eMedicine Specialties > Endocrinology > Pituitary Gland

Hypopituitarism (Panhypopituitarism): Differential Diagnoses & Workup

Author: James R Mulinda, MD, FACP, FACE, Consulting Staff, Department of Endocrinology, Endocrinology Associates, Inc
Contributor Information and Disclosures

Updated: Jul 20, 2009

Differential Diagnoses

Hyponatremia
Pituitary Microadenomas
Hypothyroidism
Polyglandular Autoimmune Syndrome, Type I
Kallmann Syndrome and Idiopathic Hypogonadotropic Hypogonadism
Polyglandular Autoimmune Syndrome, Type II
Pituitary Macroadenomas
Polyglandular Autoimmune Syndrome, Type III

Other Problems to Be Considered

Septo-optic dysplasia

Workup

Laboratory Studies

Hormonal studies should be performed in pairs of target gland and their respective stimulatory pituitary hormone for proper interpretation.6

  • ACTH and Cortrosyn stimulation test
  • TSH and thyroxine
  • FSH, LH, and either estradiol or testosterone (as appropriate for sex)
  • Prolactin
  • GH provocative testing

Imaging Studies

MRI or computed axial tomography of the pituitary

Other Tests

Other tests to ascertain the likely underlying etiology are indicated by the patient's presentation.

Procedures

Cortrosyn stimulation testing

Histologic Findings

Findings depend on etiology (eg, tumors, infiltrations, infections, empty sella).

More on Hypopituitarism (Panhypopituitarism)

Overview: Hypopituitarism (Panhypopituitarism)
Differential Diagnoses & Workup: Hypopituitarism (Panhypopituitarism)
Treatment & Medication: Hypopituitarism (Panhypopituitarism)
Follow-up: Hypopituitarism (Panhypopituitarism)
References
Further Reading
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References

  1. Clayton RN. Mortality, cardiovascular events and risk factors in hypopituitarism. Growth Horm IGF Res. Feb 1998;8 Suppl A:69-76. [Medline].

  2. Santos A, Resmini E, Martínez MA, et al. Quality of life in patients with pituitary tumors. Curr Opin Endocrinol Diabetes Obes. Aug 2009;16(4):299-303. [Medline].

  3. Fernandez A, Brada M, Zabuliene L, et al. Radiation-induced hypopituitarism. Endocr Relat Cancer. Jun 4 2009;[Medline].

  4. de Graaff LC, De Bellis A, Bellastella A, et al. Antipituitary antibodies in Dutch patients with idiopathic hypopituitarism. Horm Res. Jan 2009;71(1):22-7. [Medline].

  5. Fatemi N, Dusick JR, Mattozo C, et al. Pituitary hormonal loss and recovery after transsphenoidal adenoma removal. Neurosurgery. Oct 2008;63(4):709-18; discussion 718-9. [Medline].

  6. Nakamoto J. Laboratory diagnosis of multiple pituitary hormone deficiencies: issues with testing of the growth and thyroid axes. Pediatr Endocrinol Rev. Jan 2009;6 Suppl 2:291-7. [Medline].

  7. Walvoord E. Sex steroid replacement for induction of puberty in multiple pituitary hormone deficiency. Pediatr Endocrinol Rev. Jan 2009;6 Suppl 2:298-305. [Medline].

  8. Constine LS, Woolf PD, Cann D, et al. Hypothalamic-pituitary dysfunction after radiation for brain tumors. N Engl J Med. Jan 14 1993;328(2):87-94. [Medline].

  9. Dexter RN. Hypopituitarism. In: Becker KL, ed. Principles and Practice of Endocrinology and Metabolism. 1995. 2nd ed. Baltimore, Md: Williams and Wilkins; 1995:169-80.

  10. Garcia-Heras J, Kilani RA, Martin RA, Lamp S. A deletion of proximal 20p inherited from a normal mosaic carrier mother in a newborn with panhypopituitarism and craniofacial dysmorphism. Clin Dysmorphol. Jul 2005;14(3):137-40. [Medline].

