What is panhypopituitarism?
Panhypopituitarism occurs when the pituitary gland produces and secretes fewer hormones. The pituitary, or “master gland” of the body, is a small organ in the middle of the brain. It regulates and produces many hormones that are responsible for controlling growth, sexual function and development, metabolism, and body response to stress.
Examples of pituitary hormonal hormones include:
- Growth hormone (GH): helps children to grow taller and adults to optimize their fat and muscle growth. This hormone is also involved in bone development and maintenance.
- Thyroid stimulating hormone: This hormone directs the thyroid gland to produce thyroid hormone. This hormone is essential for the cognitive development of an infant, the growth in height, and the metabolic functions of the human body.
- Adrenocorticotropin (ACTH) hormone: Instructs the adrenal glands to produce cortisol, which helps regulate the body’s response to stress.
- The hormones Luteinizing Hormone (LH) (also known as Follicle Stimulating Hormone (FSH)) and Follicle Stimulating Hormone (FSH) are responsible for causing the gonads to produce sex steroids, such as testosterone and estrogen.
- Vasopressin (or anti-diuretic hormonal ADH): Controls the water balance of the body, including the kidneys.
Hypopituitarism is a condition that occurs when the hormones are reduced in production or release. Panhypopituitarism is when the hormones are reduced in production or release.
The effects of panhypopituitarism can be sudden, dramatic, or gradual.
Related: What’s the difference Between Hypopituitarism and Panhypopituitarism?
Causes of Panhypopituitarism
The hypothalamus, the area above the pituitary gland that regulates hormone release from this gland, is responsible for regulating the production of pituitary hormones. A problem with the hypothalamus, or pituitary, could cause a reduced hormone output. These problems can be caused by:
- The pituitary gland, hypothalamus, or a tumor or cyst on or near it
- Pituitary glands that are underdeveloped or poorly developed
- Birth trauma or another injury
- Infection
- Autoimmune reaction
- Hydrocephalus: Pressure on the brain
- The following are some of the most effective ways to reduce your risk.
- Radiation Treatment
Sometimes it is impossible to determine the exact cause of panhypopituitarism.
Signs and symptoms of panhypopituitarism
The symptoms of panhypopituitarism can vary greatly depending on how much hormone production has been reduced. Infants, children, and adolescents can experience symptoms such as:
- Growth slows down abnormally
- Delayed puberty
- Extreme thirst and excessive urination
- Menstruation less frequent
- Low blood sugar (hypoglycemia).
- Jaundice persisting in infants
- Cold Sensitivity
- Poor appetite
- Weight gain or loss
- Dry skin is not normal
- Dizziness or nausea Fatigue
- Males with small penis
These symptoms can be similar to other medical conditions. Consult your doctor to get a proper diagnosis.
Testing and Diagnosis for panhypopituitarism
Your doctor will ask you a series of questions about any symptoms that you have observed, assess your child’s weight gain and growth, and examine them. Additional testing and evaluations may be required if signs of panhypopituitarism are present.
- Examine the brain to determine mental state, coordination, reflexes, and muscle function
- Test your vision to see if you have lost vision or a narrowed field of view.
- The blood test, also known as venous sampling (or venous sampling), involves taking blood from the peripheral veins of the arms to look at hormone levels that originate from the pituitary in the brain.
- Use a computerized tomography scan (CT) or magnetic resonance imaging (MRI), to obtain visual images of the brain, spinal cord, and pituitary.
- The left wrist and hand X-rays are used to determine the “bone age”, another indicator of growth.
Treatment for panhypopituitarism
The treatment of hypopituitarism is dependent on the cause. Treatment aims to restore normal hormone levels in the body.
- The use of drugs to replace hormones that are not being produced can be used.
- Surgery may be required to remove a tumor if medication has not been able to reduce its size if the tumor is pressing on the optic nerve, surrounding brain tissue, or both. The surgeon can reach the tumor by making an incision on the top lip, bottom of the nose, or through the skull.
- Radiation therapy can be used to stop tumor growth or kill cancer cells. Radiation treatment for a pituitary tumor must be precisely targeted to avoid damaging nearby brain tissue.
Outlook
Hormone replacement therapy can restore normal hormone levels in most children and teens with panhypopituitarism. The pituitary gland produces hormones that are normally replaced by medically administered ones. Hormone replacement therapy can be used even if there is no underlying cause for panhypopituitarism.
If a tumor is the cause, it can be treated with either surgery or medication, or both. Sometimes radiation therapy is used.
Follow up care
It is important to schedule regular appointments with specialists in order ensure that medications are working as intended and that children are developing and growing as they should. Periodic follow-up testing is required when medication is used to supplement hormone production. Over time, dosage levels and combinations of medications may have to be adjusted.
Occasionally, repeat imaging tests and/or additional blood tests are recommended. Follow-up imaging and tests will be required periodically if the treatment has reduced or eliminated the size of the tumor.
Why Choose Chop?
Many pediatric specialists are required to treat children with panhypopituitarism.
The Neuroendocrine Center of Children’s Hospital Philadelphia provides families with a coordinated, multidisciplinary treatment approach for neuroendocrine diseases. Our team combines the expertise of pediatric endocrinologists, neuro-oncologists, neuro-surgeons, neuro-ophthalmologists, neuro-radiologists, and pathologists.
Our team has vast experience treating complex neuroendocrine disorders like panhypopituitarism.
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