小结
定义
病史和体格检查
关键诊断因素
- history of pituitary or hypothalamic disease
- history of traumatic brain injury
- headaches
- faltering growth or short stature
- infertility
- hypoglycemia
- amenorrhea/oligomenorrhea
- galactorrhea
- delayed puberty
- family history of pituitary hormone deficiencies
- hypotension
- visual field defects
- ophthalmoplegia
其他诊断因素
- cardiovascular events
- cold intolerance
- weight gain
- erectile dysfunction and reduced libido
- nausea
- vomiting
- fatigue
- weakness
- dizziness
- constipation
- dry skin
- delayed relaxation of reflexes
- hypoactive sexual desire
- hot flashes
- nocturia and polyuria
- breast atrophy
- reduced bone and muscle mass
- loss of axillary and pubic hair
危险因素
- pituitary tumor
- pituitary apoplexy
- pituitary surgery
- cranial radiation
- traumatic brain injury
- genetic predisposition
- inflammatory disorders
- hypothalamic disease
- severe postpartum hemorrhage (Sheehan syndrome)
- empty sella syndrome
- tuberculous meningitis
- syphilis
诊断性检查
首要检查
- serum electrolytes
- serum and urine osmolarity
- 8 a.m. cortisol and adrenocorticotropic hormone
- thyroid function tests
- 8 a.m. testosterone, follicle-stimulating hormone, and luteinizing hormone in men
- estradiol, follicle-stimulating hormone, and luteinizing hormone in women
- prolactin
- insulin-like growth factor-1
- cosyntropin stimulation test
需考虑的检查
- insulin tolerance test
- water deprivation and desmopressin response test
- MRI pituitary
- CT pituitary
- metyrapone testing of the adrenal axis
治疗流程
pituitary apoplexy
hypopituitarism
撰稿人
作者
Bridget Sinnott, MD

Professor of Medicine
Medical College of Georgia
Augusta
GA
利益声明
BS declares that she has no competing interests.
鸣谢
Dr Bridget Sinnott would like to gratefully acknowledge Dr Vidhi Shah, the previous contributor to this topic.
利益声明
VS declares that she has no competing interests.
同行评议者
Amir Hamrahian, MD
Associate Program Director
Department of Endocrinology, Diabetes and Metabolism
Cleveland Clinic
Cleveland
OH
利益声明
AH declares that he has no competing interests.
Andrew James, BSc, MB BCh, MD, MRCP, FRCP
Consultant Endocrinologist
Newcastle Hospitals NHS Foundation Trust
Royal Victoria Infirmary
Newcastle
UK
利益声明
AJ declares that he has no competing interests.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
参考文献
关键文献
Fleseriu M, Christ-Crain M, Langlois F, et al. Hypopituitarism. Lancet. 2024 Jun 15;403(10444):2632-48. 摘要
Freda PU, Beckers AM, Katznelson L, et al. Pituitary incidentaloma: an endocrine society clinical practice guideline. J Clin Endocrinol Metab. 2011 Apr;96(4):894-904.全文 摘要
Fleseriu M, Hashim IA, Karavitaki N, et al. Hormonal replacement in hypopituitarism in adults: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2016 Oct 13;101(11):3888-921.全文 摘要
Bhasin S, Brito JP, Cunningham GR, et al. Testosterone therapy in men with hypogonadism: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2018 May 1;103(5):1715-44.全文 摘要
Yuen KCJ, Biller BMK, Radovick S, et al. American Association of Clinical Endocrinologists and American College of Endocrinology guidelines for management of growth hormone deficiency in adults and patients transitioning from pediatric to adult care. Endocr Pract. 2019 Nov;25(11):1191-232.全文 摘要
参考文献
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
鉴别诊断
- Addison disease
- Primary hypothyroidism
- Shock (cardiogenic or septic)
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