Management of acute hypopituitarism
Acute hypopituitarism can be precipitated by intercurrent illness (eg vomiting, dehydration), infection or trauma in patients with hypopituitarism. Other causes of acute hypopituitarism include acute head injury, Sheehan syndrome (pituitary infarction associated with peripartum blood loss) and pituitary apoplexy.
Common presenting features of acute hypopituitarism include:
- altered mental state
- orthostatic hypotension
- fever
- hyponatraemia
- hypoglycaemia.
Collect samples for measuring plasma glucose and serum electrolyte concentrations before starting treatment. For patients with severe signs or symptoms, start glucocorticoid replacement without waiting for laboratory results. For adults, use:
hydrocortisone 100 mg intravenously, then 50 mg every 6 hours until stable and tolerating oral intake. hypopituitarism, acute (adult) hydrocortisone hydrocortisone hydrocortisone
Acute hypopituitarism is rare in children. For a neonate or child within the normal weight range for their age1, use:
hydrocortisone hypopituitarism, acute (child) hydrocortisone
neonate or child up to 6 weeks: 25 mg intravenously or intramuscularly, initially, then 5 to 10 mg intravenously or intramuscularly, 6-hourly until stable and tolerating oral intake
child 6 weeks to 3 years: 25 mg intravenously or intramuscularly, initially, then 10 mg intravenously or intramuscularly, 6-hourly until stable and tolerating oral intake
child 3 to 7 years: 50 mg intravenously or intramuscularly, initially, then 12.5 mg intravenously or intramuscularly, 6-hourly until stable and tolerating oral intake
child 7 to 12 years: 50 mg intravenously or intramuscularly, initially, then 25 mg intravenously or intramuscularly, 6-hourly until stable and tolerating oral intake.
For children outside the normal weight range for their age1, use:
hydrocortisone 50 to 75 mg/m2 intravenously or intramuscularly, initially, then 12.5 to 18.75 mg/m2 intravenously or intramuscularly, 6-hourly until stable and tolerating oral intake2. hydrocortisone
Higher doses may be needed in very sick children.
Switch to oral therapy when oral intake is tolerated. For patients with a pre-existing diagnosis of hypopituitarism, reduce the dose to the usual maintenance dose over 2 to 3 days (see glucocorticoid replacement for information about maintenance dosing). Patients without a pre-existing diagnosis should be assessed to establish the cause and guide further management.
Fluid replacement with intravenous sodium chloride 0.9%, and correction of hypoglycaemia (if present) are important aspects of management. Severe hyponatraemia can also occur, usually as a consequence of glucocorticoid deficiency; see Hyponatraemia for management advice.