Multiple Pituitary Hormone Deficiencies (MPHD)

Multiple pituitary hormone deficiencies (MPHD) means that the pituitary gland is not making several different hormones at the same time, not just one. The pituitary is a tiny gland at the base of the brain that controls growth, thyroid, stress hormones, and sex hormones. When more than one of these hormones is low, the body cannot grow, develop, or work normally. Doctors often call this situation “combined” or “generalized” hypopituitarism. [1]

Multiple pituitary hormone deficiencies (MPHD) means the pituitary gland in the brain is not making enough of several different hormones at the same time, such as growth hormone, thyroid-stimulating hormone, ACTH (adrenal), and the hormones that control sex glands. These hormones normally help control growth, weight, energy, puberty, fertility, blood pressure, and body fluids, so low levels can affect almost every system in the body.

MPHD is usually a long-term condition and may be present from birth (genetic causes) or develop later because of a tumor, surgery, radiation, infection, head injury, or autoimmune disease that damages the pituitary gland. Symptoms can include tiredness, low blood pressure, low blood sugar, slow growth in children, weight changes, delayed or absent puberty, fertility problems, and sometimes vision problems if a tumor presses on the optic nerves.

MPHD can be present from birth (congenital) because of gene changes or problems when the baby is growing in the womb. It can also develop later (acquired) after a brain injury, a pituitary tumor, an operation, or radiation. Symptoms depend on which hormones are missing and how severe the lack is. In children, slow growth and delayed puberty are common signs. In adults, tiredness, low sex drive, low blood pressure, and trouble having children are common. [2]

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Other names

Doctors use several names that all describe the same or very similar problems: more than one pituitary hormone is low. [3]

Other names (synonyms)

• Combined pituitary hormone deficiency (CPHD) – very common medical name for low growth hormone plus at least one more pituitary hormone. [4]

• Multiple pituitary hormone deficiency (MPHD) – another way to say the same thing, often used in growth and pediatric studies. [5]

• Generalized hypopituitarism – broader term meaning many or all pituitary hormones are low. [6]

• Panhypopituitarism – usually means almost all anterior pituitary hormones are missing. [7]

• Congenital combined pituitary hormone deficiency (cCPHD) – when the problem is present at birth, often genetic. [8]

Types

Simple types (ways doctors group MPHD)

1. By time of start

   • Congenital MPHD – present from birth due to gene changes or brain development problems. Babies may have low blood sugar, poor feeding, or later show poor growth. [9]

   • Acquired MPHD – starts later in life after a tumor, surgery, radiation, head trauma, bleeding, or infection. [10]

2. By number of missing hormones

   • Partial MPHD – two or three hormones are low. [11]

   • Complete MPHD / panhypopituitarism – almost all anterior pituitary hormones (GH, TSH, ACTH, LH/FSH, sometimes prolactin) are low. [12]

3. By main cause group

   • Genetic / developmental type – due to gene changes (for example PROP1, POU1F1, HESX1) that affect how the pituitary forms. [13]

   • Tumor‐related type – due to pituitary or nearby brain tumors pressing on or damaging the gland. [14]

   • Injury / treatment type – due to surgery, radiotherapy, or brain injury that harms the pituitary or hypothalamus. [15]

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Causes of multiple pituitary hormone deficiencies

Below are common and important causes. In many people, more than one factor may play a role. [16]

1. Genetic changes in pituitary development genes
   Changes in certain genes (such as PROP1, POU1F1, HESX1, LHX3, LHX4) can stop the pituitary from forming normally. Children may have small pituitary glands on MRI and multiple hormone shortages. These conditions run in families and are a major cause of congenital MPHD. [17]

2. Congenital brain or midline malformations
   Some babies have abnormal development of the brain midline, optic nerves, or septum pellucidum (for example septo‐optic dysplasia). These problems often go together with pituitary defects and MPHD. [18]

3. Pituitary adenoma (benign pituitary tumor)
   A non-cancerous tumor in the pituitary can squeeze nearby normal tissue and reduce hormone output. Large tumors can also cause headaches and vision problems because they press on the optic nerves. [19]

4. Craniopharyngioma and other sellar / suprasellar tumors
   Tumors that grow above or near the pituitary stalk, such as craniopharyngiomas, germinomas, or meningiomas, can block signals between the hypothalamus and pituitary, leading to MPHD. [20]

5. Pituitary surgery
   Surgery to remove a tumor in the pituitary region can accidentally remove or damage normal pituitary tissue. This is a common acquired cause of multiple hormone deficiencies in adults. [21]

6. Radiation therapy to the brain or pituitary
   Radiation used to treat brain tumors, leukemia, or nasopharyngeal cancer can slowly damage the hypothalamus and pituitary over years, causing progressive loss of several hormones. [22]

7. Traumatic brain injury (TBI)
   A strong head injury from accidents, falls, or sports can stretch or tear the pituitary stalk or damage blood flow to the gland. This may lead to delayed MPHD with fatigue, low blood pressure, and hormonal problems. [23]

8. Pituitary apoplexy (sudden bleeding into the gland)
   Sudden bleeding or loss of blood supply inside a pituitary tumor can destroy hormone-producing cells. People may have severe headache, vision loss, and acute adrenal crisis, followed by chronic MPHD. [24]

9. Sheehan’s syndrome (postpartum pituitary necrosis)
   Severe bleeding during or after childbirth can cause a big drop in blood pressure. This can injure the pituitary in the mother, leading to poor milk production, missed periods, and long-term MPHD. [25]

10. Autoimmune hypophysitis
    The immune system can mistakenly attack the pituitary gland, causing swelling and later scarring. This is more common in women and sometimes linked with pregnancy or other autoimmune diseases. It often leads to multiple hormone deficits. [26]

11. Infiltrative diseases (sarcoidosis, hemochromatosis, Langerhans cell histiocytosis)
    These rare conditions place abnormal cells or iron inside the pituitary or hypothalamus. Over time, this process replaces healthy tissue and reduces hormone production. [27]

