Materiały źródłowe

• #1 Diagnosis and Treatment of Hypopituitarism

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4722397/

  Hypopituitarism can be easily diagnosed by measuring basal pituitary and target hormone levels except growth hormone (GH) and adrenocorticotropic hormone (ACTH) deficiency. […] Dynamic stimulation tests are indicated in equivocal basal hormone levels and GH/ACTH deficiency. […] The diagnosis of hypopituitarism is made by measuring basal hormone levels in the morning fasting status or performing stimulation tests if necessary. […] Six anterior pituitary hormones (GH, prolactin, LH, FSH, TSH, and ACTH) as well as target hormones can be measured via sensitive and reliable immunoassay techniques. […] Other pituitary hormones except GH and ACTH deficiency can be diagnosed with basal hormone measurement. […] The expected values and responses of the pituitary gland and target organ hormones under basal and stimulated states are provided in Table 4.

• #2 Diagnosis and Treatment of Hypopituitarism

  https://www.e-enm.org/journal/view.php?doi=10.3803/enm.2015.30.4.443

  Hypopituitarism can be easily diagnosed by measuring basal pituitary and target hormone levels except growth hormone (GH) and adrenocorticotropic hormone (ACTH) deficiency. […] Dynamic stimulation tests are indicated in equivocal basal hormone levels and GH/ACTH deficiency. […] The diagnosis of hypopituitarism is made by measuring basal hormone levels in the morning fasting status or performing stimulation tests if necessary. […] Six anterior pituitary hormones (GH, prolactin, LH, FSH, TSH, and ACTH) as well as target hormones can be measured via sensitive and reliable immunoassay techniques. […] Other pituitary hormones except GH and ACTH deficiency can be diagnosed with basal hormone measurement. […] Measurement of basal hormone levels is sufficient for the differentiation of hypopituitarism from primary target organ hormone deficiency.

• #3 Diagnosis and Treatment of Hypopituitarism

  https://www.e-enm.org/journal/view.php?doi=10.3803/enm.2015.30.4.443

  Hypopituitarism can be easily diagnosed by measuring basal pituitary and target hormone levels except growth hormone (GH) and adrenocorticotropic hormone (ACTH) deficiency. […] Dynamic stimulation tests are indicated in equivocal basal hormone levels and GH/ACTH deficiency. […] The diagnosis of hypopituitarism is made by measuring basal hormone levels in the morning fasting status or performing stimulation tests if necessary. […] Six anterior pituitary hormones (GH, prolactin, LH, FSH, TSH, and ACTH) as well as target hormones can be measured via sensitive and reliable immunoassay techniques. […] Other pituitary hormones except GH and ACTH deficiency can be diagnosed with basal hormone measurement. […] Measurement of basal hormone levels is sufficient for the differentiation of hypopituitarism from primary target organ hormone deficiency.

• #4 Diagnosis and Treatment of Hypopituitarism

  https://e-enm.org/DOIx.php?id=10.3803/enm.2015.30.4.443

  Hypopituitarism can be easily diagnosed by measuring basal pituitary and target hormone levels except growth hormone (GH) and adrenocorticotropic hormone (ACTH) deficiency. […] Dynamic stimulation tests are indicated in equivocal basal hormone levels and GH/ACTH deficiency. […] The diagnosis of hypopituitarism is made by measuring basal hormone levels in the morning fasting status or performing stimulation tests if necessary. […] Six anterior pituitary hormones (GH, prolactin, LH, FSH, TSH, and ACTH) as well as target hormones can be measured via sensitive and reliable immunoassay techniques. […] Other pituitary hormones except GH and ACTH deficiency can be diagnosed with basal hormone measurement. […] Measurement of basal hormone levels is sufficient for the differentiation of hypopituitarism from primary target organ hormone deficiency.

• #5 An Update on Advances in Hypopituitarism: Etiology, Diagnosis, and Current Management

  https://www.mdpi.com/2077-0383/13/20/6161

  In the initial evaluation of a patient with suspected HP, the anterior pituitary hormones and their peripheral hormones (ACTH, cortisol, TSH and free T4, FSH, LH, testosterone in men and estradiol in women, PRL, GH, and insulin-like growth factor-1 (IGF-1) should be assessed. […] The main clinical manifestations and diagnostic approaches to hormone deficiencies in HP are summarized in Table 2. […] The diagnosis of central or secondary hypothyroidism is made by evaluating serum free T4 and TSH levels. […] The diagnosis of hypogonadotropic hypogonadism in the male adult is made by an initial clinical evaluation for symptoms and signs of hypogonadism and determination of serum levels of total testosterone, LH, and FSH on at least two different days, in the absence of acute/subacute illness and preferably before 10 a.m., after an overnight fast combined with serum PRL.

• #6 Hormone Replacement in Hypopituitarism Guideline Resources | Endocrine Society

  https://www.endocrine.org/clinical-practice-guidelines/hormone-replacement-in-hypopituitarism

  The 2016 guideline addresses: […] Diagnosis and evaluation of multiple pituitary hormonal deficiency (hypopituitarism) […] Accurate and reliable measurements are central to diagnose hypopituitarism and monitoring therapies. […] 1.1 We suggest measuring serum cortisol levels at 89 AM as the first-line test for diagnosing central adrenal insufficiency (AI). (2|) […] 1.6 We recommend measuring serum free T4 (fT4) and TSH to evaluate central hypothyroidism (CH). An fT4 level below the laboratory reference range in conjunction with a low, normal, or mildly elevated TSH in the setting of pituitary disease usually confirms a CH diagnosis. (1|) […] 1.9 In patients with suspected GH deficiency (GHD), we recommend GH stimulation testing. Single GH measurements are not helpful. (1|) […] 1.12 In males with suspected hypogonadism, we recommend measuring serum T, FSH, and LH to diagnose central hypogonadism. (1|)

• #7 Hypopituitarism | Choose the Right Test

  https://arupconsult.com/content/hypopituitarism

  If hypopituitarism is suspected, evaluations should be performed for all hormones released by the pituitary gland. […] Dynamic testing for gonadotropin-releasing hormone (GnRH) does not provide useful diagnostic information. […] A deficiency in AVP, also referred to as antidiuretic hormone (ADH) or arginine vasopressin hormone (AVH), can result in diabetes insipidus. […] Initial testing for diabetes insipidus should include measurements for urine osmolality, serum osmolality, and sodium levels. […] If results are inconclusive or suggest diabetes insipidus, a water deprivation test, long considered the standard diagnostic test for diabetes insipidus, should be performed.

• #8 Hypopituitarism – Pituitary Foundation

  https://www.pituitary.org.uk/information/hypopituitarism/

  When the hormone controlling concentration of the urine is lost (arginine vasopressin, AVP), the individual is unable to concentrate their urine and passes large amounts of dilute urine. […] The initial test to look at this would mean a blood and urine test, with nothing to drink overnight if possible, to look at the concentration of salts in the blood and urine (osmolality). […] This will show if the kidneys are concentrating urine appropriately. […] In some cases it is not possible to do this having not had a drink overnight due to the degree of urine being passed. […] Where there is any doubt further tests involving a stimulation test, or measuring urine volume and levels of salt in the blood and urine under controlled supervision and whilst not drinking fluids can be undertaken to confirm the diagnosis.

• #9 Diagnosis and Treatment of Hypopituitarism

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4722397/

  Hypopituitarism can be easily diagnosed by measuring basal pituitary and target hormone levels except growth hormone (GH) and adrenocorticotropic hormone (ACTH) deficiency. […] Dynamic stimulation tests are indicated in equivocal basal hormone levels and GH/ACTH deficiency. […] The diagnosis of hypopituitarism is made by measuring basal hormone levels in the morning fasting status or performing stimulation tests if necessary. […] Six anterior pituitary hormones (GH, prolactin, LH, FSH, TSH, and ACTH) as well as target hormones can be measured via sensitive and reliable immunoassay techniques. […] Other pituitary hormones except GH and ACTH deficiency can be diagnosed with basal hormone measurement. […] The expected values and responses of the pituitary gland and target organ hormones under basal and stimulated states are provided in Table 4.

• #10 Diagnosis and treatment of hypopituitarism: an update – PubMed

  https://pubmed.ncbi.nlm.nih.gov/16508719/

  Diagnosis and treatment of patients with hypopituitarism needs careful clinical evaluation and individual optimization. […] Diagnosis of hypopituitarism can be straightforward by measuring reduced basal hormone levels. […] Frequently, dynamic stimulation tests are indicated in equivocal basal hormone levels or to diagnose partial hormone deficiencies. […] Knowledge of the use and limitations of these dynamic tests is mandatory for proper interpretation. […] In the present overview, the principles of diagnosis and treatment of hypopituitarism are discussed.

• #11 Generalized Hypopituitarism – Endocrine and Metabolic Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/endocrine-and-metabolic-disorders/pituitary-disorders/generalized-hypopituitarism

  The short ACTH stimulation test is a safer and less labor-intensive test for cortisol deficiency than the insulin tolerance test. […] Neither the short ACTH stimulation test nor the insulin tolerance test alone will differentiate between primary (Addison disease) and secondary (hypopituitary) adrenal insufficiency. […] The corticotropin-releasing hormone (CRH) test is done to distinguish between primary, secondary (pituitary), and tertiary (hypothalamic) causes of adrenal insufficiency. […] Prolactin levels are routinely measured. […] Measurement of basal levels of LH and FSH is most helpful in evaluating hypopituitarism in postmenopausal women not taking exogenous estrogens in whom circulating gonadotropin concentrations are normally high. […] Screening for GH deficiency in adults is not recommended unless there is suspicion of pituitary damage due to trauma, surgery, or radiation and GH treatment is contemplated.

• #12 Hypopituitarism (Panhypopituitarism) Differential Diagnoses

  https://emedicine.medscape.com/article/122287-differential

  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 post therapy. Blood could be drawn to measure serum cortisol and ACTH prior to initiating glucocorticoid therapy. […] 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.

• #13 Generalized Hypopituitarism – Endocrine and Metabolic Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/endocrine-and-metabolic-disorders/pituitary-disorders/generalized-hypopituitarism

  The short ACTH stimulation test is a safer and less labor-intensive test for cortisol deficiency than the insulin tolerance test. […] Neither the short ACTH stimulation test nor the insulin tolerance test alone will differentiate between primary (Addison disease) and secondary (hypopituitary) adrenal insufficiency. […] The corticotropin-releasing hormone (CRH) test is done to distinguish between primary, secondary (pituitary), and tertiary (hypothalamic) causes of adrenal insufficiency. […] Prolactin levels are routinely measured. […] Measurement of basal levels of LH and FSH is most helpful in evaluating hypopituitarism in postmenopausal women not taking exogenous estrogens in whom circulating gonadotropin concentrations are normally high. […] Screening for GH deficiency in adults is not recommended unless there is suspicion of pituitary damage due to trauma, surgery, or radiation and GH treatment is contemplated.

