Hypothalamic Insufficiency: The Cause of Hypopituitarism in Sarcoidosis

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Abstract
Patients with generalized sarcoidosis and hypopituitarism were studied; 6 of the 10 presented with sarcoid involvement of the optic nerves resulting in asymmetric visual field defects. All patients had deficiencies of 2 or more anterior pituitary hormones and 7 had abnormalities of water metabolism. Despite hypopituitarism, 9 patients had a pituitary responsive to the synthetic hypothalamic releasing factors, thyrotropin releasing hormone and gonadotropin releasing hormone, and the 10th patient had a partially responsive pituitary. The demonstration of pituitary responsiveness suggested that hypothalamic insufficiency was the major cause for hypopituitarism in these patients. The combination of visual field defects and hypopituitarism in sarcoidosis is a medically treatable condition that simulates the clinic presentation of a pituitary tumor.