12. Metastatic cancer to the pituitary
    Cancers from other body sites, like breast or lung, can spread to the pituitary region. This can cause new MPHD, diabetes insipidus, and headaches. [28]

13. Infections of the brain or meninges
    Infections such as meningitis, encephalitis, or tuberculosis can involve the hypothalamus–pituitary area. Scarring and damage after infection may lead to chronic pituitary hormone deficiencies. [29]

14. Vascular malformations or aneurysms near the pituitary
    Abnormal blood vessels or aneurysms close to the pituitary can compress or disrupt blood flow to the gland, causing multiple hormone deficits. [30]

15. Empty sella syndrome
    In some people, the sella (bony seat of the pituitary) looks “empty” on scans because spinal fluid fills the space. The pituitary may be flattened or small. Some of these patients develop MPHD. [31]

16. Congenital pituitary hypoplasia or ectopic posterior pituitary
    Some children have a very small anterior pituitary or an ectopic (misplaced) posterior pituitary on MRI. These structural problems are strongly linked with combined hormone deficiencies. [32]

17. Long-term untreated pituitary hormone deficiency progressing over time
    Some children start with isolated growth hormone deficiency, and over years they develop deficits of other pituitary hormones. This gradual change is part of the natural course in some genetic or structural conditions. [33]

18. Chronic systemic diseases and medications
    Long-term use of high-dose glucocorticoids, some cancer drugs, or certain psychiatric medicines can suppress hypothalamic–pituitary function and contribute to MPHD, especially when combined with other risk factors. [34]

19. Idiopathic (no clear cause found)
    In some patients, even after genetic tests and scans, no clear cause is found. Doctors still diagnose MPHD based on lab tests and symptoms, and call it idiopathic (unknown cause). [35]

20. Post-COVID-19 and other critical illness–related pituitary injury (emerging evidence)
    Some studies suggest that severe systemic infections or critical illnesses may affect the hypothalamic–pituitary axis and lead to temporary or persistent hormone deficits in a few patients. Research is still ongoing. [36]

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Symptoms and signs

Symptoms vary a lot because different hormones control growth, thyroid, stress response, and sex function. Many symptoms are slow and non-specific, so MPHD is often missed without careful testing. [37]

1. Poor growth and short height in children
   Children may grow more slowly than their friends and drop down on the growth chart. Clothes and shoes may fit for many years. This is often the first clue to MPHD in childhood, mainly due to growth hormone deficiency. [38]

2. Delayed or absent puberty
   Teenagers may not develop breasts, periods, testicular enlargement, or body hair at the expected age. This happens when LH and FSH (sex hormone–controlling hormones) are low. [39]

3. Fatigue and low energy
   People often feel very tired, weak, and unable to do normal daily tasks. This can result from low thyroid hormone, low cortisol, low growth hormone, or low sex hormones together. [40]

4. Weight gain and increased body fat
   Many adults with MPHD gain weight easily, especially around the belly, and lose muscle mass. This is related to low growth hormone, low thyroid hormone, and low sex hormones. [41]

5. Cold intolerance and feeling cold easily
   Low thyroid hormone from low TSH makes the body slow down. People may feel cold, have dry skin, and have slow movements or speech. [42]

6. Low blood pressure, dizziness, or fainting
   Low cortisol (from low ACTH) can cause low blood pressure, especially when standing up. Some people feel dizzy, weak, or may even faint. [43]

7. Low blood sugar (hypoglycemia), especially in infants and children
   Babies with MPHD can have low blood sugar, seizures, or poor feeding because cortisol and growth hormone help keep blood sugar stable. [44]

8. Headache and visual problems
   Large tumors or swollen pituitary glands can press on the optic nerves. People may develop headaches, blurred vision, or loss of side vision (bitemporal hemianopia). [45]

9. Reduced sex drive and fertility problems
   Men may have low sex drive, erectile problems, and less facial or body hair. Women may have irregular or absent periods and trouble getting pregnant. This happens when LH, FSH, and sex hormones are low. [46]

10. Dry skin, hair loss, and puffiness
    Low thyroid hormone and low growth hormone can cause dry, pale skin, hair loss, and puffiness around the eyes and hands. [47]

11. Depressed mood and poor concentration
    People with MPHD often feel low in mood, anxious, or have trouble focusing. Hormone shortages, especially of thyroid and cortisol, can affect brain function and quality of life. [48]

12. Constipation and slow digestion
    Low thyroid hormone slows the digestive system, which can cause constipation, bloating, or stomach discomfort. [49]

13. Poor exercise tolerance and muscle weakness
    Low growth hormone and low sex hormones reduce muscle mass and strength. People may find it hard to climb stairs, lift things, or keep up with normal physical activity. [50]

14. Low breast milk production after childbirth
    Women with prolactin or general pituitary deficiency may not be able to produce enough breast milk after delivery, which can be an early sign of Sheehan’s syndrome or other MPHD. [51]

15. Severe cases: nausea, vomiting, confusion, or collapse (adrenal crisis)
    If cortisol is very low, people can develop nausea, vomiting, abdominal pain, confusion, and collapse, especially during stress or illness. This is a medical emergency called adrenal crisis. [52]

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Diagnostic tests

Doctors diagnose MPHD by careful history, physical examination, blood tests, special stimulation tests, and imaging of the pituitary. Often several tests are needed because hormone levels can change during the day. [53]

Physical exam tests

1. General physical examination and vital signs
   The doctor checks height, weight, heart rate, breathing rate, blood pressure (lying and standing), and looks for signs of chronic illness. Low blood pressure, slow pulse, or pale, dry skin can point toward MPHD. [54]

2. Growth chart and body proportion assessment
   In children, height and weight are plotted on standardized growth charts. Falling percentiles or very short height compared with parents suggests growth hormone deficiency and possible MPHD. Body proportions are checked for arm–leg ratios and trunk length. [55]

