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Hypopituitarism

Last reviewed: 15 Oct 2025
Last updated: 20 Jun 2025

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
Full details

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
Full details

Risk factors

  • 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
Full details

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 stimulation test
Full details

Tests to consider

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

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

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

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

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

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