Hypopituitarism

Hypopituitarism

Hypopituitarism	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 eg
Prolactinoma
Gonadotroph adenoma	Alpha subunit - this may be the main secretory product of the tumour.
Hypothalamic disorders eg	See also Pituitary/hypothalamic disorders .
Tumour
Birth asphyxia
Histiocytosis
Vascular disorders eg
Post-partum necrosis (Sheehan’s syndrome)
Post-traumatic
Post-hypophysectomy
Post-irradiation
Septo-optic dysplasia
Granulomas eg
Sarcoidosis
Tuberculosis
Empty sella syndrome
Genetic eg
Familial panhypopituitarism
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 .
Idiopathic
Genetic
Psychosocial dwarfism
Laron dwarfism	IGF-I . Growth hormone resistance, rather than deficiency; growth hormone levels are usually high.
TSH
Genetic
LH, FSH
Kallmann syndrome
Genetic
ACTH
Genetic