Aetiology

The aetiology of hypopituitarism includes:

• neoplasms in the suprasellar region:
  • pituitary adenoma in adults
  • craniopharyngioma in children
  • glioma
  • meningioma
  • metastatic cancer
    
    
• infiltration:
  • sarcoid
  • histiocytosis X
  • haemochromatosis
    
    
• infection:
  • tuberculous meningitis
  • syphilis
  • encephalitis
    
    
• vascular:
  • Sheehan's syndrome (post-partum infarction)
  • pituitary apoplexy
  • carotid artery aneurysms
    
    
• autoimmune
  
  
• iatrogenic:
  • surgery
  • radiotherapy
  • chemotherapy
    
    
• miscellaneous:
  • head injury
  • empty sella syndrome
  • emotional deprivation
  • starvation & anorexia nervosa

Notes:

• head injury and hypopituitarism (1)
  • marked changes of the hypothalamo-pituitary axis have been documented in the acute phase of traumatic brain injury(TBI)
    • following TBI as many as 80% of patients showing evidence of gonadotropin deficiency, 18% of growth hormone deficiency, 16% of corticotrophin deficiency and 40% of patients demonstrating vasopressin abnormalities leading to diabetes insipidus or the syndrome of inappropriate anti-diuresis
    • longitudinal prospective studies have shown that some of the early abnormalities are transient, whereas new endocrine dysfunctions become apparent in the post-acute phase. There remains a high frequency of hypothalamic-pituitary hormone deficiencies among long-term survivors of TBI, with approximately 25% patients showing one or more pituitary hormone deficiencies

Reference:

• 1. Behan LA et al. Neuroendocrine disorders after traumatic brain injury. J Neurol Neurosurg Psychiatry. 2008 Jul;79(7):753-9