• #14 Hypopituitarism Diagnostics Market Size & Demand 2025-2035

  https://www.futuremarketinsights.com/reports/hypopituitarism-diagnostics-market

  The market for hypopituitarism diagnostics is anticipated to grow exponentially in the forecast period of 2025 to 2035, driven by increasing diagnostic technology, endocrine disorder awareness, and a rise in diseases of the pituitary gland. […] Some of the tests used in identifying adrenal function and deficiency of pituitary hormones are insulin tolerance tests and ACTH stimulation tests. […] The increased use of automated immunoassays and artificial intelligence-based diagnostic systems is also increasing accuracy and efficiency. […] Hormone stimulation tests are the biggest market in the hypopituitarism diagnosis category because they provide accurate pituitary gland function information. […] Insulin tolerance test (ITT) is still the gold standard for assessing adrenal and growth hormone deficiency in hypopituitarism suspicion.

• #15 Generalized Hypopituitarism – Endocrine and Metabolic Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/endocrine-and-metabolic-disorders/pituitary-disorders/generalized-hypopituitarism

  The short ACTH stimulation test is a safer and less labor-intensive test for cortisol deficiency than the insulin tolerance test. […] Neither the short ACTH stimulation test nor the insulin tolerance test alone will differentiate between primary (Addison disease) and secondary (hypopituitary) adrenal insufficiency. […] The corticotropin-releasing hormone (CRH) test is done to distinguish between primary, secondary (pituitary), and tertiary (hypothalamic) causes of adrenal insufficiency. […] Prolactin levels are routinely measured. […] Measurement of basal levels of LH and FSH is most helpful in evaluating hypopituitarism in postmenopausal women not taking exogenous estrogens in whom circulating gonadotropin concentrations are normally high. […] Screening for GH deficiency in adults is not recommended unless there is suspicion of pituitary damage due to trauma, surgery, or radiation and GH treatment is contemplated.

• #16 An Update on Advances in Hypopituitarism: Etiology, Diagnosis, and Current Management

  https://www.mdpi.com/2077-0383/13/20/6161

  The diagnosis of GHD should include clinical evaluation, serum IGF-1 quantification, and GH stimulation testing. […] The diagnosis of hypoprolactinemia is not clearly defined and may vary depending on the criteria used. […] If AVP deficiency is suspected, it is recommended to measure natremia and plasma osmolality. […] The presence of hypoprolactinemia at the time of diagnosis of pituitary apoplexy would indicate a greater degree of destruction of the pituitary parenchyma and, therefore, a lower probability of recovery of pituitary hormone function. […] The insulin tolerance test (ITT) is the most sensitive test for assessing pituitary ACTH reserve. […] The presence of copeptin levels > 21.4 pmol/L indicates AVP resistance. […] The diagnosis of AVP deficiency is established when the post-stimulation copeptin level is ≤4.9 pmol/L after administration of hypertonic saline or ≤3 pmol/L after administration of arginine.

• #17 Hypopituitarism – Pituitary Foundation

  https://www.pituitary.org.uk/information/hypopituitarism/

  When the hormone controlling concentration of the urine is lost (arginine vasopressin, AVP), the individual is unable to concentrate their urine and passes large amounts of dilute urine. […] The initial test to look at this would mean a blood and urine test, with nothing to drink overnight if possible, to look at the concentration of salts in the blood and urine (osmolality). […] This will show if the kidneys are concentrating urine appropriately. […] In some cases it is not possible to do this having not had a drink overnight due to the degree of urine being passed. […] Where there is any doubt further tests involving a stimulation test, or measuring urine volume and levels of salt in the blood and urine under controlled supervision and whilst not drinking fluids can be undertaken to confirm the diagnosis.

• #18 Hypopituitarism | Choose the Right Test

  https://arupconsult.com/content/hypopituitarism

  If hypopituitarism is suspected, evaluations should be performed for all hormones released by the pituitary gland. […] Dynamic testing for gonadotropin-releasing hormone (GnRH) does not provide useful diagnostic information. […] A deficiency in AVP, also referred to as antidiuretic hormone (ADH) or arginine vasopressin hormone (AVH), can result in diabetes insipidus. […] Initial testing for diabetes insipidus should include measurements for urine osmolality, serum osmolality, and sodium levels. […] If results are inconclusive or suggest diabetes insipidus, a water deprivation test, long considered the standard diagnostic test for diabetes insipidus, should be performed.

• #19 Hormone Replacement in Hypopituitarism Guideline Resources | Endocrine Society

  https://www.endocrine.org/clinical-practice-guidelines/hormone-replacement-in-hypopituitarism

  The 2016 guideline addresses: […] Diagnosis and evaluation of multiple pituitary hormonal deficiency (hypopituitarism) […] Accurate and reliable measurements are central to diagnose hypopituitarism and monitoring therapies. […] 1.1 We suggest measuring serum cortisol levels at 89 AM as the first-line test for diagnosing central adrenal insufficiency (AI). (2|) […] 1.6 We recommend measuring serum free T4 (fT4) and TSH to evaluate central hypothyroidism (CH). An fT4 level below the laboratory reference range in conjunction with a low, normal, or mildly elevated TSH in the setting of pituitary disease usually confirms a CH diagnosis. (1|) […] 1.9 In patients with suspected GH deficiency (GHD), we recommend GH stimulation testing. Single GH measurements are not helpful. (1|) […] 1.12 In males with suspected hypogonadism, we recommend measuring serum T, FSH, and LH to diagnose central hypogonadism. (1|)

• #20 Hypopituitarism – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/hypopituitarism/diagnosis-treatment/drc-20351648

  Several tests can check hormone levels in the body and look for the cause of problems with the way the pituitary is working. These include: […] Blood tests. These tests measure levels of the hormones made in the pituitary gland and those made in glands that the pituitary controls, such as the thyroid gland. Blood tests can show if low hormone levels are due to the pituitary not working as it should. […] Stimulation or dynamic testing. A clinic that specializes in endocrine conditions can run these tests to measure hormone levels. These tests check the body’s hormone levels before and after taking medicines that cause the body to make hormones. […] Brain imaging. MRI or CT scans of the brain can show a pituitary tumor or other pituitary gland problems.

• #21 Diagnosis and Treatment of Hypopituitarism

  https://www.e-enm.org/journal/view.php?doi=10.3803/enm.2015.30.4.443

  However, sellar magnetic resonance imaging (MRI) can distinguish pituitary diseases from hypothalamic diseases, and treatment is not different. […] Thus, differentiation pituitary diseases from hypothalamic diseases may not be necessary. […] ACTH deficiency can be treated with either hydrocortisone or prednisolone, which is a synthetic corticosteroid drug. […] TSH deficiency is treated with L-thyroxine (T4). […] For patients with hypogonadotropic hypogonadism, it is important to consider both gonad steroid replacement treatment and fertility. […] GH replacement treatment is generally only utilized in children with growth disorder due to GH deficiency. […] The administration of GH also seems to influence the metabolism rates of hydrocortisone and T4 such that the doses of these drugs need to be adjusted upward. […] The diagnosis of posterior pituitary hormone deficiency can be easily made through a review of clinical symptoms/signs and a water deprivation test.

• #22 Diagnostic testing for hypopituitarism – UpToDate

  https://www.uptodate.com/contents/diagnostic-testing-for-hypopituitarism/print

  Diagnostic testing for hypopituitarism […] The diagnosis of hypopituitarism, defined as deficient secretion of one or more pituitary hormones because of pituitary or hypothalamic disease, is made by documenting subnormal secretion of these pituitary hormones in defined circumstances. Each pituitary hormone must be tested separately since there is a variable pattern of hormone deficiency among patients with hypopituitarism. Diagnostic testing for hypopituitarism will be discussed here. […] The impetus to measure pituitary hormones is the suspicion that the secretion of one or more may be subnormal. This suspicion can be based upon the knowledge that the patient has either a lesion known to cause hypopituitarism or a symptom known to be caused by hypopituitarism. […] Hormonal hyposecretion should be evaluated in any patient who has a discrete sellar mass ≥1 cm or diffuse enlargement of the pituitary of any size.

• #23 Hypopituitarism – Hormonal and Metabolic Disorders – Merck Manual Consumer Version

  https://www.merckmanuals.com/home/hormonal-and-metabolic-disorders/pituitary-gland-disorders/hypopituitarism

  Symptoms of hypopituitarism depend on what hormone is deficient and may include short height, infertility, intolerance to cold, fatigue, and an inability to produce breast milk. […] The diagnosis is based on measuring the blood levels of hormones produced by the pituitary gland and on imaging tests done on the pituitary gland. […] An evaluation usually begins by measuring blood levels of the hormones that the pituitary gland produces (typically, thyroid-stimulating hormone, prolactin, luteinizing hormone, and follicle-stimulating hormone) and at the same time measuring levels of the hormone produced by the target organs (typically, thyroid hormone, testosterone in men, and estrogen in women). […] Once hypopituitarism is established by blood tests, the pituitary gland is usually evaluated with computed tomography (CT) or magnetic resonance imaging (MRI) to identify structural problems.

• #24 Diagnostic testing for hypopituitarism – UpToDate

  https://www.uptodate.com/contents/diagnostic-testing-for-hypopituitarism/print

  To test basal ACTH secretion, we suggest measuring a morning serum cortisol (at 8 to 9 AM), and the results should be interpreted as follows: Low — A serum cortisol value of ≤3 mcg/dL (83 nmol/L, normal range 5 to 25 mcg/dL [138 to 690 nmol/L]), confirmed by a second determination, is strong evidence of cortisol deficiency, which in a patient with a disorder known to cause hypopituitarism is usually the result of that disorder.

• #25 Diagnostic testing for hypopituitarism – UpToDate

  https://www.uptodate.com/contents/diagnostic-testing-for-hypopituitarism

  For normal health, the basal secretion of corticotropin (ACTH) must be sufficient to maintain the serum cortisol concentration within the normal range. […] To test basal ACTH secretion, we suggest measuring a morning serum cortisol (at 8 to 9 AM), and the results should be interpreted as follows: A serum cortisol value of ≤3 mcg/dL (83 nmol/L, normal range 5 to 25 mcg/dL [138 to 690 nmol/L]), confirmed by a second determination, is strong evidence of cortisol deficiency, which in a patient with a disorder known to cause hypopituitarism is usually the result of that disorder.

