Sex steroid replacement for induction of puberty in multiple pituitary hormone deficiency

Hypopituitarism results from the inability of the pituitary gland to make sufficient levels of more than one of the following hormones: adrenocorticotrophic hormone, thyroid-stimulating hormone, luteinizing hormone, follicle-stimulating hormone, prolactin, and growth hormone (GH). While growth retardation is a symptom of GH deficiency in children, hypogonadism usually presents with the complete lack of puberty or a delayed onset with incomplete pubertal development. Although the goal of therapy is to simulate normal pubertal development as closely as possible, multiple approaches have been used to attain this goal. This review addresses the main factors that need to be considered when initiating sex steroid replacement in pubertal age patients with multiple pituitary hormone deficiency and offers some insight into newer treatment options.