Resumen
Definición
Anamnesis y examen
Principales factores de diagnóstico
- 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
Otros factores de diagnóstico
- 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
Factores de riesgo
- 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
Pruebas diagnósticas
Primeras pruebas diagnósticas para solicitar
- 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
Pruebas diagnósticas que deben considerarse
- insulin tolerance test
- water deprivation and desmopressin response test
- MRI pituitary
- CT pituitary
- metyrapone testing of the adrenal axis
Algoritmo de tratamiento
pituitary apoplexy
hypopituitarism
Colaboradores
Autores
Bridget Sinnott, MD

Professor of Medicine
Medical College of Georgia
Augusta
GA
Divulgaciones
BS declares that she has no competing interests.
Agradecimientos
Dr Bridget Sinnott would like to gratefully acknowledge Dr Vidhi Shah, the previous contributor to this topic.
Divulgaciones
VS declares that she has no competing interests.
Revisores por pares
Amir Hamrahian, MD
Associate Program Director
Department of Endocrinology, Diabetes and Metabolism
Cleveland Clinic
Cleveland
OH
Divulgaciones
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
Divulgaciones
AJ declares that he has no competing interests.
Agradecimiento de los revisores por pares
Los temas de BMJ Best Practice se actualizan de forma continua de acuerdo con los desarrollos en la evidencia y en las guías. Los revisores por pares listados aquí han revisado el contenido al menos una vez durante la historia del tema.
Divulgaciones
Las afiliaciones y divulgaciones de los revisores por pares se refieren al momento de la revisión.
Referencias
Artículos principales
Fleseriu M, Christ-Crain M, Langlois F, et al. Hypopituitarism. Lancet. 2024 Jun 15;403(10444):2632-48. Resumen
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.Texto completo Resumen
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.Texto completo Resumen
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.Texto completo Resumen
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.Texto completo Resumen
Artículos de referencia
Una lista completa de las fuentes a las que se hace referencia en este tema está disponible para los usuarios con acceso a todo BMJ Best Practice.
Diferenciales
- Addison disease
- Primary hypothyroidism
- Shock (cardiogenic or septic)
Más DiferencialesGuías de práctica clínica
- Hypothalamic-pituitary and growth disorders in survivors of childhood cancer
- Testosterone therapy in men with hypogonadism
Más Guías de práctica clínicaFolletos para el paciente
Fertility problems: some reasons
Fertility problems: questions to ask your doctor
Más Folletos para el pacienteInicie sesión o suscríbase para acceder a todo el BMJ Best Practice
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