Last reviewed: June 2019
Last updated: May  2019

Summary

Definition

History and exam

Key diagnostic factors

  • presence of risk factors
  • weakness
  • fatigue
  • cold intolerance
Full details

Other diagnostic factors

  • decreased memory
  • constipation
  • muscle cramps
  • weight gain
  • depression
  • dry, coarse skin
  • oligomenorrhoea/amenorrhoea
  • bradycardia
  • reduced body and scalp hair
  • delayed relaxation of deep tendon reflexes
  • hearing impairment
  • impassive facial expression
  • diabetes insipidus (DI)
  • headache
  • diplopia
  • decreased peripheral vision
  • skin depigmentation
  • atrophic breasts
  • galactorrhoea
Full details

Risk factors

  • multiple endocrine neoplasia (MEN) type I
  • age - between 5-14 years and older than 65 (craniopharyngiomas)
  • age - second to fifth decades (prolactinomas)
  • age - fourth to eighth decades (non-functioning pituitary adenomas)
  • sarcoidosis
  • head and neck irradiation
  • traumatic brain injury (TBI)
  • histiocytosis
  • haemochromatosis
  • pregnancy
  • family history of central hypothyroidism
Full details

Diagnostic investigations

1st investigations to order

  • serum free thyroxine (T4)
  • serum thyroid-stimulating hormone (TSH)
Full details

Investigations to consider

  • MRI of brain
  • CT head
  • prolactin (PRL)
  • 9 a.m. serum cortisol
  • serum testosterone
  • serum gonadotrophins
  • genetic analyses
Full details

Treatment algorithm

ONGOING

all patients

Contributors

Authors VIEW ALL

Consultant Endocrinologist

King's College Hospital NHS Foundation Trust

London

UK

Disclosures

JG declares that she has no competing interests.

Dr Jacqueline Gilbert would like to gratefully acknowledge Dr Rasa Zarnegar, a previous contributor to this topic. 

Peer reviewers VIEW ALL

Assistant Professor

Department of Endocrine Surgery

Columbia University

New York

NY

Disclosures

JL declares that he has no competing interests.

Director of Clinical Endocrinology

Beth Israel Deaconess Medical Center

Boston

MA

Disclosures

JVH declares that he has no competing interests.

Sir Arthur Hall Professor of Medicine/Pro Vice Chancellor

University of Sheffield

Sheffield

UK

Disclosures

AW declares that he has no competing interests.

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