Last reviewed: 23 Dec 2021
Last updated: 06 Dec 2018



History and exam

Key diagnostic factors

  • presence of risk factors
  • headaches
  • failure to thrive or short stature
  • infertility
  • hypoglycaemia
  • amenorrhoea/oligomenorrhoea
  • galactorrhoea
  • delayed puberty
  • family history of pituitary hormone deficiencies
  • hypotension
  • visual field defects
  • ophthalmoplegia

Other diagnostic factors

  • 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 flushes
  • nocturia and polyuria
  • breast atrophy
  • reduced bone and muscle mass
  • loss of axillary and pubic hair

Risk factors

  • pituitary tumour
  • pituitary apoplexy
  • pituitary surgery
  • cranial radiation
  • traumatic brain injury
  • genetic defects
  • inflammatory disorders
  • hypothalamic disease
  • severe postpartum haemorrhage (Sheehan syndrome)
  • empty sella syndrome
  • tuberculous meningitis
  • syphilis

Diagnostic investigations

1st investigations to order

  • serum electrolytes
  • serum and urine osmolarity
  • 8 a.m. cortisol and adrenocorticotrophic hormone
  • thyroid function tests
  • 8 a.m. testosterone, follicle-stimulating hormone, and luteinising hormone in men
  • estradiol, follicle-stimulating hormone, and luteinising hormone in women
  • prolactin
  • insulin-like growth factor-1
  • cosyntropin/tetracosactide stimulation test

Investigations to consider

  • insulin tolerance test
  • water deprivation and desmopressin response test
  • MRI pituitary
  • CT pituitary
  • metyrapone testing of the adrenal axis

Treatment algorithm



Bridget Sinnott, MD
Bridget Sinnott

Associate Professor of Medicine

Medical College of Georgia




BS declares that she has no competing interests.


Dr Bridget Sinnott would like to gratefully acknowledge Dr Vidhi Shah, the previous contributor to this monograph.


VS declares that she has no competing interests.

Peer reviewers

Amir Hamrahian, MD

Associate Program Director

Department of Endocrinology, Diabetes and Metabolism

Cleveland Clinic




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




AJ declares that he has no competing interests.

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