Pediatric Hypopituitarism Treatment & Management

Updated: Nov 02, 2015
  • Author: Romesh Khardori, MD, PhD, FACP; Chief Editor: Stephen Kemp, MD, PhD  more...
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Treatment

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 typically unrestricted in patients with hypopituitarism, but special situations do apply that can impact these areas, depending on the underlying cause of 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
  • Psychology services for neurodevelopmental and educational monitoring
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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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Diet

Special considerations may apply in dietary management for children with hypopituitarism. Children with diabetes insipidus and hypopituitarism may require close monitoring of water and fluid intake to prevent excessive fluctuations in blood sodium and osmolality.

Children with hypothalamic damage in association with their hypopituitarism may be predisposed to hypothalamic obesity, with risk for rapid weight gain with morbid obesity. This subpopulation of children with hypopituitarism require close monitoring of their daily food intake.

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