Key messages

• Growth hormone therapy improves the metabolic and functional abnormalities associated with growth hormone deficiency in adults. Growth hormone as a therapeutic strategy to improve the catabolic state of critical illness is currently under intense investigation and should still be considered experimental.

• Treatment of corticotropin deficiency is lifesaving and therefore takes precedence over that of all other anterior pituitary hormones. The goal is to restore the eucortisol state, which is achieved by hydrocortisone administration, intravenously in critical care conditions.

• Treatment of thyrotropin deficiency is achieved by administration of thyroxine associated with the more active metabolite tri-iodothyronine in critical care conditions and in case myxedema-like coma is present.

• Treatment of gonadotropin deficiency in men is partially achieved by replacing the gonadal steroid testosterone which has been shown to improve the negative nitrogen balance associated with male hypogonadism.

• Substitution therapy of hyopituitarism with glucocorticoids, growth hormone, thyroid hormones, and eventually androgens prevents evolution to a life-threatening condition and optimizes the potential for recovery from intercurrent illnesses.

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