Hypopituitarism natural history, complications and prognosis

The natural history of hypopituitarism depends on the severity of damage leading to partial or complete hormonal deficiency. If left untreated, hypopituitarism can lead to critical consequences. Complications of hypopituitarism include adrenal crisis, osteoporosis, electrolyte abnormalities, and diabetes mellitus. Hypopituitarism is often associated with vascular conditions. Hypopituitarism has a good prognosis as long as the hormonal replacement therapy is given adequately.

If left untreated, hypopituitarism may lead to the development of different symptoms according to the area/lobe of the pituitary gland affected and the deficient hormone. The natural history is variable and depends upon the severity of damage leading to partial or complete hormonal deficiency, age, rapidity of onset, and the underlying cause:^[1]

Hypogonadism

• In both genders, if left untreated, it will lead to a decrease in bone density and osteoporosis.^[2][3][4]
• In women, there may be an increased risk of coronary artery disease due to a reduction estrogen levels.^[5][6]
• In men, decreased muscle mass due to a reduction in testosterone hormone levels.

Vasopressin deficiency

• It may lead to dehydration and electrolyte abnormalities such as hypernatremia.

Growth hormone deficiency

• It may lead to serious vascular conditions most likely due to increased serum cholesterol and triglyceride concentrations causing increased mortality.^[7][8][9]

Complications that can develop as a result of hypopituitarism are include:

• Adrenal crisis, the most serious complication of hypopituitarism. It occurs in case of improper glucocorticoids replacement therapy.

• Osteoporosis
• Electrolyte abnormalities such as hypernatremia
• Diabetes insipidus
• Metabolic syndrome

• Complications of growth hormone replacement therapy:^[10]
  • Pseudotumor cerebri
  • Benign intracranial hypertension.
  • Slipped capital femoral epiphyses.
  • Diabetes mellitus due to insulin resistance.

• Hypopituitarism has a good prognosis as long as the patient is given optimum hormonal replacement therapy.^[1]
• Hypopituitarism is often associated with vascular conditions and has a high mortality rate.^[11]
• There are 6 major retrospective studies done that have shown increased mortality in patients with hypopituitarism.^{[7][12][13][14][15]}

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