When viewing this topic in a different language, you may notice some differences in the way the content is structured, but it still reflects the latest evidence-based guidance.

Hypopituitarism

  • Overview
  • Theory
  • Diagnosis
  • Management
  • Follow up
  • Resources
Last reviewed: 8 Apr 2025
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
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

Disclosures

AJ declares that he has no competing interests.

References

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.

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 Differentials

  • Guidelines

    • Hypothalamic-pituitary and growth disorders in survivors of childhood cancer
    • Testosterone therapy in men with hypogonadism
    More Guidelines

  • Patient information

    Fertility problems: some reasons

    Fertility problems: questions to ask your doctor

    More Patient information
  • padlock-lockedLog in or subscribe to access all of BMJ Best Practice

Use of this content is subject to our disclaimer