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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
 

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