3. Puberty staging (Tanner staging)
   The doctor inspects breast development, testicular size, and pubic hair stage using Tanner stages. Delayed or absent puberty with other features supports low LH and FSH as part of MPHD. [56]

4. Inspection of vision and eye movements
   Simple bedside checks of eye movements and visual fields (for example asking the patient to look in all directions and count fingers at the sides) can detect damage from a mass near the pituitary. [57]

Manual tests (bedside maneuvers)

5. Manual visual field (confrontation) test
   The doctor sits in front of the patient, covers one eye at a time, and moves fingers from the side toward the center. If the patient cannot see the fingers from the sides, this suggests compression of the optic chiasm by a pituitary mass. [58]

6. Thyroid gland palpation
   The neck is felt gently to check the size and texture of the thyroid gland. A normal or small thyroid in someone with clear hypothyroid symptoms may suggest central (pituitary) hypothyroidism rather than primary thyroid disease. [59]

7. Breast and nipple examination for galactorrhea
   The doctor may gently press around the nipples to see if any milk discharge is present. This helps assess prolactin problems and distinguish them from pure MPHD, because high prolactin is often seen with some pituitary tumors. [60]

8. Genital examination and testicular / ovarian size check
   In boys, the doctor measures testicular volume using palpation or an orchidometer; in girls, uterine and ovarian size can be assessed by pelvic exam or ultrasound. Small gonads with delayed puberty suggest low LH/FSH from MPHD. [61]

Lab and pathological tests

9. Basal pituitary and target hormone panel (morning blood tests)
   A key step is measuring morning levels of cortisol, ACTH, TSH, free T4, prolactin, LH, FSH, estradiol or testosterone, IGF-1, and sometimes growth hormone. Patterns of low pituitary hormones with low target gland hormones strongly support MPHD. [62]

10. Morning serum cortisol and ACTH
    Cortisol and ACTH levels are checked around 8 am. Very low cortisol with low or normal ACTH suggests secondary adrenal insufficiency from pituitary failure, which is life-threatening if missed. [63]

11. Short Synacthen (ACTH stimulation) test
    Synthetic ACTH (tetracosactide) is injected and cortisol is measured over time. If the adrenal glands do not produce enough cortisol after stimulation, this shows poor ACTH support and confirms adrenal insufficiency in MPHD. [64]

12. Insulin tolerance test (ITT)
    Insulin is given under careful monitoring to lower blood sugar and stress the body. In a healthy person, this should raise cortisol and growth hormone. A poor rise in both hormones shows combined ACTH and GH deficiency, but this test must be done only in expert centers. [65]

13. Growth hormone stimulation tests (arginine, clonidine, glucagon tests)
    Medicines such as arginine, clonidine, or glucagon are given to stimulate GH release. Blood samples are taken over a few hours. Low GH peaks suggest growth hormone deficiency, which often forms part of MPHD. [66]

14. IGF-1 and IGFBP-3 levels
    Insulin-like growth factor-1 (IGF-1) and its binding protein IGFBP-3 reflect longer-term growth hormone action. Low levels help support the diagnosis of GH deficiency and MPHD, especially when combined with other hormone deficits. [67]

15. Sex hormone and gonadotropin tests
    Blood levels of testosterone or estradiol, together with LH and FSH, show whether the sex glands are underactive due to pituitary failure. Low sex hormones with low or normal-low LH/FSH indicate central hypogonadism from MPHD. [68]

16. Thyroid function tests (free T4, T3, TSH)
    In central hypothyroidism due to MPHD, free T4 is low but TSH is not high and may be low or in the normal range. This pattern is different from primary thyroid disease and points to pituitary or hypothalamic dysfunction. [69]

17. Serum electrolytes, glucose, and osmolality
    Blood tests for sodium, potassium, glucose, and osmolality help detect complications such as hyponatremia or hypoglycemia caused by cortisol and thyroid deficiency in MPHD. [70]

Electrodiagnostic tests

18. Visual evoked potentials (VEP)
    In some cases, doctors record brain responses to visual stimuli using electrodes on the scalp. Delayed or abnormal responses can show damage to the optic pathways from tumors near the pituitary. [71]

19. Electroencephalogram (EEG)
    If a child with MPHD has seizures or episodes of confusion, an EEG can look for abnormal brain electrical activity related to low blood sugar, low sodium, or structural brain problems. [72]

Imaging tests

20. Magnetic resonance imaging (MRI) of the pituitary and brain
    MRI is the key imaging test. It shows the size and shape of the pituitary, stalk, and surrounding structures. Doctors can see small glands, ectopic posterior pituitary, tumors, cysts, or empty sella. MRI findings strongly help confirm causes of MPHD and guide treatment. [73]

Non-pharmacological treatments (Therapies and other approaches)

1. Education about MPHD and hormone replacement
Learning exactly which hormones are low, what each tablet or injection does, and how and when to take them is the first “treatment without drugs.” Clear teaching (using written plans, apps, or reminder alarms) helps you take medicines on time, avoid double doses, and recognise early warning signs of low cortisol or low thyroid. Good understanding also makes it easier to explain your condition to family, teachers, or employers so they can support you during illness or stress.

2. Medical alert bracelet and emergency steroid card
People with MPHD who take cortisol replacement must always wear a medical alert bracelet or necklace and carry an emergency steroid or adrenal-insufficiency card. In an accident or sudden illness, this quickly tells doctors and paramedics that you may need urgent steroid injections and should not miss your normal dose. This simple piece of jewellery can prevent life-threatening adrenal crisis and is strongly recommended in international endocrine guidelines.

3. Written sick-day rules for steroid doses
“Sick-day rules” are clear instructions on how to increase your steroid tablet dose during fever, vomiting, surgery, dental work, or major stress. They often say to double or triple the usual dose and seek urgent medical help if you cannot keep tablets down, in which case an injection of hydrocortisone is needed. Having these rules printed and kept with medicines helps you and your family act quickly when you feel unwell.

