Hypopituitarism

Last reviewed: 15 Jul 2022
Last updated: 26 Jan 2022

Summary

Definition

History and exam

Key diagnostic factors

  • presence of risk factors
  • headaches
  • faltering growth or short stature
  • infertility
  • hypoglycaemia
  • amenorrhoea/oligomenorrhoea
  • galactorrhoea
  • delayed puberty
  • family history of pituitary hormone deficiencies
  • hypotension
  • visual field defects
  • ophthalmoplegia
More key diagnostic factors

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
Other diagnostic factors

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
More risk factors

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
More 1st investigations to order

Investigations to consider

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

Treatment algorithm

INITIAL

pituitary apoplexy

ONGOING

hypopituitarism

Contributors

Authors

Bridget Sinnott, MD
Bridget Sinnott

Professor of Medicine

Medical College of Georgia

Augusta

GA

Disclosures

BS declares that she has no competing interests.

Acknowledgements

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

Disclosures

VS declares that she has no competing interests.

Peer reviewers

Amir Hamrahian, MD

Associate Program Director

Department of Endocrinology, Diabetes and Metabolism

Cleveland Clinic

Cleveland

OH

Disclosures

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

Disclosures

AJ declares that he has no competing interests.

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