Hypopituitarism medical therapy

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Hypopituitarism Microchapters


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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Iqra Qamar M.D.[2]


The mainstay of treatment for hypopituitarism is hormone replacement therapy and treating the underlying cause. Adrenocorticotrophic hormone (ACTH) deficiency is treated with glucocorticoids. Gonadotropin deficiency is treated with testosterone in men and estrogen with or without progesterone in women. Hypothyroidism is treated with levothyroxine. Growth hormone (GH) is usually replaced in children and replaced in adults only if symptomatic and after replacement of all other pituitary hormones.

Medical Therapy

1.ACTH deficiency


1.1.Acute setting

  • Preferred regimen: Hydrocortisone 100 mg IV bolus, then 300 mg/day IV divided q8hr or continuous infusion for 48 hours
    • Once patient is stable: 50 mg PO q8hr for 6 doses, later on tapered to 30-50 mg/day PO in divided doses

1.2.Chronic setting

  • Preferred regimen: Hydrocortisone 15-25 mg/day PO divided q8-12hr (20 mg on awakening and 10 mg in the early evening)
  • Alternative regimen: Prednisone (5 mg on awakening and 2.5 mg in the early evening)


2. TSH deficiency

2.1. Mild hypothyroidism

2.2. Severe hypothyroidism

  • Preferred regimen: Levothyroxine 12.5-25 mcg PO daily and later can be adjusted by 25 mcg/day q2-4 Week PRN.


3. Gonadotropin deficiency

3.1. Men

  • Preferred regimen (1): Testosterone esters (for example, Sustanon) 250 mg IM every 2–3 weeks
  • Alternative regimen (1): Transdermal testosterone
    • Patch (for example, Andropatch) 2.5–7.5 mg/24 hours
    • Gel (for example, Testogel) 5–10 g gel/24 hours
  • Alternative regimen (2): Testosterone implant 600–800 mg every 4–6 months
  • Alternative regimen (3): Buccal testosterone (for example, Striant SR) 1 buccal tablet (30 mg) applied to the gum q12h
  • Alternative regimen (4): Oral testosterone (for example, Restandol) 40–120 mg daily


3.2. Women


  • If fertility not required
    • Such women are treated with estrogen-progestin replacement therapy by using the traditional regimen of estradiol on days 1 through 25 of each month and progesterone on days 16 through 25 of each month.
    • Another regimen includes continuous transdermal estradiol throughout the month, with progestin added days 1 to 10 of the calendar month.
    • For further information regarding the indications, contraindications and adverse effects of gonadotropin replacement therapy click here.

3.3. Androgen replacement

4. Growth hormone replacement

5. ADH deficiency

  • Preferred regimen (1): Desmopressin 300–600 μg PO daily in 2–3 divided doses OR 10–40 μg intranasally daily in 2–3 divided doses

6. Prolactin deficiency


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