Summary
Definition
History and exam
Key diagnostic factors
- 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
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 flashes
- nocturia and polyuria
- breast atrophy
- reduced bone and muscle mass
- loss of axillary and pubic hair
Risk factors
- pituitary tumor
- pituitary apoplexy
- pituitary surgery
- cranial radiation
- traumatic brain injury
- genetic defects
- inflammatory disorders
- hypothalamic disease
- severe postpartum hemorrhage (Sheehan syndrome)
- empty sella syndrome
- tuberculous meningitis
- syphilis
Diagnostic tests
1st tests to order
- 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/tetracosactide stimulation test
Tests to consider
- insulin tolerance test
- water deprivation and desmopressin response test
- MRI pituitary
- CT pituitary
- metyrapone testing of the adrenal axis
Treatment algorithm
pituitary apoplexy
hypopituitarism
Contributors
Authors
Bridget Sinnott, MD
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.
References
Key articles
Prabhakar VK, Shalet SM. Aetiology, diagnosis and management of hypopituitarism in adult life. Postgrad Med J. 2006 Apr;82(966):259-66. Abstract
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.Full text Abstract
Tritos NA, Yuen KC, Kelly DF; AACE Neuroendocrine and Pituitary Scientific Committee. American Association of Clinical Endocrinologists and American College of Endocrinology disease state clinical review: a neuroendocrine approach to patients with traumatic brain injury. Endocr Pract. 2015 Jul;21(7):823-31. Abstract
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.Full text Abstract
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.Full text Abstract
Van Aken MO, Lamberts SWJ. Diagnosis and treatment of hypopituitarism: an update. Pituitary. 2005;8(3-4):183-91. Abstract
Cook DM, Yuen KC, Biller BM, et al. American Association of Clinical Endocrinologists medical guidelines for clinical practice for growth hormone use in growth hormone-deficient adults and transition patients: 2009 update. Endocr Pract. 2009 Sep-Oct;15 Suppl 2:1-29. Abstract
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
Differentials
- Addison disease
- Primary hypothyroidism
- Shock (cardiogenic or septic)
More DifferentialsGuidelines
- Hypothalamic-pituitary and growth disorders in survivors of childhood cancer
- Testosterone therapy in men with hypogonadism
More GuidelinesPatient information
Fertility problems: some reasons
Fertility problems: questions to ask your doctor
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