Endocrine Abstracts

Objective: Hypopituitarism is a rare disease,a pituitary adenoma and is treatment being the most common cause of it. In recent years there is increased reporting of rare causes of hypopituitarism acquired in adulthood, such as other sellar and parasellar masses, brain damage caused by radiation and traumatic brain injury (TBI), vascular lesions, infiltrative/immunological/inflammatory diseases and infectious diseases. Aim of our study was to increase the awareness to these rare causes of hypopituitarism.

Patiens and methods: We performed a cross-sectional database study in our population investigating the etiology of hypopituitarism in 558 patients in a tertiary care institution recorded for the last 11 years. We excluded the patients with pituitary adenomas and congenital hypopituitarism. Sixty-eight patients (32 male, 36 female) were included in the study (mean age 37.3±2.0 years, range 16–72 years).

Results: According to the causes of hypopituitarism the patients were divided in several groups: nonpituitary sellar and parasellar masses in 10 patients (pituicytoma n=1, chordoma n=2, metastasis n=3, intravascular lymphoma n=1, Langerhans cell histiocytosis n=3), brain damage in 27 patients (TBI in 9 patients and cranial irradiation in 18 patients), vascular causes in 17 patients (aneurysm n=1, apoplexy n=3, Sheehan’s syndrome n=6, subarachnoid hemorrhage n=6, glomangioma n=1), immunological/infiltrative/inflammatory disease in 7 patients (primary hypophysitis n=6, secondary hypophysitis n=1) and pituitary infections in 7 patients (viral hypophysitis-hemorrhagic fever with renal syndrome, tuberculosis). Growth hormone and ACTH deficiencies were the most common hormonal deficits (57/68, 84%), followed by FSH/LH deficiency (52/68, 76%), TSH deficiency (49/68, 72%) and ADH deficiency (8/68, 12%). Ten patients (14.7%) had isolated pituitary hormone deficiency, 13 patients (19.2%) had 2–3 pituitary hormone deficiencies and 4 pituitary hormone deficiencies were present in 45 patients (66.1%).

Conclusion: A high index of suspicion is required for diagnosing rare causes of hypopituitarism. The symptoms and signs of hypopituitarism are usually nonspecific and the recognition of these patients remains the challenge.