0521779407-09 CUNY1086/Karliner 0 521 77940 7 June 13, 2007 7:54
798 Hypopituitarism■Granulomatous disease and histiocytosis: may cause anterior and
posterior pituitary deficiency
management
What to Do First
■Determine hormone deficiencies (partial or panhypopituitarism)
and excesses
■Assess size/resectability of tumor
■Rule out apoplexy
specific therapy
■Hormone replacement therapy:
➣Cortisol
➣Thyroid hormone
➣DDAVP
➣Testosterone
➣Estrogen/progestin
➣Growth hormone
➣Gonadotropins for fertility only
➣Restoration of libido and potency
■Normalize prolactin, ACTH, or GH hypersecretion
■Surgical resection of tumor
■Medical therapy for prolactinoma and acromegaly
■Radiation therapy
■Treat granulomatous diseases
■Observation with repeated pituitary MRI to determine if tumor is
growing
Treatment Goals
■Treat hormone deficiencies and excesses
■Resect or diminish size of pituitary or CNS mass
Side Effects & Contraindications
■Surgery and radiation: panhypopituitarism, CNS injury
follow-up
■Assess adequacy of hormone replacement therapy every 6–12
months
■Repeat pituitary MRI in 3–6 mo to assess tumor growth
complications and prognosis
■Pituitary apoplexy
■Visual field changes
■Patients require lifelong observation