4. Regular endocrinology follow-up and lab monitoring
Routine appointments with an endocrinologist allow careful checking of symptoms, blood tests, blood pressure, growth (in children), and weight. Doses of thyroid, cortisol, growth hormone, and sex-hormone replacements are adjusted based on blood levels and how you feel, because “standard” doses do not fit everyone. Regular review also helps pick up new hormone shortages early, avoiding sudden crises.

5. Coordinated care for puberty and fertility
Teens with MPHD often need planned puberty induction and later fertility support. Non-drug parts include counselling about body changes, periods, erections, and emotional health, plus planning for future pregnancy or sperm banking if needed. Good coordination between endocrinology, gynaecology, and fertility services makes these life stages smoother and reduces anxiety.

6. Psychological counselling and mental-health support
Living with a lifelong hormone condition can cause worry, low mood, or body-image problems, especially if growth or puberty are delayed compared with friends. Talking therapies such as cognitive behavioural therapy (CBT), support groups, or school/college counselling help people cope, build confidence, and manage health-related stress. This emotional support improves overall quality of life and treatment adherence.

7. Structured, gentle exercise plan
Many people with MPHD feel tired and may gain weight or lose muscle, especially if growth hormone is low. A personalised exercise plan with walking, cycling, or swimming plus light strength training can improve energy, muscle strength, mood, and blood-fat levels. Exercise programmes should build up slowly, with advice from the endocrine team or a physiotherapist, especially if blood pressure or joint problems are present.

8. Nutrition and weight-management support
Hormone problems can slow metabolism, increase appetite, or cause fluid shifts, making weight control harder. Meeting a dietitian who understands pituitary disorders can help you choose regular meals with enough protein, fibre, and healthy fats, while avoiding large sugar spikes that worsen tiredness. This non-drug approach supports healthy cholesterol, blood sugar, and bone health alongside hormone tablets.

9. Sleep hygiene and daily routine
Good sleep habits, such as a regular bedtime, limiting screens before bed, and keeping the bedroom dark and quiet, can improve daytime energy and mood. Stable routines also make it easier to remember hormone doses at the same times each day. Because both low cortisol and low thyroid can mimic chronic fatigue, improving sleep helps you and your doctor better judge how well the medicine dose is working.

10. Fluid-balance and thirst awareness (especially in diabetes insipidus)
If MPHD includes a lack of antidiuretic hormone (ADH), you may pass large amounts of very dilute urine and be extremely thirsty. Learning to track daily fluid intake, urine output, and body weight, and to spot signs of dehydration or water overload, is a vital non-drug skill. Patients are often taught to avoid drinking huge volumes in the evening to reduce night-time toilet trips.

11. Vision and eye-health monitoring
Pituitary tumors that cause MPHD may also press on the optic nerves, affecting vision. Regular visits to an eye doctor (neuro-ophthalmologist or optometrist) to check visual fields and sharpness can catch changes early so that surgery or radiation can be planned in time. Protecting sight is an important part of long-term care, even after the tumor is treated.

12. Bone-health and fall-prevention strategies
Low growth hormone, sex hormones, and long-term steroids can all weaken bones. Non-drug care includes weight-bearing exercise (like walking), avoiding smoking and heavy alcohol use, home safety checks to reduce fall risk, and sometimes fall-prevention classes for older adults. Bone-density scans (DEXA) help decide if extra treatment is needed.

13. Infection-prevention and vaccination planning
MPHD itself does not always damage the immune system, but adrenal insufficiency, diabetes, and other complications can make infections more serious. Keeping up-to-date with vaccines (flu, COVID-19, pneumonia, etc.) and having an early plan for antibiotics when appropriate can reduce hospital visits. Discussing vaccines with your endocrinologist is important because illness often needs steroid dose changes.

14. School, work, and exam accommodations
Teens and adults with MPHD may need extra time for exams, flexible schedules, or rest breaks at work when fatigue is a big problem. Non-pharmacological treatment includes writing letters for schools or employers explaining the condition and agreeing reasonable adjustments. This helps protect education and career progress while respecting the need for medical appointments and occasional sick days.

15. Family education and emergency training
Parents, partners, and close friends should know basic sick-day rules, when to call emergency services, and how to give an emergency hydrocortisone injection if prescribed. Short teaching sessions, posters on the fridge, and practice with trainers (demo syringes) can make everyone more confident. Good family training can save time in a crisis and prevent dangerous delays.

16. Avoiding abrupt steroid withdrawal and risky self-medication
Stopping steroid tablets suddenly or changing doses without medical advice can trigger adrenal crisis. Non-drug management includes clear warnings on prescription labels and repeated verbal reminders never to stop steroids abruptly, even if you feel well. Patients are also advised not to use bodybuilding steroids or “fat-burning” supplements, which can interfere with hormone replacement.

17. Radiation-safety and follow-up after pituitary radiotherapy
If pituitary radiotherapy was used, long-term MRI scans and hormonal checks are needed for years to watch for new deficiencies. Non-pharmacological care includes keeping detailed records of radiation dose and dates and attending follow-up clinics. This surveillance aims to catch changes in tumor size or new pituitary damage early.

18. Support groups and peer communities
Pituitary patient groups (online or local) connect people who live with MPHD, hypopituitarism, or pituitary tumors. Hearing others’ experiences with medicines, school, relationships, and pregnancy helps people feel less alone and often improves confidence in self-management. Many foundations also provide practical tools like symptom diaries and emergency wallet cards.

19. Transition planning from pediatric to adult services
As teenagers grow into adults, care often moves from a children’s hospital to an adult endocrine clinic. Planned “transition” with joint visits, written summaries, and step-by-step education reduces the risk of lost follow-up or missed medicine refills. This stage is especially important for growth hormone, sex hormones, and fertility planning.

20. Lifestyle advice to reduce heart and metabolic risks
Even with good treatment, adults with pituitary hormone deficiencies can have higher risks of heart disease, high cholesterol, and diabetes. Lifestyle measures such as not smoking, limiting processed foods, regular physical activity, and maintaining a healthy weight work together with hormone tablets to lower these risks and protect long-term health.

