Last reviewed: February 2020
Last updated: December
2018
Summary
Definition
History and exam
Key diagnostic factors
- history of pituitary or hypothalamic disease
- history of traumatic brain injury
- headaches
- failure to thrive 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 investigations
1st investigations 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
Investigations to consider
- insulin tolerance test
- water deprivation and desmopressin response test
- MRI pituitary
- CT pituitary
- metyrapone testing of the adrenal axis
Treatment algorithm
Contributors
Authors
Associate Professor of Medicine
Medical College of Georgia
Augusta
GA
Disclosures
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.
Peer reviewers
Associate Program Director
Department of Endocrinology, Diabetes and Metabolism
Cleveland Clinic
Cleveland
OH
Disclosures
AH declares that he has no competing interests.
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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