• #26 The clinical laboratory’s role in diagnosis and management of hypopituitarism | Medical Laboratory Observer

  https://www.mlo-online.com/continuing-education/article/21110537/the-clinical-laboratorys-role-in-diagnosis-and-management-of-hypopituitarism

  The clinical laboratory is central to the diagnosis and management of many endocrine disorders. […] This report, inspired by recent clinical practice guidelines, describes the clinical laboratory’s role in the diagnosis and management of patients with hypopituitarism, an often-underestimated endocrine disorder. […] Clinical laboratory tests are central to both diagnosis and management. However, the diagnosis of hypopituitarism can be difficult, and evidence suggests it is often missed with significant morbidities. In addition to clinical diagnosis, laboratory measurements of pituitary hormones are central to confirming and establishing diagnosis of hypopituitarism, and of monitoring replacement therapy. […] Patients suspected of adrenal insufficiency secondary to hypopituitary is confirmed by measuring serum cortisol at 89 AM as the first line tests for the diagnosis of central adrenal insufficiency where a level 15ug/dL excludes adrenal insufficiency.

• #27 Generalized Hypopituitarism – Endocrine and Metabolic Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/endocrine-and-metabolic-disorders/pituitary-disorders/generalized-hypopituitarism

  The short ACTH stimulation test is a safer and less labor-intensive test for cortisol deficiency than the insulin tolerance test. […] Neither the short ACTH stimulation test nor the insulin tolerance test alone will differentiate between primary (Addison disease) and secondary (hypopituitary) adrenal insufficiency. […] The corticotropin-releasing hormone (CRH) test is done to distinguish between primary, secondary (pituitary), and tertiary (hypothalamic) causes of adrenal insufficiency. […] Prolactin levels are routinely measured. […] Measurement of basal levels of LH and FSH is most helpful in evaluating hypopituitarism in postmenopausal women not taking exogenous estrogens in whom circulating gonadotropin concentrations are normally high. […] Screening for GH deficiency in adults is not recommended unless there is suspicion of pituitary damage due to trauma, surgery, or radiation and GH treatment is contemplated.

• #28 Diagnosis and Treatment of Hypopituitarism

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4722397/

  It is widely accepted that maximum serum cortisol levels can be observed after the administration of doses of ACTH much lower than the usual dose of 250 g that is given in the rapid ACTH test. […] TSH deficiency can be easily distinguished from primary hypothyroidism in cases where the TSH level increases inordinately. […] In many cases, it is possible to diagnose gonadotropin deficiency using a basal hormone test and an evaluation of clinical symptoms. […] When diagnosing GH deficiency in adult patients, the basal GH concentration is not considered to be valuable but measures of insulin-like growth factor 1 (IGF-1) may be of some use, although they are not sufficient themselves. […] The diagnosis of posterior pituitary hormone deficiency can be easily made through a review of clinical symptoms/signs and a water deprivation test. […] It is advisable to re-evaluate pituitary gland functionality 2 to 3 months after an operation because, although most hypopituitarism symptoms are irreversible, a patient may recover some of level of function.

• #29 Hormone Replacement in Hypopituitarism Guideline Resources | Endocrine Society

  https://www.endocrine.org/clinical-practice-guidelines/hormone-replacement-in-hypopituitarism

  The 2016 guideline addresses: […] Diagnosis and evaluation of multiple pituitary hormonal deficiency (hypopituitarism) […] Accurate and reliable measurements are central to diagnose hypopituitarism and monitoring therapies. […] 1.1 We suggest measuring serum cortisol levels at 89 AM as the first-line test for diagnosing central adrenal insufficiency (AI). (2|) […] 1.6 We recommend measuring serum free T4 (fT4) and TSH to evaluate central hypothyroidism (CH). An fT4 level below the laboratory reference range in conjunction with a low, normal, or mildly elevated TSH in the setting of pituitary disease usually confirms a CH diagnosis. (1|) […] 1.9 In patients with suspected GH deficiency (GHD), we recommend GH stimulation testing. Single GH measurements are not helpful. (1|) […] 1.12 In males with suspected hypogonadism, we recommend measuring serum T, FSH, and LH to diagnose central hypogonadism. (1|)

• #30 Diagnosis and Treatment of Hypopituitarism

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4722397/

  It is widely accepted that maximum serum cortisol levels can be observed after the administration of doses of ACTH much lower than the usual dose of 250 g that is given in the rapid ACTH test. […] TSH deficiency can be easily distinguished from primary hypothyroidism in cases where the TSH level increases inordinately. […] In many cases, it is possible to diagnose gonadotropin deficiency using a basal hormone test and an evaluation of clinical symptoms. […] When diagnosing GH deficiency in adult patients, the basal GH concentration is not considered to be valuable but measures of insulin-like growth factor 1 (IGF-1) may be of some use, although they are not sufficient themselves. […] The diagnosis of posterior pituitary hormone deficiency can be easily made through a review of clinical symptoms/signs and a water deprivation test. […] It is advisable to re-evaluate pituitary gland functionality 2 to 3 months after an operation because, although most hypopituitarism symptoms are irreversible, a patient may recover some of level of function.

• #31 The clinical laboratory’s role in diagnosis and management of hypopituitarism | Medical Laboratory Observer

  https://www.mlo-online.com/continuing-education/article/21110537/the-clinical-laboratorys-role-in-diagnosis-and-management-of-hypopituitarism

  In patients suspected of GH deficiency, whereas a single random measurement is not helpful, use of body mass index (BMI) adjusted GH peak levels is recommended. […] In patients suspected of secondary hypogonadism, measurement of FSH and LH, as well as prolactin either before 10 AM (after an overnight fast), confirms the diagnosis in males. […] Diagnosis and management of hypopituitarism requires clinical laboratory support. Currently available laboratory methodologies, although usable for most, suffer from significant interferences.

• #32 An Update on Advances in Hypopituitarism: Etiology, Diagnosis, and Current Management

  https://www.mdpi.com/2077-0383/13/20/6161

  In the initial evaluation of a patient with suspected HP, the anterior pituitary hormones and their peripheral hormones (ACTH, cortisol, TSH and free T4, FSH, LH, testosterone in men and estradiol in women, PRL, GH, and insulin-like growth factor-1 (IGF-1) should be assessed. […] The main clinical manifestations and diagnostic approaches to hormone deficiencies in HP are summarized in Table 2. […] The diagnosis of central or secondary hypothyroidism is made by evaluating serum free T4 and TSH levels. […] The diagnosis of hypogonadotropic hypogonadism in the male adult is made by an initial clinical evaluation for symptoms and signs of hypogonadism and determination of serum levels of total testosterone, LH, and FSH on at least two different days, in the absence of acute/subacute illness and preferably before 10 a.m., after an overnight fast combined with serum PRL.

• #33 Hormone Replacement in Hypopituitarism Guideline Resources | Endocrine Society

  https://www.endocrine.org/clinical-practice-guidelines/hormone-replacement-in-hypopituitarism

  1.14 In the presence of oligomenorrhea or amenorrhea, we recommend measuring serum estradiol (E2), FSH, and LH. […] 1.17 We recommend simultaneously measuring serum and urine osmolarity in patients with polyuria (more than 50 mL/kg of body weight/24 hours, 3.5 L/d in a 70-kg person). […] 2.0 Treatment […] 2.1 We recommend using HC, usually 1520 mg total daily dose in single or divided doses. […] 2.6 We recommend L-T4 in doses sufficient to achieve serum fT4 levels in the mid to upper half of the reference range. […] 2.9 We suggest T replacement for adult males with central hypogonadism and no contraindications in order to prevent anemia related to T deficiency; reduce fat mass; and improve bone mineral density (BMD), libido, sexual function, energy levels, sense of well-being, and muscle mass and strength. (2|)

• #34 Diagnosis and Treatment of Hypopituitarism

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4722397/

  It is widely accepted that maximum serum cortisol levels can be observed after the administration of doses of ACTH much lower than the usual dose of 250 g that is given in the rapid ACTH test. […] TSH deficiency can be easily distinguished from primary hypothyroidism in cases where the TSH level increases inordinately. […] In many cases, it is possible to diagnose gonadotropin deficiency using a basal hormone test and an evaluation of clinical symptoms. […] When diagnosing GH deficiency in adult patients, the basal GH concentration is not considered to be valuable but measures of insulin-like growth factor 1 (IGF-1) may be of some use, although they are not sufficient themselves. […] The diagnosis of posterior pituitary hormone deficiency can be easily made through a review of clinical symptoms/signs and a water deprivation test. […] It is advisable to re-evaluate pituitary gland functionality 2 to 3 months after an operation because, although most hypopituitarism symptoms are irreversible, a patient may recover some of level of function.

• #35 Hormone Replacement in Hypopituitarism Guideline Resources | Endocrine Society

  https://www.endocrine.org/clinical-practice-guidelines/hormone-replacement-in-hypopituitarism

  The 2016 guideline addresses: […] Diagnosis and evaluation of multiple pituitary hormonal deficiency (hypopituitarism) […] Accurate and reliable measurements are central to diagnose hypopituitarism and monitoring therapies. […] 1.1 We suggest measuring serum cortisol levels at 89 AM as the first-line test for diagnosing central adrenal insufficiency (AI). (2|) […] 1.6 We recommend measuring serum free T4 (fT4) and TSH to evaluate central hypothyroidism (CH). An fT4 level below the laboratory reference range in conjunction with a low, normal, or mildly elevated TSH in the setting of pituitary disease usually confirms a CH diagnosis. (1|) […] 1.9 In patients with suspected GH deficiency (GHD), we recommend GH stimulation testing. Single GH measurements are not helpful. (1|) […] 1.12 In males with suspected hypogonadism, we recommend measuring serum T, FSH, and LH to diagnose central hypogonadism. (1|)

• #36 An Update on Advances in Hypopituitarism: Etiology, Diagnosis, and Current Management

  https://www.mdpi.com/2077-0383/13/20/6161

  The diagnosis of GHD should include clinical evaluation, serum IGF-1 quantification, and GH stimulation testing. […] The diagnosis of hypoprolactinemia is not clearly defined and may vary depending on the criteria used. […] If AVP deficiency is suspected, it is recommended to measure natremia and plasma osmolality. […] The presence of hypoprolactinemia at the time of diagnosis of pituitary apoplexy would indicate a greater degree of destruction of the pituitary parenchyma and, therefore, a lower probability of recovery of pituitary hormone function. […] The insulin tolerance test (ITT) is the most sensitive test for assessing pituitary ACTH reserve. […] The presence of copeptin levels > 21.4 pmol/L indicates AVP resistance. […] The diagnosis of AVP deficiency is established when the post-stimulation copeptin level is ≤4.9 pmol/L after administration of hypertonic saline or ≤3 pmol/L after administration of arginine.