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Drug treatments

⚠️ Very important: the medicines below are examples used by doctors to replace missing hormones in MPHD. Doses are always individual and must only be changed by a specialist. Do not start, stop, or adjust any of these by yourself.

1. Hydrocortisone tablets (e.g., CORTEF)
Hydrocortisone is a glucocorticoid that replaces cortisol when ACTH from the pituitary is low. Tablets are usually taken two or three times a day to copy the body’s normal morning-higher and evening-lower pattern. Doctors adjust dose based on symptoms, blood pressure, and sodium, and increase it temporarily during illness or surgery (stress dosing). Common side effects at high doses include weight gain, mood changes, high blood pressure, and bone thinning.

2. Prednisone delayed-release tablets (e.g., RAYOS)
Prednisone is another glucocorticoid sometimes used instead of hydrocortisone, particularly in adults who prefer once-daily dosing. Delayed-release tablets are designed to release medicine later in the day, which may help symptoms like morning stiffness or fatigue. Doctors choose the lowest effective dose because long-term over-replacement can cause high blood pressure, diabetes, weight gain, and infection risk.

3. Prednisolone (e.g., Orapred ODT)
Prednisolone is an active glucocorticoid often used in children because it is available as liquid or orally disintegrating tablets. In secondary adrenal insufficiency from MPHD, it can replace cortisol when given once or twice daily as the endocrinologist prescribes. Side effects are similar to other steroids and include tummy upset, mood swings, and, with long use, bone loss and growth suppression if overdosed in children.

4. Levothyroxine sodium tablets (e.g., SYNTHROID, LEVO-T)
Levothyroxine is synthetic T4 thyroid hormone used when the pituitary does not make enough TSH. Tablets are usually taken once daily on an empty stomach, and doses are adjusted using free T4 blood levels rather than TSH in pituitary disease. Too little dose leaves people tired and cold; too much can cause palpitations, weight loss, and bone loss, so regular monitoring is essential.

5. Somatropin injections (e.g., NORDITROPIN and similar)
Somatropin is recombinant human growth hormone (GH) given by subcutaneous injection, usually once daily in the evening. It is used in children with growth failure and in some adults with proven GH deficiency to improve body composition, bone density, and quality of life. Doses are individual and titrated using IGF-1 blood levels and side effects. Possible adverse effects include joint pain, fluid retention, high blood sugar, and, rarely, increased pressure in the brain.

6. Long-acting somatropin formulations
Some newer GH products allow weekly instead of daily injections, aiming for more convenient treatment while maintaining stable IGF-1 levels. The principle is the same—replacing missing GH to support normal growth and metabolism—but injection schedules and side-effect profiles may differ slightly. Doctors decide whether daily or weekly GH is best based on age, lifestyle, and response.

7. Testosterone cypionate injection (e.g., DEPO-Testosterone)
In males with low pituitary gonadotropins (LH/FSH), testosterone cypionate is injected into a muscle every few weeks to replace missing testosterone. It improves libido, erections, muscle mass, red-blood-cell production, and mood. Doctors monitor testosterone levels, blood count, and prostate health in adults, as very high levels can raise the risk of blood clots, acne, mood changes, and prostate problems.

8. Transdermal testosterone (gels or patches)
Testosterone gels or patches deliver hormone through the skin each day, giving more stable levels for some men than injections. They are rubbed on clean, dry skin or applied as a patch in the morning, and blood tests help adjust dose. Side effects include skin irritation, increased red-blood-cell count, and risk of transfer to others through close skin contact if precautions are not followed.

9. Estradiol transdermal patches (e.g., Climara and similar)
In women with low estrogen from pituitary failure, estradiol patches provide steady hormone through the skin and are changed once or twice weekly. They can reduce hot flushes, support bone health, and improve vaginal dryness and mood. Doctors frequently combine estradiol with a progesterone in women who still have a uterus to protect the womb lining, and monitor for side effects like breast tenderness, headache, and rare clotting events.

10. Oral estradiol or combined estrogen-progestin tablets
Some women prefer tablets rather than patches for hormone replacement. Combined estrogen-progestin pills may be used in younger women to give regular withdrawal bleeds and contraception as well as symptom control. Risks include blood clots, high blood pressure, and migraine in some people, so doctors choose the lowest effective dose and review regularly.

11. Progesterone preparations (e.g., vaginal or oral progesterone)
For women receiving estrogen who have not had a hysterectomy, adding progesterone protects the womb lining from overgrowth. This can be given as tablets or vaginal gels in different schedules (for example, 10–14 days each cycle). Side effects may include mood changes, bloating, and breast tenderness. The exact regimen is customised by the gynecologist or endocrinologist.

12. Desmopressin tablets
Desmopressin is a synthetic copy of antidiuretic hormone (ADH) that treats diabetes insipidus when the pituitary does not make enough natural ADH. Low-dose tablets or melts reduce urine volume and night-time urination, helping protect kidneys and sleep. Doctors teach patients not to drink excessive fluids and to watch for signs of water overload, such as headache or confusion, because too high a dose can cause low blood sodium.

13. Desmopressin nasal spray or sublingual tablets (e.g., DDAVP, NOCDURNA)
Some people use desmopressin given as nasal spray or sublingual tablets that dissolve under the tongue. These forms can act faster and may be convenient for people with swallowing problems or who need flexible dosing. Doctors individualise dosage and regularly check blood sodium to balance good urine control with safety.

14. Menotropins for injection (FSH/LH products such as MENOPUR, Repronex)
When MPHD affects fertility, menotropins (purified FSH and LH) can stimulate the ovaries to ripen eggs in women or support sperm production in men, usually together with hCG. These injections are given under close specialist monitoring with ultrasound and hormone tests. Possible side effects include ovarian hyperstimulation syndrome, multiple pregnancy, mood changes, and injection-site reactions.

