Presentation Symptoms depend on specific hormone deficiency ↓ FSH/LH impotence (males), amenorrhea (females) late-onset puberty (children) ↓ GH growth delay (children) muscle wasting (adults) hypoglycemia (adults) GH normally gluconeogenic ↓ TSH weakness constipation cold intolerance Evaluation FSH/LH GnRH stimulation test no change in FSH/LH release in hypopituitarism see ↑ in cases of hypothalamic causes GH Arginine and sleep stimulation tests no change in GH release in hypopituitarism GH normally released at maximum rate at 5 AM TSH TRF stimulation no change in TSH release in hypopituitarism ACTH metyrapone test inhibitor of adrenal 11-hydroxylase normally results in ↓ conversion of 11-deoxycortisol to cortisol consequent ↑ in ACTH release and ↑ in 11-deoxycortisol proximal to the inhibited enzymes in cases of hypopituitarism there is no ↑ in ACTH or 11-deoxycortisol in adrenal disease there is an ↑ in ACTH but not 11-deoxycortisol