• #37 An Update on Advances in Hypopituitarism: Etiology, Diagnosis, and Current Management

  https://www.mdpi.com/2077-0383/13/20/6161

  The diagnosis of GHD should include clinical evaluation, serum IGF-1 quantification, and GH stimulation testing. […] The diagnosis of hypoprolactinemia is not clearly defined and may vary depending on the criteria used. […] If AVP deficiency is suspected, it is recommended to measure natremia and plasma osmolality. […] The presence of hypoprolactinemia at the time of diagnosis of pituitary apoplexy would indicate a greater degree of destruction of the pituitary parenchyma and, therefore, a lower probability of recovery of pituitary hormone function. […] The insulin tolerance test (ITT) is the most sensitive test for assessing pituitary ACTH reserve. […] The presence of copeptin levels > 21.4 pmol/L indicates AVP resistance. […] The diagnosis of AVP deficiency is established when the post-stimulation copeptin level is ≤4.9 pmol/L after administration of hypertonic saline or ≤3 pmol/L after administration of arginine.

• #38 Hypopituitarism – Pituitary Foundation

  https://www.pituitary.org.uk/information/hypopituitarism/

  When the hormone controlling concentration of the urine is lost (arginine vasopressin, AVP), the individual is unable to concentrate their urine and passes large amounts of dilute urine. […] The initial test to look at this would mean a blood and urine test, with nothing to drink overnight if possible, to look at the concentration of salts in the blood and urine (osmolality). […] This will show if the kidneys are concentrating urine appropriately. […] In some cases it is not possible to do this having not had a drink overnight due to the degree of urine being passed. […] Where there is any doubt further tests involving a stimulation test, or measuring urine volume and levels of salt in the blood and urine under controlled supervision and whilst not drinking fluids can be undertaken to confirm the diagnosis.

• #39 Diagnosis and Treatment of Hypopituitarism

  https://www.e-enm.org/journal/view.php?doi=10.3803/enm.2015.30.4.443

  Conversely there is an increase in pituitary hormone levels when there is target organ hormone deficiency. […] The expected values and responses of the pituitary gland and target organ hormones under basal and stimulated states are provided in Table 4. […] In several cases, it is necessary to distinguish between a pituitary disease (primary hypopituitarism) and a hypothalamic disease (secondary hypopituitarism), but this is not easily accomplished. […] In these situations, it is helpful to diagnose hypothalamic diseases based on the expression of clinical manifestations, such as diabetes insipidus or hypopituitarism accompanying hyperprolactinemia, neuro-ophthalmological symptom, such as visual impairments, neuropsychiatric symptoms. […] For purposes of differentiation, a stimulation test using hypothalamus releasing hormones can be performed.

• #40 Diagnosis and Treatment of Hypopituitarism

  https://e-enm.org/DOIx.php?id=10.3803/enm.2015.30.4.443

  Conversely there is an increase in pituitary hormone levels when there is target organ hormone deficiency. […] Thus, the differentiation of a target organ deficiency from a hypothalamic or pituitary gland disease is relatively simple but a stimulation test may also be necessary to determine the origin of the disease, albeit rarely. […] The expected values and responses of the pituitary gland and target organ hormones under basal and stimulated states are provided in Table 4. […] In several cases, it is necessary to distinguish between a pituitary disease (primary hypopituitarism) and a hypothalamic disease (secondary hypopituitarism), but this is not easily accomplished. […] In these situations, it is helpful to diagnose hypothalamic diseases based on the expression of clinical manifestations, such as diabetes insipidus or hypopituitarism accompanying hyperprolactinemia, neuro-ophthalmological symptom, such as visual impairments, neuropsychiatric symptoms.

• #41 Diagnosis and Treatment of Hypopituitarism

  https://www.e-enm.org/journal/view.php?doi=10.3803/enm.2015.30.4.443

  Conversely there is an increase in pituitary hormone levels when there is target organ hormone deficiency. […] The expected values and responses of the pituitary gland and target organ hormones under basal and stimulated states are provided in Table 4. […] In several cases, it is necessary to distinguish between a pituitary disease (primary hypopituitarism) and a hypothalamic disease (secondary hypopituitarism), but this is not easily accomplished. […] In these situations, it is helpful to diagnose hypothalamic diseases based on the expression of clinical manifestations, such as diabetes insipidus or hypopituitarism accompanying hyperprolactinemia, neuro-ophthalmological symptom, such as visual impairments, neuropsychiatric symptoms. […] For purposes of differentiation, a stimulation test using hypothalamus releasing hormones can be performed.

• #42 Diagnosis and Treatment of Hypopituitarism

  https://e-enm.org/DOIx.php?id=10.3803/enm.2015.30.4.443

  For purposes of differentiation, a stimulation test using hypothalamus releasing hormones can be performed. […] However, sellar magnetic resonance imaging (MRI) can distinguish pituitary diseases from hypothalamic diseases, and treatment is not different. […] Thus, differentiation pituitary diseases from hypothalamic diseases may not be necessary.

• #43 Diagnosis and Treatment of Hypopituitarism

  https://www.e-enm.org/journal/view.php?doi=10.3803/enm.2015.30.4.443

  However, sellar magnetic resonance imaging (MRI) can distinguish pituitary diseases from hypothalamic diseases, and treatment is not different. […] Thus, differentiation pituitary diseases from hypothalamic diseases may not be necessary. […] ACTH deficiency can be treated with either hydrocortisone or prednisolone, which is a synthetic corticosteroid drug. […] TSH deficiency is treated with L-thyroxine (T4). […] For patients with hypogonadotropic hypogonadism, it is important to consider both gonad steroid replacement treatment and fertility. […] GH replacement treatment is generally only utilized in children with growth disorder due to GH deficiency. […] The administration of GH also seems to influence the metabolism rates of hydrocortisone and T4 such that the doses of these drugs need to be adjusted upward. […] The diagnosis of posterior pituitary hormone deficiency can be easily made through a review of clinical symptoms/signs and a water deprivation test.

• #44 Diagnosis and Treatment of Hypopituitarism

  https://www.e-enm.org/journal/view.php?doi=10.3803/enm.2015.30.4.443

  Conversely there is an increase in pituitary hormone levels when there is target organ hormone deficiency. […] The expected values and responses of the pituitary gland and target organ hormones under basal and stimulated states are provided in Table 4. […] In several cases, it is necessary to distinguish between a pituitary disease (primary hypopituitarism) and a hypothalamic disease (secondary hypopituitarism), but this is not easily accomplished. […] In these situations, it is helpful to diagnose hypothalamic diseases based on the expression of clinical manifestations, such as diabetes insipidus or hypopituitarism accompanying hyperprolactinemia, neuro-ophthalmological symptom, such as visual impairments, neuropsychiatric symptoms. […] For purposes of differentiation, a stimulation test using hypothalamus releasing hormones can be performed.

• #45 Diagnosis and Treatment of Hypopituitarism

  https://e-enm.org/DOIx.php?id=10.3803/enm.2015.30.4.443

  For purposes of differentiation, a stimulation test using hypothalamus releasing hormones can be performed. […] However, sellar magnetic resonance imaging (MRI) can distinguish pituitary diseases from hypothalamic diseases, and treatment is not different. […] Thus, differentiation pituitary diseases from hypothalamic diseases may not be necessary.

• #46

  https://link.springer.com/article/10.1007/s11154-024-09881-1

  The diagnostic approach to hypopituitarism involves many disciplines. Clinical symptoms rarely are specific. […] Therefore, the definitive diagnosis of pituitary insufficiency is largely based on laboratory tests. However, also laboratory methods come with inherent limitations, and it is essential for the clinician to know and recognize typical pitfalls. […] Biochemical analyses are an important cornerstone to guide the diagnostic process. However, laboratory data also must be used with an appropriate understanding of potential limitations. […] In the following, we discuss some typical pitfalls related to biological, pharmacological, and analytical factors with the potential to affect the measurement and interpretation of hormone concentrations. […] Appropriate and standardized preanalytical conditions are key to make laboratory tests a clinically useful tool – way more important than the choice of the one or the other analytical method to measure a hormone within the laboratory.

• #47

  https://link.springer.com/article/10.1007/s11154-024-09881-1

  Therefore, it is important in a clinical setting to take care of critical aspects during the pre-analytical phase. […] The specific details for the best pre-analytical procedures to collect and handle blood samples depend on the specific local setting, and the analytical methods used by the laboratory. […] These pre-analytical conditions should be reflected by each endocrinologist ordering hormone analyses in the context of diagnosing pituitary insufficiencies. […] In contrast, body position or postural changes per se are less important for regulation of pituitary hormones. […] However, it is also important to ask patients about intake or application of topical or over-the-counter medication, and, potentially, abuse of illicit substances. […] The actual measurement of the hormone concentration – the technical part of the quantification of hormone concentrations in a sample is only one part in the total diagnostic process associated with term lab assessment.

• #48

  https://link.springer.com/article/10.1007/s11154-024-09881-1

  The diagnostic approach to hypopituitarism involves many disciplines. Clinical symptoms rarely are specific. […] Therefore, the definitive diagnosis of pituitary insufficiency is largely based on laboratory tests. However, also laboratory methods come with inherent limitations, and it is essential for the clinician to know and recognize typical pitfalls. […] Biochemical analyses are an important cornerstone to guide the diagnostic process. However, laboratory data also must be used with an appropriate understanding of potential limitations. […] In the following, we discuss some typical pitfalls related to biological, pharmacological, and analytical factors with the potential to affect the measurement and interpretation of hormone concentrations. […] Appropriate and standardized preanalytical conditions are key to make laboratory tests a clinically useful tool – way more important than the choice of the one or the other analytical method to measure a hormone within the laboratory.

• #49 Hypopituitarism (Panhypopituitarism) Differential Diagnoses

  https://emedicine.medscape.com/article/122287-differential

  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 post therapy. Blood could be drawn to measure serum cortisol and ACTH prior to initiating glucocorticoid therapy. […] 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.

• #50 Hypopituitarism – Wikipedia

  https://en.wikipedia.org/wiki/Hypopituitarism

  Occasionally, the pituitary hormone may be normal but the effector gland hormone decreased; in this case, the pituitary is not responding appropriately to effector hormone changes, and the combination of findings is still suggestive of hypopituitarism. […] If one of these tests shows a deficiency of hormones produced by the pituitary, magnetic resonance imaging (MRI) scan of the pituitary is the first step in identifying an underlying cause.

