Hypopituitarism (Panhypopituitarism) Differential Diagnoses

Updated: Nov 10, 2022
  • Author: Ricardo R Correa Marquez, MD, EsD, FACP, FACE, FAPCR, CMQ, ABDA, FACHT; Chief Editor: Romesh Khardori, MD, PhD, FACP  more...
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Diagnostic Considerations

A diagnosis of hypopituitarism may be missed if apparently normal pituitary hormone levels are interpreted with respective subnormal target organ hormone levels. Adrenal insufficiency should be treated upon suspicion and definitive diagnosis made posttherapy. Blood could be drawn to measure serum cortisol and ACTH prior to initiating glucocorticoid therapy. Adrenal replacement should precede thyroxine (T4) replacement to avoid a possible acute cortisol insufficiency state.

Hypopituitarism may manifest several years after radiation exposure and in chronic Sheehan syndrome. In acute pituitary failure, as in Sheehan syndrome, the ACTH stimulation test may be normal because the adrenal glands are not atrophied in the acute setting, requiring at least 3 months.

Differential Diagnoses