Gonadal hormone replacement in hypopituitarism

Hypogonadism is common in patients with hypopituitarism. Replacement therapy is required to restore muscle, bone and sexual function. The target gland hormones are replaced, rather than the pituitary hormone (with the exception of gonadotrophin therapy for induction of fertility). In men, gonadal hormone replacement is indicated indefinitely. In women, it is indicated at least up to the age of 50 years, after which the need for continued therapy can be re-assessed on an individual basis.

Hormone replacement therapy in premenopausal women with hypopituitarism constitutes physiological replacement, and has not been associated with the adverse effects seen in postmenopausal women (eg breast cancer).

Transdermal estrogen has a lower risk of venous thromboembolism than oral estrogen. It also preserves growth hormone sensitivity compared with oral estrogen, allowing the use of a lower dose of somatropin to treat coexisting growth hormone deficiency.

For detailed information about gonadal hormone replacement therapy, see Treatment of amenorrhoea and Approach to testosterone replacement therapy.