eMedicine Specialties > Pediatrics: General Medicine > Endocrinology

Panhypopituitarism: Follow-up

Author: Robert P Hoffman, MD, Associate Professor of Pediatrics, Department of Pediatrics, Ohio State University College of Medicine
Contributor Information and Disclosures

Updated: Oct 21, 2009

Follow-up

Further Outpatient Care

  • Patients with hypopituitarism need close, ongoing, and regular follow-up by a pediatric endocrinologist.
  • Closely monitor growth and measure free T4 levels on a regular basis to assess the adequacy of T4 replacement.
  • Body size and symptoms and signs of cortisol deficiency (eg, anorexia, recurrent abdominal pain, malaise) or cortisol excess (eg, excess weight gain, Cushingoid features, hypertension) determine the adequacy of cortisol replacement.
  • Close monitoring of pubertal status is also appropriate.

Complications

  • Adrenal crisis, as mentioned, is the most acute complication that can arise in the treatment of patients with hypopituitarism and occurs when glucocorticoid replacement is not appropriately administered or, more likely, when the child develops a concurrent illness or medical treatment that increases the requirement for glucocorticoid and prevents oral replacement.
  • Growth hormone (GH) therapy is reported to cause some rare adverse effects. These include benign intracranial hypertension and slipped capital femoral epiphyses. Treatment also increases insulin resistance and, therefore, possibly increases the risk of diabetes. Although questions have been raised about malignancy, most data show little or no risk.
  • Appropriate monitoring should minimize any risks from thyroid or sex steroid treatment.

Patient Education

  • Educate parents about the dangers of adrenal insufficiency when the child is unable to take oral medication. Instruct parents to rapidly seek medical care. Many families can intramuscularly administer hydrocortisone at home if the child is unable to take oral medications. The home dose is generally 25 mg in children younger than 2 years, 50 mg in children younger than 5 years, and 100 mg in all other children. If children require intramuscular medication, they should be brought to the emergency department. If the family is unable to administer the intramuscular injection, they can take the parenteral hydrocortisone with them to the emergency department to avoid delays in administering appropriate treatment.32
  • Parents also need to be taught home stress coverage with doubling the dose of glucocorticoid for less serious illnesses, such as fever greater than 38°C.
  • For excellent patient education resources, visit eMedicine's Endocrine System Center and Growth Hormone Deficiency Center. Also, see eMedicine's patient education articles Hypopituitarism in Children, Growth Hormone Deficiency in Children, Growth Failure in Children, and Understanding Growth Hormone Deficiency Medications.

Miscellaneous

Medicolegal Pitfalls

  • The major error that can be made is the failure to adequately evaluate all parts of anterior pituitary function. Of primary importance in this area is the failure to establish adequacy of cortisol function in a child with secondary hypothyroidism prior to T4 replacement. T4 replacement increases cortisol degradation and leads to adrenal crisis in a child with limited adrenocorticotropic hormone (ACTH) reserve.
 


More on Panhypopituitarism

Overview: Panhypopituitarism
Differential Diagnoses & Workup: Panhypopituitarism
Treatment & Medication: Panhypopituitarism
Follow-up: Panhypopituitarism
Multimedia: Panhypopituitarism
References
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References

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Further Reading

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Keywords

panhypopituitarism, pituitary gland, inadequate anterior pituitary hormone production, absent anterior pituitary hormone production, congenital anterior hypopituitarism, micropenis, hypoglycemia, poor growth, short stature, delayed puberty, interrupted puberty

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Contributor Information and Disclosures

Author

Robert P Hoffman, MD, Associate Professor of Pediatrics, Department of Pediatrics, Ohio State University College of Medicine
Robert P Hoffman, MD is a member of the following medical societies: American Diabetes Association, American Pediatric Society, Christian Medical & Dental Society, Endocrine Society, and Lawson-Wilkins Pediatric Endocrine Society
Disclosure: Nothing to disclose.

Medical Editor

Thomas A Wilson, MD, Professor of Clinical Pediatrics, Department of Pediatrics; Director of Pediatric Endocrinology, Division of Pediatric Endocrinology, Department of Pediatrics, State University of New York at Stony Brook
Thomas A Wilson, MD is a member of the following medical societies: Endocrine Society, Lawson-Wilkins Pediatric Endocrine Society, and Phi Beta Kappa
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

Lynne Lipton Levitsky, MD, Chief, Pediatric Endocrine Unit, Massachusetts General Hospital; Associate Professor, Department of Pediatrics, Harvard University Medical School
Lynne Lipton Levitsky, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Pediatrics, American Diabetes Association, American Pediatric Society, Endocrine Society, Lawson-Wilkins Pediatric Endocrine Society, and Society for Pediatric Research
Disclosure: Pfizer Grant/research funds P.I.; Tercica Grant/research funds PI, also occasional consultant

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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