• #51 Hypopituitarism (Panhypopituitarism) Differential Diagnoses

  https://emedicine.medscape.com/article/122287-differential

  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 post therapy. Blood could be drawn to measure serum cortisol and ACTH prior to initiating glucocorticoid therapy. […] 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.

• #52

  https://link.springer.com/article/10.1007/s11154-024-09881-1

  Overall, significant progress has been made over the past decades in our ability to measure hormones. […] Notably, despite all the progress made in laboratory medicine, all hormone assays have inherent problems. […] If results from the laboratory do not fit with the clinical picture at all, cross-reaction might be suspected. […] The post-analytical phase includes technical aspects (transmission of the measurement results), but also the interpretation of the results. […] Therefore, the clinical decision limits must appropriately reflect an individual patients biological situation.

• #53 Hypopituitarism – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/hypopituitarism/diagnosis-treatment/drc-20351648

  Several tests can check hormone levels in the body and look for the cause of problems with the way the pituitary is working. These include: […] Blood tests. These tests measure levels of the hormones made in the pituitary gland and those made in glands that the pituitary controls, such as the thyroid gland. Blood tests can show if low hormone levels are due to the pituitary not working as it should. […] Stimulation or dynamic testing. A clinic that specializes in endocrine conditions can run these tests to measure hormone levels. These tests check the body’s hormone levels before and after taking medicines that cause the body to make hormones. […] Brain imaging. MRI or CT scans of the brain can show a pituitary tumor or other pituitary gland problems.

• #54 An Update on Advances in Hypopituitarism: Etiology, Diagnosis, and Current Management

  https://www.mdpi.com/2077-0383/13/20/6161

  This article provides an updated review of hypopituitarism (HP), an endocrine disorder characterized by a deficiency of one or more pituitary hormones. […] Diagnosis is based on clinical evaluation and hormonal testing, with identification of the specific hormonal deficiencies essential for effective treatment. […] The complexity of diagnosing HP, especially in cases with atypical presentations or underlying conditions, highlights the importance of comprehensive evaluation and individualized hormone replacement therapy to improve patient outcomes and quality of life. […] Evaluation of pituitary hormone function should be performed in all patients with symptoms or suspicion of HP, in those at risk of HP (radiation therapy, cranio-encephalic trauma, brain injury, etc.), or in those with known hypothalamic–pituitary disease.

• #55 Hypopituitarism (Panhypopituitarism) Workup: Approach Considerations, ACTH (Cortrosyn) Stimulation Test, TSH and Thyroxine

  https://emedicine.medscape.com/article/122287-workup

  Assessment of thyroid function is important in the evaluation of ACTH deficiency. […] In suspected TSH deficiency, measure serum TSH and thyroxine. A normal level of total free T4 rules out hypothyroidism. […] LH and FSH deficiencies may indicate secondary hypogonadism. […] Given that GH secretion is pulsatile and low in most adults through most of the day, a single low serum level cannot be interpreted, whereas a single elevated or normal serum GH level can exclude the diagnosis of GH deficiency. […] A water deprivation test can help to differentiate psychogenic polydipsia from diabetes insipidus and nephrogenic diabetes insipidus. […] A study by Li et al concluded that magnetic resonance imaging (MRI) findings can be correlated with pituitary function and can provide evidence of multiple pituitary hormone deficiencies. […] In the presence of clinical or biochemical evidence of hypopituitarism, visualization of the sellar/suprasellar areas is needed to identify the nature of the causative disease process.

• #56 Diagnostic testing for hypopituitarism – UpToDate

  https://www.uptodate.com/contents/diagnostic-testing-for-hypopituitarism

  Diagnostic testing for hypopituitarism […] The diagnosis of hypopituitarism, defined as deficient secretion of one or more pituitary hormones because of pituitary or hypothalamic disease, is made by documenting subnormal secretion of these pituitary hormones in defined circumstances. Each pituitary hormone must be tested separately since there is a variable pattern of hormone deficiency among patients with hypopituitarism. Diagnostic testing for hypopituitarism will be discussed here. […] The impetus to measure pituitary hormones is the suspicion that the secretion of one or more may be subnormal. This suspicion can be based upon the knowledge that the patient has either a lesion known to cause hypopituitarism or a symptom known to be caused by hypopituitarism. […] Hormonal hyposecretion should be evaluated in any patient who has a discrete sellar mass ≥1 cm or diffuse enlargement of the pituitary of any size.

• #57 An Update on Advances in Hypopituitarism: Etiology, Diagnosis, and Current Management

  https://www.mdpi.com/2077-0383/13/20/6161

  This article provides an updated review of hypopituitarism (HP), an endocrine disorder characterized by a deficiency of one or more pituitary hormones. […] Diagnosis is based on clinical evaluation and hormonal testing, with identification of the specific hormonal deficiencies essential for effective treatment. […] The complexity of diagnosing HP, especially in cases with atypical presentations or underlying conditions, highlights the importance of comprehensive evaluation and individualized hormone replacement therapy to improve patient outcomes and quality of life. […] Evaluation of pituitary hormone function should be performed in all patients with symptoms or suspicion of HP, in those at risk of HP (radiation therapy, cranio-encephalic trauma, brain injury, etc.), or in those with known hypothalamic–pituitary disease.

• #58 Hypopituitarism – Knowledge @ AMBOSS

  https://www.amboss.com/us/knowledge/hypopituitarism/

  Hypopituitarism is diagnosed by measuring specific hormone levels (depending on the underlying hormone deficiency) and with cranial imaging (in order to identify damage to the pituitary gland and/or hypothalamus). […] Each hormone deficiency must be tested individually because the pattern of hormone deficiency may vary. […] If a hormone deficiency is identified, cranial imaging (preferably MRI) is indicated to identify the cause (e.g., pituitary adenoma). […] Imaging of the pituitary is indicated in all patients to determine the underlying cause. […] MRI brain is the preferred imaging modality. […] Testing is required if treatment is planned and optional if treatment is not planned and hormonal deficiencies exist in 3 pituitary axes. […] Routine testing is not performed in the investigation of hypopituitarism.

• #59 Generalized Hypopituitarism – Endocrine and Metabolic Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/endocrine-and-metabolic-disorders/pituitary-disorders/generalized-hypopituitarism

  Generalized hypopituitarism refers to endocrine deficiency syndromes due to partial or complete loss of anterior lobe pituitary function. […] Diagnosis involves imaging tests and measurement of pituitary hormone levels basally and after various provocative stimuli. […] Clinical features are often nonspecific, and the diagnosis must be established with certainty before committing the patient to a lifetime of hormone replacement therapy. […] Evidence of structural pituitary abnormalities and of hormonal deficiencies should be sought with imaging and laboratory tests. […] Patients should undergo high-resolution CT or MRI, with contrast agent as required (to rule out structural abnormalities, such as pituitary adenomas). […] Initial evaluation should include testing for TSH and ACTH deficiencies, because both conditions are potentially life threatening.

• #60 Hypopituitarism – Symptoms, diagnosis and treatment | BMJ Best Practice US

  https://bestpractice.bmj.com/topics/en-us/521

  1st tests to order include serum electrolytes, serum and urine osmolarity, 8 a.m. cortisol and adrenocorticotropic hormone, thyroid function tests, 8 a.m. testosterone, follicle-stimulating hormone, and luteinizing hormone in men, estradiol, follicle-stimulating hormone, and luteinizing hormone in women, prolactin, insulin-like growth factor-1, and cosyntropin/tetracosactide stimulation test. […] Tests to consider include insulin tolerance test, water deprivation and desmopressin response test, MRI pituitary, CT pituitary, and metyrapone testing of the adrenal axis.

• #61 Hypopituitarism: What It Is, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/22102-hypopituitarism

  Hypopituitarism is a rare condition in which theres a deficiency of one, multiple or all of the hormones made by your pituitary gland. […] Symptoms, diagnosis and treatment depend on which hormones are lacking. […] Your healthcare provider may order any of the following tests to diagnose hypopituitarism: […] Hormone level blood tests: Your provider may order different blood tests that measure the levels of certain hormones in your blood depending on your symptoms. […] Hormone stimulation tests: For this test, your provider uses medicine to stimulate your pituitary gland to release the hormone that theyre testing. […] MRI (magnetic resonance imaging) scans: MRI scans use radio waves and strong magnets to create detailed images of inside your body. […] Your healthcare team will work with you to customize the right treatment plan. Common treatment options for hypopituitarism include:

• #62 Azthena logo with the word Azthena

  https://www.news-medical.net/health/Hypopituitarism-Diagnosis.aspx

  In some cases, urine tests are used in the diagnostic process for hypopituitarism. […] Imaging of the brain with magnetic resonance imaging may be indicated to detect the presence of a pituitary tumor or other abnormality. […] Vision tests may also be useful to investigate if a tumor of the pituitary gland has affected the visual field or impaired the sight of the individual.

• #63 Hypopituitarism – Symptoms, diagnosis and treatment | BMJ Best Practice US

  https://bestpractice.bmj.com/topics/en-us/521

  Hypopituitarism is a deficiency of one or more pituitary hormones. […] Hypopituitarism refers to the partial or complete deficiency of one or more pituitary hormones. It may arise as a congenital defect during the development of the pituitary gland or as a result of acquired diseases of the pituitary gland, the parasellar structures, or the hypothalamus. […] Key diagnostic factors include history of pituitary or hypothalamic disease, history of traumatic brain injury, headaches, faltering growth or short stature, infertility, hypoglycemia, amenorrhea/oligomenorrhea, galactorrhea, delayed puberty, family history of pituitary hormone deficiencies, hypotension, visual field defects, and ophthalmoplegia. […] Other diagnostic factors include cardiovascular events, cold intolerance, weight gain, erectile dysfunction and reduced libido, nausea, vomiting, fatigue, weakness, dizziness, constipation, dry skin, delayed relaxation of reflexes, hypoactive sexual desire, hot flashes, nocturia and polyuria, breast atrophy, reduced bone and muscle mass, and loss of axillary and pubic hair.

• #64 Hypopituitarism in Children | Cedars-Sinai

  https://www.cedars-sinai.org/health-library/diseases-and-conditions—pediatrics/h/hypopituitarism-in-children.html

  How is hypopituitarism diagnosed in a child? The healthcare provider will ask about your child’s symptoms and health history. They may also ask about your family’s health history. Your child will also have a physical exam: […] Blood tests. These are done to check hormone levels. […] X-ray. This test uses a small amount of radiation to make images of tissues inside the body. An X-ray may be done of the left hand and wrist. This can estimate your child’s bone age. With hypopituitarism, bone age is often younger than calendar age. […] CT scan. This test uses a series of X-rays and a computer to make detailed images of the body. A CT scan can show bones, muscles, fat, and organs. CT scans are more detailed than regular X-rays. […] MRI. This test uses large magnets and a computer to make detailed images of tissues in the body without the use of X-rays.

