Last reviewed: June 2020
Last updated: December  2018



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
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


Bridget Sinnott

Associate Professor of Medicine

Medical College of Georgia




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 reviewersVIEW ALL

Associate Program Director

Department of Endocrinology, Diabetes and Metabolism

Cleveland Clinic




AH declares that he has no competing interests.

Consultant Endocrinologist

Newcastle Hospitals NHS Foundation Trust

Royal Victoria Infirmary




AJ declares that he has no competing interests.

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