Hypopituitarism causes

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Laboratory Findings

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Iqra Qamar M.D.[2]

Overview

Causes of hypopituitarism can be classified based upon the etiology into congenital or acquired. Common congenital causes include idiopathic, anatomic lesion in the sella turcica and CNS malformations. Common acquired causes may include pituitary macroadenoma, craniopharyngioma, surgery, radiation, traumatic brain injury, Sheehan's syndrome, apoplexy, SAH, meningitis, hypophysitis, meningioma, lymphoma, hemochromatosis and Wegner's granulomatosis. Less common causes include Peri-natal insults, genetic causes, such as Kallman syndrome, Pallister-Hall syndrome, Rieger syndrome, and pituitary hypoplasia or aplasia.

Common Causes

Causes can be classified based upon the etiology into congenital or acquired. The most common cause is a pituitary tumor. Other possible causes may include cyst or a tumor in hypothalamus or infundibulum, vascular disorders, infiltrative diseases, genetic disorders, radiation, and surgery.

Etiology Underlying cause/disease
Congeital Idiopathic
Anatomic lesion in sella turcica: Rathke's cyst
CNS malformations: septo-optic-dysplasia, Kallmann syndrome, and pituitary stalk interruption syndrome
Acquired Pituitary tumor: mainly displacing macroadenoma (non-functioning or functioning adenomas)
Posterior pituitary tumor: astrocytoma, ganglioneuroma
Metastatic: breast, lungs, colon, prostate
Peripituitary lesions: Craniopharyngioma, meningioma, chordoma, optic nerve glioma
Surgery: Transsphenoidal or transcranial surgery in the hypothalamo-pituitary region
Radiation
Systemic cancer treatment
Traumatic brain injury
Sheehan's syndrome
Pituitary apoplexy
Meningitis
Hypophysitis
Lymphoma

Less common causes:

Less common causes of hypopituitarism include:[1][2][3][4][5][6][7][8][9][10][11][12][13][14]

Causes by Organ System

Cardiovascular Congestive heart failure, arteriosclerosis, arteritis temporalis, eclampsia, intracranial cartoid branch aneurysm
Chemical/Poisoning No underlying causes
Dental No underlying causes
Dermatologic No underlying causes
Drug Side Effect Anticoagulant therapy
Ear Nose Throat No underlying causes
Endocrine Empty sella syndrome, diabetes mellitus, Sheehan's Syndrome, pituitary apoplexy
Environmental No underlying causes
Gastroenterologic No underlying causes
Genetic Hemochromatosis, Genetic mutations: GHRHR, GH1, TSHB, TRHR, TPIT, GnRHR, PC1, POMC, DAX1, CRH, KAL1, FGFR1, leptin, leptin-R, GPR54, Kisspeptin, FSHB, LHB, PROK2, PROKR2, AVP-NPII, POU1F1, PROP1, HESX1, LHX3, LHX4, SOX3, GLI2, SOX2, GLI3, PITX2
Hematologic Blood dyscrasias, sickle cell anemia
Iatrogenic Radiation, surgery
Infectious Disease Fungal, malaria, meningitis, syphillis, tuberculosis
Musculoskeletal/Orthopedic No underlying causes
Neurologic Stroke
Nutritional/Metabolic No underlying causes
Obstetric/Gynecologic Peri-natal insults
Oncologic Brain tumor, meningioma, craniopharyngioma, metastasis, optic nerve neuroma, lymphoma
Ophthalmologic No underlying causes
Overdose/Toxicity No underlying causes
Psychiatric Anorexia nervosa, bulimia nervosa
Pulmonary Sarcoidosis
Renal/Electrolyte Renal failure
Rheumatology/Immunology/Allergy Wegener's granulomatosis
Sexual No underlying causes
Trauma Head trauma
Urologic No underlying causes
Miscellaneous Infiltrative lesions (sarcoidosis, Langerhans cell histiocytosis, hypophysitis, hemochromatosis)

Causes in Alphabetical Order


Hypopituitarism Microchapters

Home

Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Hypopituitarism from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

History and Symptoms

Physical Examination

Laboratory Findings

Electrocardiogram

X Ray

CT

MRI

Ultrasound

Other Imaging Findings

Other Diagnostic Studies

Treatment

Medical Therapy

Surgery

Primary Prevention

Secondary Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Case Studies

Case #1

Hypopituitarism causes On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

American Roentgen Ray Society Images of Hypopituitarism causes

All Images
X-rays
Echo & Ultrasound
CT Images
MRI

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Hypopituitarism causes

CDC on Hypopituitarism causes

Hypopituitarism causes in the news

Blogs on Hypopituitarism causes

Directions to Hospitals Treating Hypopituitarism

Risk calculators and risk factors for Hypopituitarism causes

Etiology based on anatomical location of pathology:

Hypopituitarism can be classified based upon the anatomical location of pathology such as hypothalamus or pituitary gland.[15][16][17][18][19][20][21][22][3][10][23][9][12][24][25][26][27][8][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43]

Anatomical location Cause
Hypothalmic Mass lesions: 
Radiation : CNS and nasopharyngeal malignancies
Infections: Tuberculous meningitis
Infiltrative lesions:
Other :
Pituitary Mass lesions:
Pituitary radiation
Pituitary surgery
Infection or abscess
Infiltrative lesions:

1. Hypophysitis:

2. Hemochromatosis

InfarctionSheehan's syndrome
Apoplexy
Empty sella 
Genetic mutations

Genetic Causes

Hypopituitarism is caused by mutation in any one of the following genes.[44][45][46][47][48][49][50][51][52][53][54][55][56][57][58][59][60][61][62][63]

Isolated

hormone abnormalities

Gene Inheritance Phenotype
GH1 AR, AD Isolated GH deficiency
GHRHR AR Isolated GH deficiency
TSHB AR Isolated TSH deficiency
TRHR AR Isolated TSH deficiency
TPIT AR Isolated ACTH deficiency
GnRHR AR HH
PC1 AR ACTH deficiency, hypoglycemia, HH, obesity
POMC AR ACTH deficiency, obesity, red hair
DAX1 XL Adrenal hypoplasia congenital and HH
CRH AR CRH deficiency
KAL1 XL Kallman syndrome, renal agenesis, synkinesia
FGFR1 AD, AR Kallman syndrome, cleft lip and palate, facial dysmorphism
Leptin AR HH, obesity
Leptin-R AR HH, obesity
GPR54 AR HH
Kisspeptin AR HH
FSHB AR Primary amenorrhea, defective spermatogenesis
LHB AR Delayed puberty
PROK2 AD Kallman syndrome, severe sleep disorder, obesity
PROKR2 AD, AR Kallman syndrome
AVP-NPII AR, AD Diabetes insipidus
Combined pituitary hormone deficiency POU1F1 AR, AD GH, TSH, and prolactin deficiencies
PROP1 AR GH, TSH, LH, FSH, prolactin, and evolving ACTH deficiencies
Specific syndromes HESX1 AR, AD Septo-optic dysplasia
LHX3 AR GH, TSH, LH, FSH, prolactin deficiencies, limited neck rotation
LHX4 AD GH, TSH, ACTH deficiencies with cerebellar abnormalities
SOX3 XL Hypopituitarism and mental retardation
GLI2 AD Holoprosencephaly and multiple midline defects
SOX2 AD Anophthalmia, hypopituitarism, oesophageal atresia
GLI3 AD Pallister-Hall syndrome
PITX2 AD Rieger syndrome

References

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