• #65 Hypopituitarism in Children | Boston Children’s Hospital

  https://www.childrenshospital.org/conditions/hypopituitarism

  Hypopituitarism occurs when the anterior (front) lobe of the pituitary gland loses its ability to make hormones. The resulting symptoms depend on which hormones are no longer being produced by the gland. […] Because the symptoms of hypopituitarism may resemble other conditions or medical problems, you should always consult your child’s physician for a diagnosis. […] When your child has hypopituitarism, indicating multiple pituitary hormone deficiencies, tell-tale symptoms alone may help your child’s physician make a diagnosis. In addition to a complete medical history and physical examination, other diagnostic procedures may include: Blood tests to measure hormone levels, X-rays of the hand and wrist to determine bone age, Magnetic resonance imaging (MRI) of the head, which uses a combination of large magnets, radiofrequencies and a computer to produce detailed images of organs and structures within the body. […] After we complete all necessary tests, our experts meet to review and discuss what they have learned about your child’s condition. Then we will meet with you and your family to discuss the results and outline the best course of action.

• #66 Diagnostic testing for hypopituitarism – UpToDate

  https://www.uptodate.com/contents/diagnostic-testing-for-hypopituitarism/print

  Diagnostic testing for hypopituitarism […] The diagnosis of hypopituitarism, defined as deficient secretion of one or more pituitary hormones because of pituitary or hypothalamic disease, is made by documenting subnormal secretion of these pituitary hormones in defined circumstances. Each pituitary hormone must be tested separately since there is a variable pattern of hormone deficiency among patients with hypopituitarism. Diagnostic testing for hypopituitarism will be discussed here. […] The impetus to measure pituitary hormones is the suspicion that the secretion of one or more may be subnormal. This suspicion can be based upon the knowledge that the patient has either a lesion known to cause hypopituitarism or a symptom known to be caused by hypopituitarism. […] Hormonal hyposecretion should be evaluated in any patient who has a discrete sellar mass ≥1 cm or diffuse enlargement of the pituitary of any size.

• #67 Diagnostic testing for hypopituitarism – UpToDate

  https://www.uptodate.com/contents/diagnostic-testing-for-hypopituitarism

  Diagnostic testing for hypopituitarism […] The diagnosis of hypopituitarism, defined as deficient secretion of one or more pituitary hormones because of pituitary or hypothalamic disease, is made by documenting subnormal secretion of these pituitary hormones in defined circumstances. Each pituitary hormone must be tested separately since there is a variable pattern of hormone deficiency among patients with hypopituitarism. Diagnostic testing for hypopituitarism will be discussed here. […] The impetus to measure pituitary hormones is the suspicion that the secretion of one or more may be subnormal. This suspicion can be based upon the knowledge that the patient has either a lesion known to cause hypopituitarism or a symptom known to be caused by hypopituitarism. […] Hormonal hyposecretion should be evaluated in any patient who has a discrete sellar mass ≥1 cm or diffuse enlargement of the pituitary of any size.

• #68 Hypopituitarism – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/hypopituitarism/symptoms-causes/syc-20351645

  Hypopituitarism is when there isn’t enough of one or more of the pituitary hormones. This lack of hormones, called a deficiency, can affect how the body works in many ways. These include growth, blood pressure and the ability to have children, among others. Symptoms depend on which hormones are missing. […] People who have hypopituitarism usually need to take medicines for the rest of their lives. These medicines replace the missing hormones, which helps control symptoms. […] See your health care provider if you develop any symptoms of hypopituitarism. […] Contact your health care provider right away if symptoms of hypopituitarism start suddenly or come with a bad headache, changes in vision, confusion or a drop in blood pressure. These could be symptoms of sudden damage to the pituitary gland tissue. This condition is known as pituitary apoplexy.

• #69 Diagnostic testing for hypopituitarism – UpToDate

  https://www.uptodate.com/contents/diagnostic-testing-for-hypopituitarism

  Diagnostic testing for hypopituitarism […] The diagnosis of hypopituitarism, defined as deficient secretion of one or more pituitary hormones because of pituitary or hypothalamic disease, is made by documenting subnormal secretion of these pituitary hormones in defined circumstances. Each pituitary hormone must be tested separately since there is a variable pattern of hormone deficiency among patients with hypopituitarism. Diagnostic testing for hypopituitarism will be discussed here. […] The impetus to measure pituitary hormones is the suspicion that the secretion of one or more may be subnormal. This suspicion can be based upon the knowledge that the patient has either a lesion known to cause hypopituitarism or a symptom known to be caused by hypopituitarism. […] Hormonal hyposecretion should be evaluated in any patient who has a discrete sellar mass ≥1 cm or diffuse enlargement of the pituitary of any size.

• #70 Diagnostic testing for hypopituitarism – UpToDate

  https://www.uptodate.com/contents/diagnostic-testing-for-hypopituitarism/print

  Diagnostic testing for hypopituitarism […] The diagnosis of hypopituitarism, defined as deficient secretion of one or more pituitary hormones because of pituitary or hypothalamic disease, is made by documenting subnormal secretion of these pituitary hormones in defined circumstances. Each pituitary hormone must be tested separately since there is a variable pattern of hormone deficiency among patients with hypopituitarism. Diagnostic testing for hypopituitarism will be discussed here. […] The impetus to measure pituitary hormones is the suspicion that the secretion of one or more may be subnormal. This suspicion can be based upon the knowledge that the patient has either a lesion known to cause hypopituitarism or a symptom known to be caused by hypopituitarism. […] Hormonal hyposecretion should be evaluated in any patient who has a discrete sellar mass ≥1 cm or diffuse enlargement of the pituitary of any size.

• #71 An Update on Advances in Hypopituitarism: Etiology, Diagnosis, and Current Management

  https://www.mdpi.com/2077-0383/13/20/6161

  This article provides an updated review of hypopituitarism (HP), an endocrine disorder characterized by a deficiency of one or more pituitary hormones. […] Diagnosis is based on clinical evaluation and hormonal testing, with identification of the specific hormonal deficiencies essential for effective treatment. […] The complexity of diagnosing HP, especially in cases with atypical presentations or underlying conditions, highlights the importance of comprehensive evaluation and individualized hormone replacement therapy to improve patient outcomes and quality of life. […] Evaluation of pituitary hormone function should be performed in all patients with symptoms or suspicion of HP, in those at risk of HP (radiation therapy, cranio-encephalic trauma, brain injury, etc.), or in those with known hypothalamic–pituitary disease.

• #72 Azthena logo with the word Azthena

  https://www.news-medical.net/health/Hypopituitarism-Diagnosis.aspx

  The presentation of a patient with hypopituitarism can vary significantly; some individuals may be symptomatic while others are diagnosed following an acute collapse. […] It is essential that the condition is diagnosed and treated as soon as possible, because untreated hypopituitarism has the potential to lead to permanent disability or death. […] The family and medical history of patients are important in the diagnosis of hypopituitarism, as certain health conditions can predispose an individual to abnormal pituitary function. […] A history of headache and visual field defects or diplopia may indicate the need to test for a pituitary tumor. […] Additionally, a personal medical history of head trauma, brain surgery or tumor growth in the brain is closely linked to reduced pituitary function.

• #73 Hypopituitarism – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/hypopituitarism/symptoms-causes/syc-20351645

  Hypopituitarism is when there isn’t enough of one or more of the pituitary hormones. This lack of hormones, called a deficiency, can affect how the body works in many ways. These include growth, blood pressure and the ability to have children, among others. Symptoms depend on which hormones are missing. […] People who have hypopituitarism usually need to take medicines for the rest of their lives. These medicines replace the missing hormones, which helps control symptoms. […] See your health care provider if you develop any symptoms of hypopituitarism. […] Contact your health care provider right away if symptoms of hypopituitarism start suddenly or come with a bad headache, changes in vision, confusion or a drop in blood pressure. These could be symptoms of sudden damage to the pituitary gland tissue. This condition is known as pituitary apoplexy.

• #74 Hormone Replacement in Hypopituitarism Guideline Resources | Endocrine Society

  https://www.endocrine.org/clinical-practice-guidelines/hormone-replacement-in-hypopituitarism

  2.11 We recommend offering GH replacement to those patients with proven GHD and no contraindications. […] 3.23 We recommend testing for acute pituitary insufficiency in all patients with pituitary apoplexy. (1|) […] 3.24 Because acute AI is a major cause of mortality, we recommend GC therapy until a laboratory diagnosis is established and the patient maintains normal pituitary function. (1|)

• #75 Diagnosis and Treatment of Hypopituitarism

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4722397/

  It is widely accepted that maximum serum cortisol levels can be observed after the administration of doses of ACTH much lower than the usual dose of 250 g that is given in the rapid ACTH test. […] TSH deficiency can be easily distinguished from primary hypothyroidism in cases where the TSH level increases inordinately. […] In many cases, it is possible to diagnose gonadotropin deficiency using a basal hormone test and an evaluation of clinical symptoms. […] When diagnosing GH deficiency in adult patients, the basal GH concentration is not considered to be valuable but measures of insulin-like growth factor 1 (IGF-1) may be of some use, although they are not sufficient themselves. […] The diagnosis of posterior pituitary hormone deficiency can be easily made through a review of clinical symptoms/signs and a water deprivation test. […] It is advisable to re-evaluate pituitary gland functionality 2 to 3 months after an operation because, although most hypopituitarism symptoms are irreversible, a patient may recover some of level of function.

• #76 Azthena logo with the word Azthena

  https://www.news-medical.net/health/Hypopituitarism-Diagnosis.aspx

  The presentation of a patient with hypopituitarism can vary significantly; some individuals may be symptomatic while others are diagnosed following an acute collapse. […] It is essential that the condition is diagnosed and treated as soon as possible, because untreated hypopituitarism has the potential to lead to permanent disability or death. […] The family and medical history of patients are important in the diagnosis of hypopituitarism, as certain health conditions can predispose an individual to abnormal pituitary function. […] A history of headache and visual field defects or diplopia may indicate the need to test for a pituitary tumor. […] Additionally, a personal medical history of head trauma, brain surgery or tumor growth in the brain is closely linked to reduced pituitary function.

