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Hypopituitarism
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Hypopituitarism

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Contributors: Shanna Yang, Marilyn Augustine MD, Abhijeet Waghray MD
Other Resources UpToDate PubMed

Synopsis

Hypopituitarism is a rare condition characterized by deficient pituitary hormone resulting from damage to the pituitary gland (primary hypopituitarism) or from damage to the hypothalamus or pituitary stalk (secondary hypopituitarism). The most common cause in adults is pituitary tumors or adenomas. Other causes include sellar / parasellar tumors (usually craniopharyngiomas), inflammation, infection, surgery, radiation, traumatic brain injury, subarachnoid hemorrhage, and postpartum pituitary necrosis (also known as Sheehan syndrome). Causes of secondary hypopituitarism include inflammatory hypophysitis and germ cell tumors.

Patients usually have involvement of just one or some pituitary hormones, although they can also have deficiency of all pituitary hormones (panhypopituitarism). Onset is typically insidious and may go unrecognized by the patient. Rarely, onset may be acute and require immediate attention. Clinical signs and symptoms depend on specific pituitary hormones affected.

Codes

ICD10CM:
E23.0 – Hypopituitarism

SNOMEDCT:
74728003 – Hypopituitarism

Look For

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Diagnostic Pearls

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Differential Diagnosis & Pitfalls

ACTH deficiency:
  • Exogenous glucocorticoid usage, which suppresses ACTH release
  • Primary adrenal insufficiency with secondary increase in ACTH release
    • ACTH does not cause salt wasting, volume contraction, or hyperkalemia due to lack of clinically significant aldosterone deficiency
    • ACTH deficiency does not result in hyperpigmentation
  • Congenital adrenal hyperplasia, most commonly due to 21-hydroxylase deficiency
TSH deficiency: Gonadotropin deficiency:
  • Women – Primary hypogonadism from primary ovarian insufficiency / premature ovarian failure; normal menstrual cycle excludes hypopituitarism
  • Men – Primary hypogonadism, such as from Klinefelter syndrome, or primary testicular failure
GH deficiency:
  • Increased central adiposity, which typically blunts GH response to any stimulus
  • Children – Other causes of growth failure including chronic systemic disease, congenital hypothyroidism, Turner syndrome (in females), and skeletal disorders
ADH deficiency:
  • Psychogenic polydipsia: urine osmolality > 800 mOsm/kg after fluid deprivation (excludes ADH deficiency)

Best Tests

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Management Pearls

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Therapy

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Drug Reaction Data

Below is a list of drugs with literature evidence indicating an adverse association with this diagnosis. The list is continually updated through ongoing research and new medication approvals. Click on Citations to sort by number of citations or click on Medication to sort the medications alphabetically.

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References

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Last Reviewed: 02/06/2019
Last Updated: 02/25/2019
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Hypopituitarism
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Hypopituitarism : Fatigue, Headache, Nausea/vomiting, Areflexia, Hyponatremia, Sparse body hair, Weight loss, HR decreased, BP decreased, Hypocortisolism
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