  11. Harzallah L, Migaw H, Harzallah F, Kraiem Ch. Diabetes insipidus and panhypopituitarism revealing pituitary metastasis of small cell lung carcinoma: a case report. Ann Endocrinol (Paris). Apr 2005;66(2 Pt 1):117-20. [Medline].

  12. Koh WJ, Kwon OJ. Mycobacterium avium complex lung disease and panhypopituitarism. Mayo Clin Proc. Jul 2005;80(7):961-2. [Medline].

  13. Lasheen I, Doi SA, Al-Shoumer KA. Glucocorticoid replacement in panhypopituitarism complicated by myelinolysis. Med Princ Pract. Mar-Apr 2005;14(2):115-7. [Medline].

  14. Thorner MO, Vance ML, Horvath E. The anterior pituitary. In: Williams Textbook of Endocrinology. 8th ed. Philadelphia, Pa: WB Saunders and Co; 1992:221-310.

  15. Vance ML. Hypopituitarism. N Engl J Med. Jun 9 1994;330(23):1651-62. [Medline].

  16. Wolfgang KHO. Hypopituitarism. In: Bardin CW, ed. Current Therapy in Endocrinology and Metabolism. 6th ed. St. Louis, Mo: Mosby-Year Book; 1997:27-31.

  17. Yamakita N, Yasuda K. Pulmonary Mycobacterium avium complex infection in patients with panhypopituitarism not receiving hormone replacement therapy. Mayo Clin Proc. Feb 2005;80(2):291. [Medline].

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Keywords

hypopituitarism, panhypopituitarism, pituitary, human hormone, growth hormone, pituitary gland, endocrine system, hormone replacement, pituitary adenoma, hypothalamus, growth hormone deficiency, pituitary hormone, tumor pituitary gland, pituitary tumors, pituitary glands
 
adrenocorticotropic hormone, ACTH, corticotropin, follicle-stimulating hormone, FSH, luteinizing hormone, LH, prolactin, thyroid-stimulating hormone, TSH, thyrotropin, antidiuretic hormone, ADH, pituitary insufficiency, lack of trophic stimulus

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Contributor Information and Disclosures

Author

James R Mulinda, MD, FACP, FACE, Consulting Staff, Department of Endocrinology, Endocrinology Associates, Inc
James R Mulinda, MD, FACP, FACE is a member of the following medical societies: American College of Clinical Endocrinologists and American College of Physicians
Disclosure: Nothing to disclose.

Medical Editor

David S Schade, MD, Chief, Division of Endocrinology and Metabolism, Professor, Department of Internal Medicine, University of New Mexico School of Medicine and Health Sciences Center
David S Schade, MD is a member of the following medical societies: American College of Physicians, American Diabetes Association, American Federation for Medical Research, Endocrine Society, New Mexico Medical Society, New York Academy of Sciences, and Society for Experimental Biology and Medicine
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Don S Schalch, MD, Professor Emeritus, Department of Internal Medicine, Division of Endocrinology, University of Wisconsin Hospitals and Clinics
Don S Schalch, MD is a member of the following medical societies: American Diabetes Association, American Federation for Medical Research, Central Society for Clinical Research, and Endocrine Society
Disclosure: Nothing to disclose.

CME Editor

Mark Cooper, MBBS, PhD, FRACP, Head, Diabetes & Metabolism Division, Baker Heart Research Institute, Professor of Medicine, Monash University
Disclosure: Nothing to disclose.

Chief Editor

George T Griffing, MD, Professor of Medicine, St Louis University School of Medicine
George T Griffing, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Medical Practice Executives, American College of Physician Executives, American College of Physicians, American Diabetes Association, American Federation for Medical Research, American Heart Association, Central Society for Clinical Research, Endocrine Society, International Society for Clinical Densitometry, and Southern Society for Clinical Investigation
Disclosure: Nothing to disclose.

 
 
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