Isolated anterior pituitary dysfunction in adulthood

Area of Science:

• Endocrinology
• Internal Medicine
• Oncology

Background:

• Hypopituitarism involves deficiency in one or more pituitary hormones, impacting overall health and increasing mortality.
• Adult-onset isolated pituitary deficits present with vague symptoms, posing diagnostic challenges for physicians.
• Common causes include pituitary tumors, head trauma, surgery, radiotherapy, and increasingly, immune-related dysfunction from cancer therapies.

Purpose of the Study:

• To provide a comprehensive review of anterior pituitary deficits in adulthood.
• To analyze etiologies, signs, symptoms, diagnostic approaches, and treatments for each pituitary hormone deficiency.
• To offer a step-based diagnostic strategy and discuss current therapeutic debates.

Main Methods:

• Narrative review of literature on anterior pituitary deficits.
• Analysis of etiologies, clinical presentations, diagnostic methods (hormonal assessments, dynamic tests), and treatment strategies.
• Inclusion of genetic causes, uncommon symptoms, and follow-up protocols.

Main Results:

• Isolated pituitary deficits in adults are often caused by tumors, trauma, surgery, radiotherapy, and immune-related causes.
• Diagnosis relies on hormonal assessments and dynamic tests, though some cases remain idiopathic.
• Treatment varies: ACTH and TSH deficiencies require prompt replacement; gonadal replacement needs risk-benefit assessment; GH replacement is debated; prolactin replacement is unavailable.

Conclusions:

• This review offers a broad evaluation of causes, diagnosis, and therapies for isolated anterior pituitary deficits in adults.
• It emphasizes the diagnostic challenges and outlines management strategies for various hormone deficiencies.
• The review aims to improve clinical understanding and patient care for hypopituitarism.