Recognition
- GH deficiency (adults): Reduced muscle mass, increased central adiposity, fatigue, decreased exercise tolerance, reduced bone density
- TSH deficiency (central hypothyroidism): Fatigue, cold intolerance, constipation, dry skin, weight gain — same clinical picture as primary hypothyroidism
- ACTH deficiency (secondary adrenal insufficiency): Fatigue, hypotension, nausea, weight loss. Key distinction: NO hyperpigmentation (unlike primary Addison disease, where elevated ACTH causes pigmentation)
- Gonadotropin deficiency (LH/FSH): Amenorrhea, loss of libido, sexual dysfunction, infertility, osteoporosis
- Prolactin deficiency: Inability to lactate postpartum (Sheehan syndrome)
- Mass effect symptoms: Headache and bitemporal hemianopsia (visual field defects from pituitary adenoma compressing the optic chiasm)
- Multiple hormone replacements (levothyroxine, hydrocortisone, GH injections, sex hormones) on the medication list
MT Relevance
- ACTH deficiency (secondary adrenal insufficiency) is the primary safety risk — cortisol-dependent stress response is compromised. Sessions should not be excessively physically or emotionally taxing. Confirm the client has taken their hydrocortisone on the day of treatment.
- Adrenal crisis risk: Sudden severe hypotension, nausea, confusion, loss of consciousness — do not mistake for vasovagal syncope. Call 911
- Orthostatic hypotension: Clients with ACTH deficiency have baseline low blood pressure — slow repositioning is essential
- Osteoporosis/reduced bone density: GH deficiency reduces bone density. Avoid deep pressure over the spine, ribs, and pelvis. Adjust to tissue tolerance
- Fatigue: Very common — keep sessions within the client's comfortable energy envelope. Avoid overstimulating the nervous system
- Hormone replacement complexity: Clients on multiple hormonal replacements — review medications carefully at each visit. Some affect coagulation, tissue quality, or cardiovascular response
- Pituitary surgery history: If the client has had transsphenoidal surgery or cranial radiation, be aware of any specific head/neck restrictions from their medical team
Required Actions
- Adrenal crisis signs (severe hypotension, confusion, nausea, collapse): Call 911 — do not dismiss as vasovagal syncope
- New visual changes (visual field loss, double vision) in a client with pituitary history: Urgent referral — may indicate tumor growth or recurrence
- Client has not taken hydrocortisone: Postpone the session
Key Takeaways
- Hypopituitarism is deficiency of one or more anterior pituitary hormones — pan-hypopituitarism affects all
- ACTH deficiency (secondary adrenal insufficiency) is the primary safety risk — cortisol-dependent stress response is compromised. Know adrenal crisis signs
- GH deficiency causes fatigue, decreased muscle mass, and osteoporosis — reduce pressure and pace sessions to tolerance
- Clients are often on multiple hormone replacements with various MT implications (hypotension, tissue fragility, coagulation effects)
- Distinguish from primary endocrine failure: no hyperpigmentation in secondary adrenal insufficiency, and the deficit is central (pituitary) not glandular