Hypopituitarism

Last updated: Tuesday, 14, December, 2010
CausesAppropriate Tests

Diagnosis and evaluation may involve assay of pituitary or target gland hormones.

Dynamic stimulation tests may assist to evaluate hormone reserves: insulin hypoglycaemia stimulation test is usually sufficient; rarely, stimulation tests using gonadotrophin releasing hormones are occasionally of value - consult pathologist.

Panhypopituitarism

 Patients may have clinical or radiological evidence of a space occupying lesion in the pituitary fossa.

They may present initially with deficiency of a single hormone: prolactin, testosterone (in males), LH, FSH (in post-menopausal females), TSH, thyroxine (free), cortisol.

Non-functioning tumours

  • Adenoma
  • Craniopharyngioma
  • Meningioma
  • Germinoma
  • Metastatic carcinoma

Functioning tumours

  • Prolactinoma
  • Gonadotroph adenoma

 


Alpha subunit - this may be the main secretory product of the tumour.

Hypothalamic disorders 

  • Tumour
  • Birth asphyxia
  • Histiocytosis

See also Pituitary/hypothalamic disorders

Vascular disorders

  • Post-partum necrosis (Sheehan's syndrome)

Post-traumatic

Post-hypophysectomy

Post-irradiation

Septo-optic dysplasia

Granulomas

  • Sarcoidosis
  • Tuberculosis

Empty sella syndrome

Genetic

Single hormone deficiency

May be the presenting feature of any cause of panhypopituitarism, however single hormone deficiency can occur and is usually genetic.

Growth hormone

Growth hormone stimulation test.

See Short stature
  • Idiopathic 
  • Genetic 
  • Psychosocial dwarfism 
  • Laron dwarfism 

IGF-I

Growth hormone resistance, rather than deficiency; growth hormone levels are usually high.

TSH

See also Hypothyroidism
  • Genetic 

LH, FSH

See also Infertility and Testicular failure
  • Kallmann syndrome
  • Genetic

ACTH

See also Adrenocortical insufficiency
  • Genetic