15. Human chorionic gonadotropin (hCG) injections (e.g., Pregnyl, Novarel, Ovidrel)
hCG acts like LH and is used with other fertility drugs to trigger ovulation in women or stimulate testosterone production and sperm development in men with MPHD. Injections are timed carefully in fertility cycles. Side effects can include local pain, mood changes, and, rarely, ovarian hyperstimulation or multiple pregnancy, so close monitoring is essential.

16. Cabergoline tablets (e.g., DOSTINEX)
If MPHD is linked with a prolactin-secreting pituitary tumour, cabergoline, a dopamine agonist, can shrink the tumor and lower prolactin levels, sometimes improving other pituitary hormone function. It is usually taken once or twice weekly. Common side effects include nausea, headache, dizziness, and low blood pressure on standing; rare long-term risks include heart-valve problems at high doses, so regular follow-up is needed.

17. Fludrocortisone acetate tablets (special situations)
Fludrocortisone is a mineralocorticoid that helps the body keep salt and water. It is mainly used in primary adrenal insufficiency but may occasionally be needed in complex cases where pituitary disease coexists with other adrenal problems. Doses are tiny and adjusted with blood pressure and blood tests for sodium and potassium. Too much fludrocortisone can cause high blood pressure, ankle swelling, and low potassium.

18. Hydrocortisone granules for children (e.g., ALKINDI SPRINKLE)
For infants and young children, tiny hydrocortisone granules in capsules can be sprinkled on food to give accurate low doses when tablets are too big. This allows more precise cortisol replacement and easier stress-dosing during illness. Side effects are similar to other hydrocortisone forms and depend mainly on whether the child receives the right dose.

19. Dopamine agonists and other tumor-targeted drugs
Besides cabergoline, other dopamine agonists (like bromocriptine) or targeted therapies may be used depending on the type of pituitary tumor. These aim to shrink the mass, protect vision, and sometimes improve hormone output, reducing replacement needs. Each medicine has its own side-effect profile, so treatment is personalised in specialist centres.

20. Adjunct medicines for associated conditions (lipids, blood pressure, diabetes)
Because MPHD and its treatments can change blood fats, blood sugar, and blood pressure, many patients also need standard medicines such as statins, blood-pressure tablets, or diabetes drugs. These are not pituitary drugs but help reduce long-term heart and stroke risk. They must be carefully chosen to fit alongside steroid and thyroid replacement.

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Dietary molecular supplements

⚠️ Always ask your endocrinologist before starting any supplement, especially if you take thyroid, steroid, or diabetes medicines.

1. Vitamin D
Vitamin D supports calcium absorption and bone strength, which is especially important when estrogen, testosterone, or growth hormone are low, or when you take long-term steroids. Doctors often recommend daily or weekly vitamin D in doses based on blood levels to reach a safe target range. Too much can cause high calcium, nausea, and kidney problems, so blood tests are important.

2. Calcium
Adequate calcium intake from food or supplements helps keep bones strong and reduces fracture risk in people with MPHD and osteoporosis risk factors. Typical daily needs are met mainly through diet (dairy, fortified plant milks, leafy greens), with tablets added only if food intake is low. Excess calcium without medical advice can lead to kidney stones or constipation.

3. Omega-3 fatty acids (fish oil or algae oil)
Omega-3 fats can help improve blood lipid profile and may reduce inflammation, which is helpful because growth hormone deficiency and some hormone replacements affect cholesterol and triglycerides. Usual supplemental doses are modest and tailored to cardiovascular risk and diet. Side effects may include mild stomach upset or a fishy after-taste, and high doses can slightly increase bleeding risk.

4. Vitamin B12
B12 is important for nerve function, red-blood-cell production, and energy levels. Some people with MPHD may have associated stomach or intestinal issues or dietary patterns that lower B12. Oral tablets or injections can correct deficiency; doses depend on levels and symptoms. Over-the-counter doses are usually safe, but high doses should still be discussed with a doctor.

5. Folate (folic acid or methylfolate)
Folate works with B12 in red-blood-cell production and DNA synthesis. Doctors may check folate if anemia or poor diet is present and recommend supplements if levels are low. It is especially important for people planning pregnancy to reduce certain birth-defect risks. Taking folate without checking B12 can hide some B12-related nerve damage, so coordinated testing is ideal.

6. Iron
Iron is needed to make hemoglobin, which carries oxygen in the blood. Heavy periods, diet, or gastrointestinal issues may cause iron deficiency anemia, worsening fatigue in MPHD. Doctors usually recommend iron only when blood tests confirm deficiency, because excess iron can upset the stomach and damage organs. Iron interacts with levothyroxine, so doses are separated by several hours.

7. Zinc
Zinc is involved in immune function, wound healing, and hormone metabolism. Low zinc from poor diet can worsen hair loss, taste changes, or infection risk. Modest supplementation may be suggested, but excess zinc can cause nausea and lower copper levels, so long-term high doses are not advised without medical supervision.

8. Selenium
Selenium is important for some enzymes that convert T4 to active T3 and protect thyroid tissue from oxidative stress. In patients with thyroid autoimmunity or borderline intake, small selenium supplements may be considered, but data in MPHD are limited. High doses can cause hair loss, brittle nails, and nerve problems, so more is not always better.

9. Magnesium
Magnesium helps with nerve and muscle function, heart rhythm, and energy production. Stress, poor diet, or certain medicines can lower magnesium. Supplements may improve cramps, sleep, or constipation in some people, but high doses may cause diarrhea or, in kidney disease, build-up in the blood. Forms like magnesium citrate or glycinate are often better tolerated.

10. Probiotics and fibre supplements
Because steroids and other medicines can affect gut health and blood sugar, some people find probiotics and soluble fibre helpful for digestion and metabolic balance. Evidence is still growing, so they should be used as an add-on to—not a replacement for—good diet and prescribed drugs. Side effects are usually mild gas or bloating at first.

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Immune-booster, regenerative and stem-cell-related treatments

There are no FDA-approved stem-cell drugs specifically for MPHD. Research is ongoing into stem-cell-based pituitary repair, but this is still experimental and not part of standard care.

