History
Presentation varies from asymptomatic to acute collapse, depending on the etiology, rapidity of onset, and predominant hormones involved. Initially, a patient with any hormone deficiency may be asymptomatic. Individuals with the following deficiencies present with the indicated condition:
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ACTH deficiency - Adrenal (cortisol) insufficiency
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TSH deficiency - Hypothyroidism
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Gonadotropin deficiency - Hypogonadism
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GH deficiency - Failure to thrive and short stature in children; most adults are asymptomatic, but some may experience fatigue, weakness, alteration in body composition (increased fat mass relative to lean body mass), and decreased quality of life.
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ADH deficiency - Polyuria and polydipsia
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Prolactin deficiency - Impaired lactation after delivery
Other presenting features may be attributable to the underlying cause. A patient with a space-occupying lesion may present with headaches, double-vision, or visual-field deficits. A patient with large lesions involving the hypothalamus may present with polydipsia/polyuria or, rarely, syndrome of inappropriate secretion of antidiuretic hormone (SIADH).
Physical Examination
Physical examination findings may be normal in subtle presentations. Patients may present with features attributable to deficiency of target hormones, including hypothyroidism (with a small, soft thyroid gland), adrenal insufficiency, hypogonadism (with small, soft testes in men), and failure to thrive. In women, loss of adrenal and ovarian function results in loss of all androgens; loss of axillary and pubic hair may result.
In the stable patient, with the diverse complaints associated with hypopituitarism, a complete physical examination, including thyroid palpation, genital inspection, and ophthalmic examination, can support the diagnosis of hypopituitarism. During the neurologic and ophthalmic examinations, check specifically for visual acuity, extraocular movements, and bitemporal hemianopsia. Also look for evidence of hormonal hypersecretion due to a large functioning adenoma, such as signs of Cushing disease, acromegaly, or galactorrhea.
