Disease Description (Causes and Symptoms)
- Definition and pathophysiology: A condition in which the secretion of several hormones produced by the pituitary gland decreases or is lost due to damage to the pituitary gland (or the hypothalamus that regulates it). The extent and rate of hormone deficiency vary depending on the cause, and common causes include tumors, surgery, radiation, hemorrhage (e.g., Sheehan syndrome), infection, autoimmune disease, and trauma.
- Typical order of hormone deficiency progression: In general, deficiencies tend to occur in the following order: growth hormone (GH) → gonadotropins (LH/FSH) → thyroid-stimulating hormone (TSH) → adrenocorticotropic hormone (ACTH).
- Main symptoms (examples according to the deficient hormone)
- General: Fatigue, weakness, loss of appetite, weight changes (abdominal obesity), decreased muscle strength
- Sex hormone deficiency: Oligomenorrhea, amenorrhea, infertility, vaginal dryness, and decreased libido in women; decreased libido, erectile dysfunction, and muscle weakness in men
- Hypothyroidism-like symptoms (TSH deficiency): Sensitivity to cold, fatigue, edema, constipation, dry skin
- Adrenal insufficiency (ACTH deficiency): Low blood pressure, hypoglycemia, nausea and vomiting, reduced ability to cope with stress (shock in severe cases)
- Growth hormone deficiency (adults): Increased body fat, decreased muscle mass, reduced energy, decreased quality of life
- Other: Osteoporosis (due to sex hormone or GH deficiency), hypoglycemia (especially in children), increased cardiovascular risk
- Diagnostic overview: Blood hormone tests (baseline and stimulation tests; e.g., pituitary stimulation tests, insulin tolerance tests), and pituitary MRI to identify causes such as tumors or cysts.
Treatment Methods
- Basic principles: Appropriately replace deficient end hormones, and treat the underlying lesion (e.g., a tumor) if present through surgery, medication, or radiation.
- Hormone replacement therapy (examples)
- Glucocorticoids: Essential for the stress response in cases of ACTH deficiency. Typical medications include hydrocortisone (e.g., a total of 15–25 mg/day divided into multiple doses) or prednisolone as an alternative. Adjust the dose and divided dosing according to the treating physician’s instructions.
- Thyroid hormone: Levothyroxine. Begin thyroid hormone replacement after cortisol has been adequately replaced (or prioritize cortisol if starting both simultaneously)—administering thyroid hormone alone first when adrenal function is uncertain may trigger an adrenal crisis.
- Sex hormones: Estrogen + progesterone in women (the combination depends on whether the uterus is present); testosterone in men (injections, gel, etc.).
- Growth hormone: Recombinant human growth hormone (rhGH) treatment may be considered for confirmed GH deficiency even in adults (injectable). In children, growth hormone treatment promotes growth.
- Treatment of the cause
- Tumorous lesions: Depending on whether the adenoma is functioning or nonfunctioning, treatment may include medication (e.g., dopamine agonists—for prolactinomas), transsphenoidal surgery, or radiation therapy.
- Emergency and stress management
- During severe infection, surgery, trauma, or severe diarrhea/vomiting, administer a steroid stress dose (an increased dose directed by a physician). If oral medication cannot be taken due to vomiting or other reasons, replace it immediately through intravenous or intramuscular injection.
- Follow-up and monitoring
- Regular clinical evaluations, blood tests (hormone levels), bone density tests, assessment of cardiovascular risk factors, and repeat MRI when necessary.
- Lifestyle management
- Learn how to increase the steroid dose independently when necessary (as instructed by medical staff), do not stop taking steroids, and consider carrying a steroid injection for emergency use or wearing an emergency card or medical information alert bracelet.
Outpatient Visit Checklist (Including Example Questions)
- Items to prepare/submit
- A list of all currently used medications, supplements, and injectable medications (including doses and administration times)
- Previous test results (recent blood tests, hormone tests, MRI/CT images or radiology reports)
- History of previous surgery, radiation therapy, or hemorrhage (related to childbirth)
- A record of recent symptom changes (fatigue level, weight, menstrual changes, changes in libido or erections, dizziness or fainting, etc.)—organize by timeline when possible
- Whether emergency situations (low blood pressure, decreased consciousness, etc.) have occurred
- Whether planning a pregnancy or currently breastfeeding (women)
- Items to show the doctor during the outpatient visit
- Recent blood pressure measurements (including both arms and orthostatic measurements), self-measured blood glucose levels (and whether symptoms of hypoglycemia occurred)
- Points to check before the visit
- Do not stop any steroids you are currently taking
- Record any history of needing emergency steroid injections, if applicable
Examples of General Questions to Ask the Doctor
- What is the exact cause of this disease? (Can it be confirmed by MRI or additional tests?)
- Which hormones are deficient? Which medications should I take, and for how long?
- What is the dose of steroid (cortisol) replacement therapy, and how should the dose be increased during stress?
- What benefits and side effects can be expected from replacement therapy for each hormone, such as thyroid, sex, and growth hormones?
- Which tests should I undergo regularly during hormone replacement therapy? (Frequency and test items)
- What is the prognosis with proper treatment? What impact will it have on daily life, exercise, and pregnancy plans?
Examples of Disease-Specific Questions
- A tumor appears on my MRI. Is surgery necessary? How likely is it that hormone function will recover after surgery?
- I am planning a pregnancy. How should hormone replacement therapy (especially cortisol, thyroid, and sex hormones) be adjusted, and how should I be followed before, during, and after pregnancy?
(When necessary, submitting diagnostic test results and imaging findings together can help establish a more specific consultation and treatment plan.)