Pediatric Hypopituitarism Treatment & Management

  • Author: Joel W Steelman, MD; Chief Editor: Stephen Kemp, MD, PhD   more...
 
Updated: Jul 14, 2011
 

Approach Considerations

Treatment for hypopituitarism primarily involves appropriate hormone replacement.[27] The presence of 1 or more hormone deficiencies determines medication choice. Conduct appropriate stress dosing of corticosteroid replacement. Surgical intervention can be employed in tumor-associated hypopituitarism, with the tumor location and type dictating the choice of surgical procedure. Diet and activity are unrestricted in patients with hypopituitarism.

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Consultations

Consultations are dependent on the etiology of hypopituitarism. Some of the consultants that may be involved in the care of patients with hypopituitarism come from the following specialties:

  • Ophthalmology - Optic nerve hypoplasia, septo-optic dysplasia, pituitary tumors
  • Neurology - Septo-optic dysplasia, holoprosencephaly, traumatic brain injury, pituitary tumors or other CNS tumors
  • Genetics - Congenital hypopituitarism, septo-optic dysplasia, holoprosencephaly
  • Oncology - CNS tumors (including pituitary tumors), other malignancies
  • Rehabilitation medicine
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Long-Term Monitoring

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 and insulinlike growth factor binding protein-3 (IGFBP3) levels at least annually. Also, consider monitoring for impaired glucose tolerance with a fasting morning blood sugar or hemoglobin A1c (HgbA1c), particularly in the patient with risk factors for diabetes mellitus (eg, family history, obesity).

Monitor thyroid functions routinely in hypopituitarism (FT4) or as part of scheduled monitoring in isolated GHD, when appropriate. Consider repeat low-dose ACTH stimulation testing in high-risk patients or if clinical symptoms of cortisol deficiency are apparent.

Home blood glucose monitoring to screen for hypoglycemia in very young patients and/or patients with central adrenal insufficiency should be strongly considered. In those patients with hypopituitarism that includes adrenal insufficiency, a medical alert bracelet should be worn, alerting first-responders of the patient’s need for stress hydrocortisone therapy.

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Proceed to Medication
 
 
Contributor Information and Disclosures
Author

Joel W Steelman, MD  Endocrine Consultant, Division of Endocrinology and Diabetes, Cook Children's Medical Center

Joel W Steelman, MD is a member of the following medical societies: American Academy of Pediatrics, American Association of Clinical Endocrinologists, American Society for Bone and Mineral Research, Endocrine Society, and Pediatric Endocrine Society

Disclosure: Pfizer Honoraria Speaking and teaching

Specialty Editor Board

Phyllis W Speiser, MD  Chief, Division of Pediatric Endocrinology, Steven and Alexandra Cohen Children's Medical Center of New York; Professor of Pediatrics, Hofstra-North Shore LIJ School of Medicine at Hofstra University

Phyllis W Speiser, MD is a member of the following medical societies: American Association of Clinical Endocrinologists, Endocrine Society, Pediatric Endocrine Society, and Society for Pediatric Research

Disclosure: Nothing to disclose.

Mary L Windle, PharmD  Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

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; UNESCO Chair on Adolescent Health Care, University of Athens, 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, Pediatric Endocrine Society, and Society for Pediatric Research

Disclosure: Nothing to disclose.

Chief Editor

Stephen Kemp, MD, PhD  Professor, Department of Pediatrics, Section of Pediatric Endocrinology, University of Arkansas for Medical Sciences College of Medicine, 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: Nothing to disclose.

Acknowledgments

I want to thank Simon Rhodes, PhD and Stephen Shalet, MD for kindly allowing me to republish illustrations from their work.

References

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The left photograph shows an untreated 21-month-old girl with congenital hypopituitarism. The right panel depicts the same child aged 29 months, following 8 months of growth hormone therapy.
Regulation of the development of the mammalian anterior pituitary gland by transcription factors. Following, inductive signals between the developing diencephalon and the oral ectoderm, early transcription factors guide the formation of rudimentary Rathke's Pouch (rRP) and then subsequent gene regulatory pathways control the determination, proliferation, and differentiation events that establish the specialized hormone-secreting cells. AP = anterior pituitary, IP = intermediate pituitary, PP = posterior pituitary. Modified by S. Rhodes from Mullen, R.D., Colvin, S.C., Hunter, C.H., Savage, J.J., Walvoord, E.C., Bhangoo, A.P.S., Ten, T., Weigel, J., Pfäffle, R.W., and Rhodes, S.J. (2007). Roles of the LHX3 and LHX4 LIM-homeodomain factors in pituitary development. Mol. Cell. Endocrinol., 265-266: 190-195.
Summary of Neuroendocrine Dysfunction following radiotherapy (courtesy of Stephen M Shalet, MD)
 
 
 
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