eMedicine Specialties > Pediatrics: General Medicine > Endocrinology

Hypopituitarism: Follow-up

Author: Lawrence A Wetterau, MD, Assistant Professor, Section of Endocrinology, Children's Hospital Central California
Contributor Information and Disclosures

Updated: May 5, 2009

Follow-up

Further Outpatient Care

  • Routinely monitor growth and development at 3-month intervals in patients with hypopituitarism.
  • If a patient is receiving recombinant human growth hormone (rhGH) therapy, monitor for adverse effects and monitor insulinlike growth factor (IGF)-I levels at least annually. Also, consider obtaining periodic hemoglobin A1c (HgbA1c), particularly in the patient with risk factors (eg, family history, obesity) for diabetes mellitus.
  • Monitor low free thyroxine (FT4), when appropriate.
  • When relevant, monitor blood sugar to ensure euglycemia; the condition may or may not require intravenous dextrose.

Inpatient & Outpatient Medications

  • The presence of one or more hormone deficiencies determines medication choice (see Medication).

Deterrence/Prevention

  • Genetic counseling with parents and patients about the mode of transmission is important for cases involving heritable forms of hypopituitarism.

Complications

  • Sequelae from episodes of severe hypoglycemia, hypernatremia, or adrenal crises are among potential complications. Long-term complications include short stature and infertility.

Prognosis

  • With appropriate treatment, overall prognosis is very good. Previous findings of increased cardiovascular morbidity and decreased life expectancy in adults with hypopituitarism were thought to be largely secondary to untreated growth hormone deficiency (GHD).

Patient Education

Miscellaneous

Medicolegal Pitfalls

  • Any patient with hypopituitarism must have an MRI examination to exclude a brain tumor.
  • Close monitoring is mandatory for patients receiving recombinant human growth hormone (rhGH) therapy to identify possible adverse effects.

Special Concerns

  • Conduct appropriate stress dosing of corticosteroid replacement.
 


More on Hypopituitarism

Overview: Hypopituitarism
Differential Diagnoses & Workup: Hypopituitarism
Treatment & Medication: Hypopituitarism
Follow-up: Hypopituitarism
Multimedia: Hypopituitarism
References
Further Reading
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Keywords

hypopituitarism, growth hormone deficiency, GHD, multiple pituitary hormone deficiency, MPHD, pituitary hypothalamus, hypoglycemia, short stature, jaundice, hyponatremia, sepsis, microgenitalia, growth failure, diabetes insipidus, gonadotropin deficiency, cold intolerance, constipation, micropenis, obesity, craniofacial abnormalities, Kallmann syndrome, KS, septo-optic dysplasia, anencephaly, holoprosencephaly, Pallister-Hall syndrome, histiocytosis, tuberculosis, tuberculosis, sarcoidosis, lymphocytic hypophysitis, hemochromatosis, craniopharyngioma, germinoma, glioma, astrocytoma, pituitary adenoma, treatment, diagnosis

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Contributor Information and Disclosures

Author

Lawrence A Wetterau, MD, Assistant Professor, Section of Endocrinology, Children's Hospital Central California
Lawrence A Wetterau, MD is a member of the following medical societies: American Academy of Pediatrics, Endocrine Society, and Lawson-Wilkins Pediatric Endocrine Society
Disclosure: Nothing to disclose.

Medical Editor

Phyllis W Speiser, MD, Chief of Pediatric Endocrinology, Schneider Children's Hospital; Professor of Pediatrics, New York University School of Medicine
Phyllis W Speiser, MD is a member of the following medical societies: American Association of Clinical Endocrinologists, Endocrine Society, Lawson-Wilkins Pediatric Endocrine Society, and Society for Pediatric Research
Disclosure: Nothing to disclose.

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine
Disclosure: Pfizer Inc Stock Investment from financial planner; Avanir Pharma Stock Investment from financial planner ; WebMD Salary and stock Employment and investment from financial planner

Managing Editor

George P Chrousos, MD, FAAP, MACP, MACE, FRCP(London), Professor and Chair, First Department of Pediatrics, Athens University Medical School, Aghia Sophia Children's Hospital, Greece
George P Chrousos, MD, FAAP, MACP, MACE, FRCP(London) is a member of the following medical societies: American Academy of Pediatrics, American College of Endocrinology, American College of Physicians, American Pediatric Society, American Society for Clinical Investigation, Association of American Physicians, Endocrine Society, Lawson-Wilkins Pediatric Endocrine Society, and Society for Pediatric Research
Disclosure: Nothing to disclose.

CME Editor

Merrily P M Poth, MD, Professor, Department of Pediatrics and Neuroscience, Uniformed Services University of the Health Sciences
Merrily P M Poth, MD is a member of the following medical societies: American Academy of Pediatrics, Endocrine Society, and Lawson-Wilkins Pediatric Endocrine Society
Disclosure: Nothing to disclose.

Chief Editor

Stephen Kemp, MD, PhD, Professor, Department of Pediatrics, Section of Pediatric Endocrinology, University of Arkansas and Arkansas Children's Hospital
Stephen Kemp, MD, PhD is a member of the following medical societies: American Academy of Pediatrics, American Association of Clinical Endocrinologists, American Pediatric Society, Endocrine Society, Phi Beta Kappa, Southern Medical Association, and Southern Society for Pediatric Research
Disclosure: Genentech, Inc. Honoraria Speaking and teaching; Pfizer, Inc. Honoraria Consulting

 
 
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