• #77 Hypopituitarism | Endocrine Society

  https://www.endocrine.org/patient-engagement/endocrine-library/hypopituitarism

  Your doctor will conduct a series of tests to first determine if you suffer from hypopituitarism and if you do, discover its cause including: Physical Examination: Your doctor will do a careful physical examination that will include checking your blood pressure laying down, sitting and standing up, skin and overall appearance Blood Tests: Your doctor will order blood tests to check hormone levels. These could include: […] Stimulation Test: Additional stimulation tests might be needed. These usually involve injection of medications that will increase your pituitary hormones in the blood. […] Magnetic Resonance Imaging (MRI): Your doctor will also order an MRI scan to look at the pituitary gland and other structures around it. The MRI will show the size of your pituitary gland and whether there is a tumor, a cyst (fluid collection) or inflammation that affects your pituitary function.

• #78 Generalized Hypopituitarism – Endocrine and Metabolic Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/endocrine-and-metabolic-disorders/pituitary-disorders/generalized-hypopituitarism

  Generalized hypopituitarism refers to endocrine deficiency syndromes due to partial or complete loss of anterior lobe pituitary function. […] Diagnosis involves imaging tests and measurement of pituitary hormone levels basally and after various provocative stimuli. […] Clinical features are often nonspecific, and the diagnosis must be established with certainty before committing the patient to a lifetime of hormone replacement therapy. […] Evidence of structural pituitary abnormalities and of hormonal deficiencies should be sought with imaging and laboratory tests. […] Patients should undergo high-resolution CT or MRI, with contrast agent as required (to rule out structural abnormalities, such as pituitary adenomas). […] Initial evaluation should include testing for TSH and ACTH deficiencies, because both conditions are potentially life threatening.

• #79 Hormone Replacement in Hypopituitarism Guideline Resources | Endocrine Society

  https://www.endocrine.org/clinical-practice-guidelines/hormone-replacement-in-hypopituitarism

  The 2016 guideline addresses: […] Diagnosis and evaluation of multiple pituitary hormonal deficiency (hypopituitarism) […] Accurate and reliable measurements are central to diagnose hypopituitarism and monitoring therapies. […] 1.1 We suggest measuring serum cortisol levels at 89 AM as the first-line test for diagnosing central adrenal insufficiency (AI). (2|) […] 1.6 We recommend measuring serum free T4 (fT4) and TSH to evaluate central hypothyroidism (CH). An fT4 level below the laboratory reference range in conjunction with a low, normal, or mildly elevated TSH in the setting of pituitary disease usually confirms a CH diagnosis. (1|) […] 1.9 In patients with suspected GH deficiency (GHD), we recommend GH stimulation testing. Single GH measurements are not helpful. (1|) […] 1.12 In males with suspected hypogonadism, we recommend measuring serum T, FSH, and LH to diagnose central hypogonadism. (1|)

• #80 Hypopituitarism (Panhypopituitarism) Workup: Approach Considerations, ACTH (Cortrosyn) Stimulation Test, TSH and Thyroxine

  https://emedicine.medscape.com/article/122287-workup

  Hormonal studies should be performed on pairs of target glands and their respective stimulatory pituitary hormones for proper interpretation, as follows: ACTH (Cortrosyn) stimulation test (or morning cortisol and ACTH), TSH and thyroxine (free T4), FSH, LH, and either estradiol (if amenorrheic) or morning testosterone (as appropriate for gender), Prolactin, GH provocative testing with various stimulation tests, IGF-1 levels. […] Corticotropin deficiency may be evident with the finding of a decreased serum cortisol level. However, a low cortisol level may not help to distinguish primary adrenal insufficiency from secondary adrenal insufficiency due to hypopituitarism. […] The ACTH stimulation test, which evaluates the hypothalamic-pituitary-adrenal axis, is a superior tool in the diagnosis of adrenal insufficiency, but it does not generally separate pituitary from adrenal causation.

• #81 Hormone Replacement in Hypopituitarism Guideline Resources | Endocrine Society

  https://www.endocrine.org/clinical-practice-guidelines/hormone-replacement-in-hypopituitarism

  1.14 In the presence of oligomenorrhea or amenorrhea, we recommend measuring serum estradiol (E2), FSH, and LH. […] 1.17 We recommend simultaneously measuring serum and urine osmolarity in patients with polyuria (more than 50 mL/kg of body weight/24 hours, 3.5 L/d in a 70-kg person). […] 2.0 Treatment […] 2.1 We recommend using HC, usually 1520 mg total daily dose in single or divided doses. […] 2.6 We recommend L-T4 in doses sufficient to achieve serum fT4 levels in the mid to upper half of the reference range. […] 2.9 We suggest T replacement for adult males with central hypogonadism and no contraindications in order to prevent anemia related to T deficiency; reduce fat mass; and improve bone mineral density (BMD), libido, sexual function, energy levels, sense of well-being, and muscle mass and strength. (2|)

• #82 Hypopituitarism – Knowledge @ AMBOSS

  https://www.amboss.com/us/knowledge/hypopituitarism/

  Hypopituitarism is diagnosed by measuring specific hormone levels (depending on the underlying hormone deficiency) and with cranial imaging (in order to identify damage to the pituitary gland and/or hypothalamus). […] Each hormone deficiency must be tested individually because the pattern of hormone deficiency may vary. […] If a hormone deficiency is identified, cranial imaging (preferably MRI) is indicated to identify the cause (e.g., pituitary adenoma). […] Imaging of the pituitary is indicated in all patients to determine the underlying cause. […] MRI brain is the preferred imaging modality. […] Testing is required if treatment is planned and optional if treatment is not planned and hormonal deficiencies exist in 3 pituitary axes. […] Routine testing is not performed in the investigation of hypopituitarism.

• #83 Hypopituitarism – Hormonal and Metabolic Disorders – Merck Manual Consumer Version

  https://www.merckmanuals.com/home/hormonal-and-metabolic-disorders/pituitary-gland-disorders/hypopituitarism

  Symptoms of hypopituitarism depend on what hormone is deficient and may include short height, infertility, intolerance to cold, fatigue, and an inability to produce breast milk. […] The diagnosis is based on measuring the blood levels of hormones produced by the pituitary gland and on imaging tests done on the pituitary gland. […] An evaluation usually begins by measuring blood levels of the hormones that the pituitary gland produces (typically, thyroid-stimulating hormone, prolactin, luteinizing hormone, and follicle-stimulating hormone) and at the same time measuring levels of the hormone produced by the target organs (typically, thyroid hormone, testosterone in men, and estrogen in women). […] Once hypopituitarism is established by blood tests, the pituitary gland is usually evaluated with computed tomography (CT) or magnetic resonance imaging (MRI) to identify structural problems.

• #84 Hypopituitarism – Wikipedia

  https://en.wikipedia.org/wiki/Hypopituitarism

  Hypopituitarism is the decreased (hypo) secretion of one or more of the eight hormones normally produced by the pituitary gland at the base of the brain. […] The diagnosis of hypopituitarism is made by blood tests, but often specific scans and other investigations are needed to find the underlying cause, such as tumors of the pituitary, and the ideal treatment. […] The diagnosis of hypopituitarism is made on blood tests. Two types of blood tests are used to confirm the presence of a hormone deficiency: basal levels, where blood samples are taken usually in the morning without any form of stimulation, and dynamic tests, where blood tests are taken after the injection of a stimulating substance. […] Generally, the finding of a combination of a low pituitary hormone together with a low hormone from the effector gland is indicative of hypopituitarism.

• #85 Diagnosis and Treatment of Hypopituitarism

  https://e-enm.org/DOIx.php?id=10.3803/enm.2015.30.4.443

  Conversely there is an increase in pituitary hormone levels when there is target organ hormone deficiency. […] Thus, the differentiation of a target organ deficiency from a hypothalamic or pituitary gland disease is relatively simple but a stimulation test may also be necessary to determine the origin of the disease, albeit rarely. […] The expected values and responses of the pituitary gland and target organ hormones under basal and stimulated states are provided in Table 4. […] In several cases, it is necessary to distinguish between a pituitary disease (primary hypopituitarism) and a hypothalamic disease (secondary hypopituitarism), but this is not easily accomplished. […] In these situations, it is helpful to diagnose hypothalamic diseases based on the expression of clinical manifestations, such as diabetes insipidus or hypopituitarism accompanying hyperprolactinemia, neuro-ophthalmological symptom, such as visual impairments, neuropsychiatric symptoms.

• #86 Hypopituitarism – Wikipedia

  https://en.wikipedia.org/wiki/Hypopituitarism

  Occasionally, the pituitary hormone may be normal but the effector gland hormone decreased; in this case, the pituitary is not responding appropriately to effector hormone changes, and the combination of findings is still suggestive of hypopituitarism. […] If one of these tests shows a deficiency of hormones produced by the pituitary, magnetic resonance imaging (MRI) scan of the pituitary is the first step in identifying an underlying cause.

• #87 Generalized Hypopituitarism – Endocrine and Metabolic Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/endocrine-and-metabolic-disorders/pituitary-disorders/generalized-hypopituitarism

  The short ACTH stimulation test is a safer and less labor-intensive test for cortisol deficiency than the insulin tolerance test. […] Neither the short ACTH stimulation test nor the insulin tolerance test alone will differentiate between primary (Addison disease) and secondary (hypopituitary) adrenal insufficiency. […] The corticotropin-releasing hormone (CRH) test is done to distinguish between primary, secondary (pituitary), and tertiary (hypothalamic) causes of adrenal insufficiency. […] Prolactin levels are routinely measured. […] Measurement of basal levels of LH and FSH is most helpful in evaluating hypopituitarism in postmenopausal women not taking exogenous estrogens in whom circulating gonadotropin concentrations are normally high. […] Screening for GH deficiency in adults is not recommended unless there is suspicion of pituitary damage due to trauma, surgery, or radiation and GH treatment is contemplated.

• #88 Hypopituitarism – Symptoms, diagnosis and treatment | BMJ Best Practice US

  https://bestpractice.bmj.com/topics/en-us/521

  1st tests to order include serum electrolytes, serum and urine osmolarity, 8 a.m. cortisol and adrenocorticotropic hormone, thyroid function tests, 8 a.m. testosterone, follicle-stimulating hormone, and luteinizing hormone in men, estradiol, follicle-stimulating hormone, and luteinizing hormone in women, prolactin, insulin-like growth factor-1, and cosyntropin/tetracosactide stimulation test. […] Tests to consider include insulin tolerance test, water deprivation and desmopressin response test, MRI pituitary, CT pituitary, and metyrapone testing of the adrenal axis.

