What Causes Hypopituitarism?

Hypopituitarism is a disorder when the pituitary gland, located between the ears at the base of the brain, does not produce enough of its hormones or does not produce one or more of its hormones at all. This gland is often called the master gland because it manages the functions of most other endocrine glands in the body. The pituitary gland does this by producing hormones such as adrenocorticotropic hormone, thyroid-stimulating hormone, follicle stimulating hormone, growth hormone, prolactin, and antidiuretic hormone. When an individual with hypopituitarism is unable to produce one of these hormones, it results in the loss of function or decreased function of the organ or gland it manages. Some individuals may experience symptoms of hypopituitarism gradually, while others will experience them suddenly. The symptoms a patient will experience depends on which hormone(s) are affected. The causes of hypopituitarism vary from genetic factors to other medical conditions like an infection.

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Pituitary Tumors

Pituitary tumors are abnormal growths of cells that occur in the pituitary gland. These tumors cannot spread to other regions or organs of the body. However, benign tumors in the pituitary gland can result in numerous issues because they can invade nearby tissues in the brain. A pituitary adenoma is a noncancerous tumor that does not spread past the skull. There are two types of pituitary adenomas. A microadenoma is a tumor smaller than a centimeter in diameter. Microadenomas often cause problems with the production of certain hormones, but they rarely damage tissues nearby. Macroadenomas are pituitary tumors larger than a centimeter in diameter. Microadenomas and macroadenomas considered non-functional are the most common types associated with hypopituitarism. As the tumor increases in size, it has the potential to press on and squeeze pituitary tissues around it. This compression results in interference of hormone production. Although it is rare, a cancerous pituitary tumor is called a pituitary carcinoma, and these tumors may or may not cause issues with pituitary hormone production.

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Hypophysitis

Hypophysitis is a condition where the pituitary gland or pituitary stalk becomes inflamed. This can result in any degree of pituitary gland failure that manifests as hypopituitarism. It is believed hypophysitis occurs due to an abnormal response of the immune system that causes it to attack its own healthy pituitary tissues. This attack causes a decrease in the production of several hormones that are the responsibility of the pituitary gland. Often, there will be a reduction in the production of the antidiuretic hormone that results in symptoms such as increased urination and excessive thirst. Another commonly affected hormone in patients with hypophysitis is the thyroid-stimulation hormone. A decrease in the production of this hormone will result in symptoms such as constipation, sensitivity to cold, muscle weakness, decreased energy, weight gain, and constipation. Some cases of hypophysitis will cause a decrease in nearly all of the hormones the pituitary gland is responsible for producing. Such cases will be difficult to diagnose because hypophysitis and the resulting hypopituitarism will produce various symptoms due to the malfunction of numerous glands throughout the body.

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Tuberculosis

Tuberculosis is a serious infectious disease caused by a bacteria called Mycobacterium TB. This bacteria usually has a primary effect on the lungs, but it can cause damage to other parts of the body as well. There are a couple of ways tuberculosis can cause hypopituitarism. Tuberculoma or a firm mass of tubercles that forms from tuberculosis can have the same effects on the pituitary gland a benign tumor would. Tuberculosis can also cause vasculitis or blood vessel thickening in the areas around the pituitary gland. Vasculitis in these areas may make it difficult for the pituitary tissues to receive a sufficient amount of oxygen because of reduced blood flow. A lack of oxygen can cause damage or death of the pituitary gland tissues responsible for the production of certain hormones. In addition, tuberculosis can cause fluids to leak out of the blood vessels around the pituitary gland, and triggering inflammation in this area. The exudate or mass of cells and fluid causes interference in pituitary hormone production with the same mechanism as a benign pituitary tumor.

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Hemochromatosis

Hemochromatosis is a disorder that occurs when excessive amounts of iron build up in the body. In healthy individuals, the intestines absorb a precise quantity of iron from the foods consumed. Individuals with hemochromatosis tend to absorb too much of that iron and then store it in the joints and organs such as the heart, pituitary gland, pancreas, and liver. When the body has no way to get rid of excess iron, it displaces it in numerous tissues, including the cells in the anterior portion of the pituitary gland. The cells of the pituitary tissues are highly sensitive to iron toxicity. This sensitivity combined with the displacement of iron causes cell death in the pituitary tissues resulting in impaired function of hormone production. For unknown reasons, most cases of hemochromatosis only affect the anterior part of the pituitary gland responsible for producing the adrenocorticotropic, growth, follicle-stimulating, prolactin, and thyroid-stimulating hormones. Low blood pressure, weight loss, nausea, depression, weakness, vomiting, decreased strength, decreased muscle mass, erectile dysfunction, infertility, and lack of milk production can all be indicative of hypopituitarism triggered by hemochromatosis.

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Head Injuries

Head injuries occur when an individual experiences some type of severe trauma to the head. These injuries can cause an individual to develop hypopituitarism through several mechanisms. Most cases of hypopituitarism that occur after a brain injury are due to a combination of direct mechanical injury and injuries that arise from other problems a brain injury causes. Hypotension can be caused by a head injury and result in damage to the pituitary tissues from a lack of oxygen. Hypoxia, oxygen deprivation of the pituitary tissues, can also occur in a brain injury due to excessive internal or external bleeding, swelling, inflammation of the affected areas, and several other mechanisms. Too much blood loss from a brain injury can result in anemia. All of these mechanisms result in the necrosis or death of any number of pituitary cells needed to produce critical hormones that influence every organ system in the body.