15th September 2024

Management

The mainstay of management of anterior pituitary hormone deficiency is adequate target hormone replacement and management of the underlying cause. Exceptions are growth hormone replacement in adults and when fertility is required (GnRH therapy is given instead of testosterone or oestrogen).

Patients with ACTH deficiency need glucocorticoid replacement only and do not need mineralocorticoid in contrast to patients with primary adrenal disease. GH is replaced in adults when symptomatic, affecting the quality of life as compared to children where regular replacement is required for growth. Thyroid hormone replacement-in pituitary disease, thyroid replacement is monitored via clinical and Free T4 levels as TSH measurement cannot be used to assess adequate replacement due to the TSH deficiency.

Pituitary apoplexy

Haemorrhage directly into the pituitary gland, known as pituitary apoplexy, tends to occur in individuals with a preexisting pituitary adenoma. Patients typically experience a sudden headache, diplopia, and hypopituitarism. Urgent MRI is required for diagnosis and treatment consists of initial steroid replacement and neurosurgical evaluation. Additional hormone replacement may be necessary, depending on the clinical picture.