Key takeaway
The anterior pituitary controls thyroid (TSH), adrenal (ACTH), gonads (LH/FSH), growth (GH), and lactation (prolactin); deficiencies produce secondary hypothyroidism, adrenal insufficiency, and hypogonadism.
What is hypopituitarism?
Causes include pituitary tumors, surgery, radiation, infarction (including postpartum Sheehan syndrome), and trauma. Treatment is lifelong replacement of the deficient target-gland hormones.
Key points to remember
- The anterior pituitary controls thyroid (TSH), adrenal (ACTH), gonads (LH/FSH), growth (GH), and lactation (prolactin); deficiencies produce secondary hypothyroidism, adrenal insufficiency, and hypogonadism.
- ACTH deficiency (causing cortisol loss) is the most life-threatening and can lead to adrenal crisis.
- Sheehan syndrome is pituitary infarction from postpartum hemorrhage, classically presenting with failure to lactate and amenorrhea.
- Symptoms vary by hormone: fatigue and hypotension (cortisol), cold intolerance and weight gain (thyroid), loss of libido/menses (gonadotropins), and short stature in children (GH).
- When replacing multiple hormones, cortisol (glucocorticoid) is started before thyroid hormone to avoid precipitating adrenal crisis.
- Diagnosis uses low target hormone with low/inappropriately normal pituitary hormone, plus stimulation testing and pituitary MRI.
Signs & symptoms
- ↓TSH→hypothyroid; ↓ACTH→↓cortisol
- ↓FSH/LH→infertility, ↓libido
- Fatigue, weakness, cold
Nursing priorities
- Assess for and prioritize signs of cortisol deficiency/adrenal crisis (hypotension, hypoglycemia, weakness).
- Administer hormone replacement as ordered, giving glucocorticoids before thyroid hormone when both are deficient.
- Monitor vital signs, blood glucose, and electrolytes for instability.
- Educate on lifelong, consistent hormone replacement and the need for stress dosing of steroids.
- Provide emotional support regarding fertility, sexual function, and body image changes.
Labs & values
Low TSH with low free T4 (secondary hypothyroidism)
Low ACTH with low cortisol (secondary adrenal insufficiency)
Low LH/FSH with low estrogen or testosterone
Low IGF-1 with GH deficiency
Normal free T4 ~0.8-1.8 ng/dL for reference
Patient teaching
- Hormone replacement is lifelong and must be taken consistently; never stop steroids abruptly.
- Increase glucocorticoid dose ('stress dose') during illness, infection, surgery, or injury and wear a medical alert bracelet.
- Report fatigue, dizziness, fainting, or weight changes that may signal inadequate replacement.
- Keep regular follow-up for hormone level monitoring and dose adjustment.
Red flags: report now
- Signs of adrenal crisis from ACTH/cortisol deficiency: severe hypotension, hypoglycemia, altered mentation — emergency.
- Sudden severe headache, vision loss, and ophthalmoplegia suggest pituitary apoplexy (acute hemorrhage/infarction) — emergency.
- Abruptly stopping steroid replacement can trigger life-threatening crisis.
References
Clinical references for this topic
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