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Endocrine Society: Hormone replacement should reach natural levels in hypopituitarism
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Adults with hypopituitarism and insufficient hormone levels should be treated by replacing hormones at levels close to the body’s natural patterns, according to a recent guideline from the Endocrine Society.
“Hypopituitarism can manifest as low levels of a variety of hormones, including cortisol, thyroid hormone, estrogen, testosterone and growth hormone,” Maria Fleseriu, MD, FACE, professor of medicine and neurological surgery at Oregon Health & Science University in Portland, said in a press release. “The goal of treatment should be to restore hormone levels as close to healthy levels as possible. The interactions between these hormones also are very important, and patients might require dose changes of one or more of the replacement hormones after starting or discontinuing another one.”
Specific recommendations include the following:
- Central hypothyroidism should be evaluated with measurement of both free thyroxine and thyroid-stimulating hormone.
- Levothyroxine doses should be sufficient enough to raise levels of free T4 to the upper half of the reference range in adults with central hypothyroidism.
- Patients with suspected GH deficiency should be diagnosed using GH stimulation testing.
- GH replacement should be offered to adults with proven GH deficiency and no contraindications.
- Hormone treatment should be given to premenopausal women with central hypogonadism as long as there are no contraindications.
- Adults should be tested for central diabetes insipidus if they produce abnormally large volumes of dilute urine.
- All patients with hypopituitarism should obtain a medical emergency card, bracelet or necklace warning about the possibility of adrenal insufficiency.
- An immediate injection of 50 mg to 100 mg hydrocortisone should be given to patients who are suspected of having an adrenal crisis.
- The lowest tolerable dose of hydrocortisone replacement should be given on a long-term basis to adults with central adrenal insufficiency to reduce the risk for metabolic and cardiovascular disease.
Special circumstances that may affect treatment of adults with hypopituitarism are also addressed in the guidelines.
Disclosure: Fleseriu reports financial ties with Novo Nordisk, Pfizer and The Pituitary Society. Please see the full study for a list of all other authors’ relevant financial disclosures.
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