An Update on Advances in Hypopituitarism: Etiology, Diagnosis, and Current Management

Abstract

This article provides an updated review of hypopituitarism (HP), an endocrine disorder characterized by a deficiency of one or more pituitary hormones. The various etiologies are reviewed, including pituitary neuroendocrine tumors (PitNETs), hypothalamic lesions, genetic mutations, and acquired factors such as head trauma, medications, neoplasms, and infiltrative diseases. It is noted that PitNETs are responsible for approximately half of the cases in adults, whereas in children the causes are predominantly congenital. Diagnosis is based on clinical evaluation and hormonal testing, with identification of the specific hormonal deficiencies essential for effective treatment. Laboratory tests present challenges and limitations that must be understood and addressed. Hormone replacement therapy is the mainstay of treatment, significantly improving patients' quality of life. It is important to know the possible interactions between hormone replacement therapies in HP. Recent advances in understanding the pathophysiology of HP and the importance of a multidisciplinary approach to the management of associated complications are discussed. This article emphasizes the need for comprehensive evaluation and continuous follow-up to optimize outcomes in patients with HP and highlights the importance of ongoing research to improve diagnostic and treatment strategies.

Keywords: corticotropin; diagnosis and treatment; gonadotropins; growth hormone; hormone replacement therapy; hypopituitarism; prolactin; thyrotropin.

Figure 1

Diagram showing the main etiologies of hypopituitarism.

Figure 2

Percentage distribution of the different histologic types of pituitary neuroendocrine tumors (PitNETs) associated with hypopituitarism (adapted from ref. [4]).

Figure 3

Pre-analytical, analytical, and post-analytical phases in hormonal evaluation.