Internal Medicine

0521779407-09 CUNY1086/Karliner 0 521 77940 7 June 13, 2007 7:54

Hypopituitarism 797

Signs & Symptoms

■Fatigue, lethargy

■Headache, cachexia

■Altered mental status, coma

■Cold intolerance

■Constipation

■Diminished pubic, axillary hair

■Inability to lactate

■Increased adiposity, decreased lean tissue

■Orthostatic hypotension

■Polydipsia, polyuria, nocturia

■Impotence

■Decreased libido

■Hypoglycemia

■Dry, pale, wrinkled skin

■Visual field defect

tests

Laboratory

■Basic blood studies:

➣LH, FSH, prolactin, free T4, TSH, testosterone

➣Cortisol after Cosyntropin or insulin tolerance test

➣Electrolytes, glucose

➣Urinalysis

➣Insulin-like growth factor-I (IGF-I)

➣Growth hormone (GH)

■Ancillary blood test: estradiol

Imaging

■MRI of pituitary and brain

differential diagnosis

■Pituitary tumor: nonsecretory, prolactinoma, acromegaly, Cushing

syndrome;

➣Usually causes partial or complete anterior pituitary insuffi-

ciency

➣Most common deficiencies: GH > LH, FSH > TSH, ACTH

■Pituitary apoplexy

■Hypothalamic mass: craniopharyngioma, dysgerminoma, metas-

tases

➣Usually causes diabetes insipidus