Management of hypopituitarism: a perspective from the Brazilian Society of Endocrinology and Metabolism
Heraldo Mendes Garmes, César Luiz Boguszewski, Paulo Augusto Carvalho Miranda, Manoel Ricardo Alves Martins, Silvia R. Correa‐Silva, Júlio Abucham, Nina Rosa de Castro Musolino, Lúcio Vilar, Luiz Henrique Corrêa Portari, Mônica R. Gadelha, Leandro Kasuki, Luciana Ansaneli Naves, Mauro Antônio Czepielewski, Tobias Skrebsky de Almeida, Felipe Henning Gaia Duarte, Andréa Glezer, Marcello D. Bronstein
Abstract
Hypopituitarism is a disorder characterized by insufficient secretion of one or more pituitary hormones. New etiologies of hypopituitarism have been recently described, including head trauma, cerebral hemorrhage, and drug-induced hypophysitis. The investigation of patients with these new disorders, in addition to advances in diagnosis and treatment of hypopituitarism, has increased the prevalence of this condition. Pituitary hormone deficiencies can induce significant clinical changes with consequent increased morbidity and mortality rates, while hormone replacement based on current guidelines protects these patients. In this review, we will first discuss the different etiologies of hypopituitarism and then address one by one the clinical aspects, diagnostic evaluation, and therapeutic options for deficiencies of TSH, ACTH, gonadotropin, and GH. Finally, we will detail the hormonal interactions that occur during replacement of pituitary hormones.