This protocol covers the management of hypopituitarism presenting with central adrenal insufficiency caused by ACTH deficiency — a specific clinical scenario in which inadequate cortisol secretion arises at the pituitary level.

Clinical Scenario

Central adrenal insufficiency in this setting represents inadequate cortisol secretion due to ACTH deficiency. The treatment approach in hypopituitarism is shaped directly by this underlying mechanism.

Treatment Approach

Management centres on glucocorticoid replacement; hydrocortisone is the principal agent used. The complete dosing framework — including whether a single or divided schedule is appropriate and how each option is structured throughout the day — is available in the full protocol.

References

DOI: 10.1210/jc.2016-2118

Central AI represents inadequate cortisol secretion due to ACTH deficiency.
We recommend using HC, usually 15–20 mg total daily dose in single or divided doses.
Patients using divided doses should take the highest dose in the morning at awakening and the second in the afternoon (two-dose regime) or the second and third at lunch and late afternoon, respectively (three-dose regime).
We suggest using longer-acting GCs in selected cases (eg, nonavailability, poor compliance, convenience).

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Treatment of Hypopituitarism in Central (Secondary) Adrenal Insufficiency Due to ACTH Deficiency