Last reviewed: 5 Oct 2024
Last updated: 26 Jan 2022
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 defects
- 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/tetracosactide 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
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.
Differentials
- Addison disease
- Primary hypothyroidism
- Shock (cardiogenic or septic)
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