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Updated: Dec 25 2015

General Hypopituitarism

  • 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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