1. Optimised hormone replacement as “immune support”
The safest and most effective way to support the immune system in MPHD is to keep cortisol, thyroid, sex hormones, and growth hormone in appropriate ranges. Too little cortisol or thyroid makes you more vulnerable to infections and slows recovery; too much steroid suppresses immunity. Careful dose adjustment with an endocrinologist is therefore the real “immune booster.”

2. Vaccinations and infection-prevention strategy
Standard vaccines (influenza, COVID-19, pneumococcal, etc.) are a key immune-support treatment plan for MPHD, especially in people with adrenal insufficiency, obesity, or diabetes. Having clear rules for early medical review and stress-dose steroids during infections is as important as any drug designed to “boost immunity.”

3. Growth hormone’s regenerative effects
While primarily given for growth and metabolic reasons, growth hormone can improve body composition by increasing lean muscle and reducing fat, which indirectly supports physical resilience. It may also help bone remodeling and cardiovascular risk factors when used correctly. This is not a general “anti-aging” drug and must only be used in proven deficiency.

4. Experimental pituitary cell or stem-cell therapies
Laboratory studies are exploring ways to grow pituitary cells from stem cells and transplant them to restore hormone production. So far, these approaches are in animals or very early research and not used in routine clinical practice. Anyone offering stem-cell “cures” for MPHD outside regulated trials should be viewed with great caution.

5. Regenerative approaches after radiotherapy or surgery
Rehabilitation after pituitary surgery or radiation sometimes includes physical therapy, cognitive training, and psychological support to help the brain adapt and recover function, rather than specific regenerative drugs. These therapies help people regain independence, return to work or school, and manage memory or concentration problems.

6. Avoiding unproven “immune-boosting” supplements or injections
Some products marketed online as immune-boosting or stem-cell-based are unregulated and may interfere with hormone medicines or cause harm. For people with MPHD, sticking to evidence-based hormone replacement, vaccines, and healthy lifestyle changes is safer than trying untested treatments. Always discuss any such products with your endocrinology team.

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Surgeries and procedures

1. Endoscopic transsphenoidal pituitary surgery
If a pituitary tumor or cyst is causing MPHD and compressing nearby structures, surgeons often remove it through the nose using an endoscope. This approach avoids opening the skull and usually has a quicker recovery. The goal is to relieve pressure on the optic nerves and surrounding brain while preserving any remaining healthy pituitary tissue.

2. Transcranial (open) pituitary surgery
For very large or complex tumors that cannot safely be reached through the nose, surgeons may need an open approach through the skull. This is more invasive and has a longer recovery time but can give better access to tumors extending into nearby brain areas. Hormone replacement is almost always needed afterwards and may be lifelong.

3. Stereotactic radiosurgery (e.g., Gamma Knife)
When surgery is risky or tumor tissue remains afterwards, highly focused radiation can be used to control growth. Radiosurgery delivers a strong dose to the tumor while sparing most surrounding brain. Over months to years, it can shrink or stabilise the mass, but it may also gradually reduce pituitary function, so careful hormone monitoring is essential.

4. Conventional fractionated radiotherapy
Some patients receive multiple small doses of radiation over several weeks to treat pituitary tumors. This slower, fractionated approach can be chosen when the tumor is large or close to sensitive structures. It is effective in tumor control but has a high chance of causing or worsening MPHD over time, which is why regular endocrine follow-up is crucial.

5. CSF leak repair and skull-base reconstruction
After pituitary surgery, some patients develop a leak of cerebrospinal fluid (CSF) from the nose. Surgeons may need to repair this with nasal endoscopic techniques and grafts to close the skull-base defect. Repairing leaks prevents meningitis and stabilises the surgical site, supporting long-term pituitary and brain health.

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Prevention of complications

1. Never stop steroid tablets suddenly – always taper under medical supervision and follow sick-day rules during illness.

2. Attend regular endocrine follow-ups to adjust doses as your body changes with age, weight, pregnancy, or other illnesses.

3. Wear a medical alert bracelet and carry an emergency steroid card at all times.

4. Keep vaccinations up to date and seek early treatment for infections.

5. Avoid smoking and limit alcohol, which worsen bone and heart problems already increased in MPHD.

6. Maintain a healthy weight and active lifestyle to reduce diabetes and heart-disease risk.

7. Have regular eye checks if a pituitary mass has ever affected your vision.

8. Monitor bone density and take steps for bone health (vitamin D, calcium, exercise) as advised.

9. Store medicines correctly and check expiry dates, especially hormone injections and steroid tablets.

10. Keep written treatment plans at home and share them with family, school, or workplace so others know what to do in emergencies.

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When to see a doctor or get urgent help

You should contact your endocrinologist or local doctor promptly if you notice new symptoms such as worsening fatigue, dizziness on standing, unexplained weight loss or gain, mood changes, changes in periods or erections, increased thirst and urination, or headaches and visual changes. These may mean your hormone doses need adjusting or that a tumor has changed.

Call emergency services or go to the nearest emergency department (and show your steroid card) if you have severe vomiting and cannot keep medicines down, very low blood pressure, confusion, severe weakness, chest pain, shortness of breath, sudden vision loss, or collapse. These can be signs of adrenal crisis, severe low sodium, or other emergencies needing immediate hospital care and injected steroids.

Because you are a teenager, it is important to involve a parent or trusted adult whenever you feel seriously unwell or worried about your hormones or medicines. They can help communicate with doctors and make sure you get to medical care quickly.

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What to eat and what to avoid

1. Eat regular, balanced meals with a mix of whole grains, lean protein, healthy fats, fruits, and vegetables to support stable energy and blood sugar.

2. Limit sugary drinks and sweets, which cause rapid blood-sugar spikes and crashes and can worsen weight gain linked with low hormones or steroids.

