of hypopituitarism should undergo further investigations. The diagnosis is based on a combination of the following; clinical history and examination, baseline biochemical investigations, provocative testing of the hypothalamo-pituitary axis, genetic investigations and magnetic resonance imaging (MRI). All children being investigated for possible hypopituitarism should be under the care of a paediatrician or a paediatric endocrinologist. Baseline biochemical investigations vary according to the age of the child. Detailed pituitary function tests (e.g. GH stimulation tests, water deprivation test) should be performed in a centre with expertise in endocrinology where these tests are performed regularly. This review outlines the pathophysiology, clinical presentation, diagnosis and management of hypopituitarism.