3. Choose high-fibre foods (whole grains, beans, vegetables) to help bowel health and keep you fuller longer.

4. Include calcium-rich foods (dairy or fortified alternatives, leafy greens) daily to support bones affected by low sex hormones, GH, or steroids.

5. Prioritise lean proteins (fish, poultry, eggs, beans, tofu) to maintain muscle, especially if GH is low.

6. Use healthy fats (olive oil, nuts, seeds, avocado) instead of trans-fats and deep-fried foods to protect heart health.

7. Limit very salty processed foods if you have high blood pressure or fluid retention; your doctor will advise if extra salt is ever needed (for some adrenal patients).

8. Avoid crash diets or extreme fasting, which can be dangerous in adrenal insufficiency and may unbalance blood sugar and blood pressure.

9. Be careful with caffeine and energy drinks, which can worsen palpitations, anxiety, and sleep problems already linked to hormone changes.

10. Discuss any special diets (keto, intermittent fasting, bodybuilding supplements) with your endocrinologist before starting, to avoid conflicts with hormone tablets and your overall safety.

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Frequently asked questions

1. Is MPHD the same as hypopituitarism?
MPHD is a type of hypopituitarism where more than one pituitary hormone is low; some people have only one missing hormone, while others have several. The more hormones affected, the more areas of the body are involved, and the more complex the treatment plan becomes.

2. Can MPHD be cured?
In most cases, MPHD cannot be completely cured, especially when it is genetic or due to permanent damage from surgery or radiation. However, hormone-replacement therapy can usually control symptoms very well, allowing many people to study, work, have relationships, and raise families.

3. Will I need hormone medicines for life?
Many patients need lifelong treatment, but some hormone levels can change over time. For example, growth hormone treatment may stop in early adulthood after re-testing, while thyroid or steroid replacement often continues. Doctors may occasionally retest certain hormones to see if replacement is still needed.

4. Can MPHD affect my height and puberty?
Yes. In children and teens, low growth hormone and sex hormones can slow growth and delay puberty, leading to shorter adult height if not treated in time. Early diagnosis and correct hormone replacement help optimise final height and normal sexual development.

5. Is pregnancy possible with MPHD?
Many people with MPHD can become pregnant or help their partner become pregnant with the right combination of hormone replacement and fertility treatments. This usually involves specialist care, careful monitoring, and sometimes injectable fertility medicines. Pregnancy must be managed in a centre familiar with pituitary disease.

6. Will growth hormone make me “too big” or cause cancer?
When used correctly in people with proven GH deficiency, growth hormone aims to restore normal, not excessive, levels. Studies and guidelines show it is generally safe when properly monitored, although people with past tumors need careful follow-up. Doctors avoid GH in active cancer or certain other conditions.

7. What happens if I miss a steroid dose?
Missing a single dose may cause mild tiredness or dizziness in some people, but repeatedly missing or stopping suddenly can lead to adrenal crisis, which is an emergency. If you forget a dose, follow your doctor’s advice (often take it when remembered unless near the next dose) and never stop tablets on your own.

8. Can I play sports or exercise normally?
Most people with MPHD can exercise and even play competitive sports once their hormones are stable. You may need to adjust timing of meals, fluids, and sometimes steroid doses for very intense activities, so discuss training plans with your endocrinology team first.

9. Why do I still feel tired even with treatment?
Tiredness can come from many causes: under-replacement or over-replacement of hormones, sleep problems, mood issues, anemia, or lifestyle factors. Doctors often review all these areas, repeat blood tests, and may involve a psychologist or sleep specialist to understand and treat ongoing fatigue.

10. Is it safe to drink alcohol if I have MPHD?
Small amounts of alcohol may be safe for some adults, but it can worsen low blood sugar, dizziness, and poor judgement about medicines. Heavy drinking is risky, especially if you have adrenal insufficiency or liver problems, and should be avoided. Always ask your doctor what is safe for you personally.

11. What if I need surgery or a dental operation?
People on steroid replacement usually need higher “stress doses” of steroids before and after surgery or invasive dental work. You must tell your surgeon and dentist about your MPHD and steroid use well in advance so they can plan extra steroid cover and monitoring.

12. Can I fast for religious or cultural reasons?
Fasting can be dangerous if you have adrenal insufficiency, diabetes, or need medicines with food. It is essential to discuss any planned fast with your endocrinologist, who may adjust doses or, in some cases, advise against fasting for safety reasons.

13. How often should my blood tests be checked?
The exact schedule depends on which hormones are low and how stable your levels are, but early in treatment tests may be every few weeks or months, then less often once things are stable. Extra tests are done if your symptoms change, you start new medicines, or you have surgery or pregnancy.

14. Can MPHD shorten my life?
Untreated or poorly treated MPHD, especially with adrenal insufficiency, can increase the risk of serious illness or early death. However, with good hormone replacement, emergency planning, and healthy lifestyle changes, many people live normal or near-normal lifespans. Following your treatment plan closely makes a big difference.

15. What should I do right now if I have MPHD and feel confused about my plan?
The best step is to ask your endocrinologist for a clear, written plan that lists your daily doses, sick-day rules, emergency contacts, and when to get blood tests. Bring a family member or trusted adult to appointments so they can help remember the advice. You can also keep a health diary or use an app to track symptoms and questions between visits.

Disclaimer: Each person’s journey is unique, treatment plan, life style, food habit, hormonal condition, immune system, chronic disease condition, geological location, weather and previous medical  history is also unique. So always seek the best advice from a qualified medical professional or health care provider before trying any treatments to ensure to find out the best plan for you. This guide is for general information and educational purposes only. Regular check-ups and awareness can help to manage and prevent complications associated with these diseases conditions. If you or someone are suffering from this disease condition bookmark this website or share with someone who might find it useful! Boost your knowledge and stay ahead in your health journey. We always try to ensure that the content is regularly updated to reflect the latest medical research and treatment options. Thank you for giving your valuable time to read the article.

The article is written by Team RxHarun and reviewed by the Rx Editorial Board Members

Last Updated: February 25, 2025.