• #89 Hormone Replacement in Hypopituitarism Guideline Resources | Endocrine Society

  https://www.endocrine.org/clinical-practice-guidelines/hormone-replacement-in-hypopituitarism

  The 2016 guideline addresses: […] Diagnosis and evaluation of multiple pituitary hormonal deficiency (hypopituitarism) […] Accurate and reliable measurements are central to diagnose hypopituitarism and monitoring therapies. […] 1.1 We suggest measuring serum cortisol levels at 89 AM as the first-line test for diagnosing central adrenal insufficiency (AI). (2|) […] 1.6 We recommend measuring serum free T4 (fT4) and TSH to evaluate central hypothyroidism (CH). An fT4 level below the laboratory reference range in conjunction with a low, normal, or mildly elevated TSH in the setting of pituitary disease usually confirms a CH diagnosis. (1|) […] 1.9 In patients with suspected GH deficiency (GHD), we recommend GH stimulation testing. Single GH measurements are not helpful. (1|) […] 1.12 In males with suspected hypogonadism, we recommend measuring serum T, FSH, and LH to diagnose central hypogonadism. (1|)

• #90 Hypopituitarism – Symptoms, diagnosis and treatment | BMJ Best Practice US

  https://bestpractice.bmj.com/topics/en-us/521

  1st tests to order include serum electrolytes, serum and urine osmolarity, 8 a.m. cortisol and adrenocorticotropic hormone, thyroid function tests, 8 a.m. testosterone, follicle-stimulating hormone, and luteinizing hormone in men, estradiol, follicle-stimulating hormone, and luteinizing hormone in women, prolactin, insulin-like growth factor-1, and cosyntropin/tetracosactide stimulation test. […] Tests to consider include insulin tolerance test, water deprivation and desmopressin response test, MRI pituitary, CT pituitary, and metyrapone testing of the adrenal axis.

• #91 Hypopituitarism: What It Is, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/22102-hypopituitarism

  Hypopituitarism is a rare condition in which theres a deficiency of one, multiple or all of the hormones made by your pituitary gland. […] Symptoms, diagnosis and treatment depend on which hormones are lacking. […] Your healthcare provider may order any of the following tests to diagnose hypopituitarism: […] Hormone level blood tests: Your provider may order different blood tests that measure the levels of certain hormones in your blood depending on your symptoms. […] Hormone stimulation tests: For this test, your provider uses medicine to stimulate your pituitary gland to release the hormone that theyre testing. […] MRI (magnetic resonance imaging) scans: MRI scans use radio waves and strong magnets to create detailed images of inside your body. […] Your healthcare team will work with you to customize the right treatment plan. Common treatment options for hypopituitarism include:

• #92 Diagnosis and treatment of hypopituitarism: an update – PubMed

  https://pubmed.ncbi.nlm.nih.gov/16508719/

  Diagnosis and treatment of patients with hypopituitarism needs careful clinical evaluation and individual optimization. […] Diagnosis of hypopituitarism can be straightforward by measuring reduced basal hormone levels. […] Frequently, dynamic stimulation tests are indicated in equivocal basal hormone levels or to diagnose partial hormone deficiencies. […] Knowledge of the use and limitations of these dynamic tests is mandatory for proper interpretation. […] In the present overview, the principles of diagnosis and treatment of hypopituitarism are discussed.

• #93 Hypopituitarism in Children | Boston Children’s Hospital

  https://www.childrenshospital.org/conditions/hypopituitarism

  Hypopituitarism occurs when the anterior (front) lobe of the pituitary gland loses its ability to make hormones. The resulting symptoms depend on which hormones are no longer being produced by the gland. […] Because the symptoms of hypopituitarism may resemble other conditions or medical problems, you should always consult your child’s physician for a diagnosis. […] When your child has hypopituitarism, indicating multiple pituitary hormone deficiencies, tell-tale symptoms alone may help your child’s physician make a diagnosis. In addition to a complete medical history and physical examination, other diagnostic procedures may include: Blood tests to measure hormone levels, X-rays of the hand and wrist to determine bone age, Magnetic resonance imaging (MRI) of the head, which uses a combination of large magnets, radiofrequencies and a computer to produce detailed images of organs and structures within the body. […] After we complete all necessary tests, our experts meet to review and discuss what they have learned about your child’s condition. Then we will meet with you and your family to discuss the results and outline the best course of action.

• #94 Hypopituitarism in Children | Cedars-Sinai

  https://www.cedars-sinai.org/health-library/diseases-and-conditions—pediatrics/h/hypopituitarism-in-children.html

  How is hypopituitarism diagnosed in a child? The healthcare provider will ask about your child’s symptoms and health history. They may also ask about your family’s health history. Your child will also have a physical exam: […] Blood tests. These are done to check hormone levels. […] X-ray. This test uses a small amount of radiation to make images of tissues inside the body. An X-ray may be done of the left hand and wrist. This can estimate your child’s bone age. With hypopituitarism, bone age is often younger than calendar age. […] CT scan. This test uses a series of X-rays and a computer to make detailed images of the body. A CT scan can show bones, muscles, fat, and organs. CT scans are more detailed than regular X-rays. […] MRI. This test uses large magnets and a computer to make detailed images of tissues in the body without the use of X-rays.

• #95 Hypopituitarism Treatment & Causes | Lurie Children’s

  https://www.luriechildrens.org/en/specialties-conditions/hypopituitarism/

  Hypopituitarism (an underactive pituitary gland) is rare in children. When a child has hypopituitarism, the pituitary gland has lost its ability to make one, some or all pituitary hormones. The condition is often permanent, but very treatable. […] Our approach to diagnosing hypopituitarism is very thorough. We take one step at a time and minimize invasive procedures. […] At your first visit, the doctor gets a complete medical history. Next is a head-to-toe physical exam. This includes the genitalia/private areas to determine if puberty is happening. If we need a blood test, you may be asked to return for a morning blood draw. […] We measure hormone levels in the blood sample. The morning is the best time for this because hormone levels go up and down throughout the day. This blood test may be all that’s needed.

• #96 Hypopituitarism in Children | Boston Children’s Hospital

  https://www.childrenshospital.org/conditions/hypopituitarism

  Hypopituitarism occurs when the anterior (front) lobe of the pituitary gland loses its ability to make hormones. The resulting symptoms depend on which hormones are no longer being produced by the gland. […] Because the symptoms of hypopituitarism may resemble other conditions or medical problems, you should always consult your child’s physician for a diagnosis. […] When your child has hypopituitarism, indicating multiple pituitary hormone deficiencies, tell-tale symptoms alone may help your child’s physician make a diagnosis. In addition to a complete medical history and physical examination, other diagnostic procedures may include: Blood tests to measure hormone levels, X-rays of the hand and wrist to determine bone age, Magnetic resonance imaging (MRI) of the head, which uses a combination of large magnets, radiofrequencies and a computer to produce detailed images of organs and structures within the body. […] After we complete all necessary tests, our experts meet to review and discuss what they have learned about your child’s condition. Then we will meet with you and your family to discuss the results and outline the best course of action.

• #97 Hypopituitarism (Panhypopituitarism) Differential Diagnoses

  https://emedicine.medscape.com/article/122287-differential

  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 post therapy. Blood could be drawn to measure serum cortisol and ACTH prior to initiating glucocorticoid therapy. […] 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.

• #98 Hypopituitarism – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/hypopituitarism/symptoms-causes/syc-20351645

  Hypopituitarism is when there isn’t enough of one or more of the pituitary hormones. This lack of hormones, called a deficiency, can affect how the body works in many ways. These include growth, blood pressure and the ability to have children, among others. Symptoms depend on which hormones are missing. […] People who have hypopituitarism usually need to take medicines for the rest of their lives. These medicines replace the missing hormones, which helps control symptoms. […] See your health care provider if you develop any symptoms of hypopituitarism. […] Contact your health care provider right away if symptoms of hypopituitarism start suddenly or come with a bad headache, changes in vision, confusion or a drop in blood pressure. These could be symptoms of sudden damage to the pituitary gland tissue. This condition is known as pituitary apoplexy.

• #99 Hormone Replacement in Hypopituitarism Guideline Resources | Endocrine Society

  https://www.endocrine.org/clinical-practice-guidelines/hormone-replacement-in-hypopituitarism

  2.11 We recommend offering GH replacement to those patients with proven GHD and no contraindications. […] 3.23 We recommend testing for acute pituitary insufficiency in all patients with pituitary apoplexy. (1|) […] 3.24 Because acute AI is a major cause of mortality, we recommend GC therapy until a laboratory diagnosis is established and the patient maintains normal pituitary function. (1|)

• #100 An Update on Advances in Hypopituitarism: Etiology, Diagnosis, and Current Management

  https://www.mdpi.com/2077-0383/13/20/6161

  The diagnosis of GHD should include clinical evaluation, serum IGF-1 quantification, and GH stimulation testing. […] The diagnosis of hypoprolactinemia is not clearly defined and may vary depending on the criteria used. […] If AVP deficiency is suspected, it is recommended to measure natremia and plasma osmolality. […] The presence of hypoprolactinemia at the time of diagnosis of pituitary apoplexy would indicate a greater degree of destruction of the pituitary parenchyma and, therefore, a lower probability of recovery of pituitary hormone function. […] The insulin tolerance test (ITT) is the most sensitive test for assessing pituitary ACTH reserve. […] The presence of copeptin levels > 21.4 pmol/L indicates AVP resistance. […] The diagnosis of AVP deficiency is established when the post-stimulation copeptin level is ≤4.9 pmol/L after administration of hypertonic saline or ≤3 pmol/L after administration of arginine.

• #101 Diagnosis and Treatment of Hypopituitarism

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4722397/

  It is widely accepted that maximum serum cortisol levels can be observed after the administration of doses of ACTH much lower than the usual dose of 250 g that is given in the rapid ACTH test. […] TSH deficiency can be easily distinguished from primary hypothyroidism in cases where the TSH level increases inordinately. […] In many cases, it is possible to diagnose gonadotropin deficiency using a basal hormone test and an evaluation of clinical symptoms. […] When diagnosing GH deficiency in adult patients, the basal GH concentration is not considered to be valuable but measures of insulin-like growth factor 1 (IGF-1) may be of some use, although they are not sufficient themselves. […] The diagnosis of posterior pituitary hormone deficiency can be easily made through a review of clinical symptoms/signs and a water deprivation test. […] It is advisable to re-evaluate pituitary gland functionality 2 to 3 months after an operation because, although most hypopituitarism symptoms are irreversible, a patient may recover some of level of function.

• #102 Pituitary Health – Management Of Hypopituitarism

  https://pituitarysociety.org/hypopituitarism/

  Sometimes, a stimulation test is necessary to determine if there is a hormone deficiency. This is particularly true when evaluating cortisol or GH deficiencies. […] Hormone deficiency is treated by replacing the deficient hormones. The goals of treatment are to improve symptoms and to replace the deficient hormone or hormones at a level that is as close to physiologically correct as possible. […] If the pituitary gland is permanently damaged, proper hormone replacement usually requires life-long treatment. The optimal dose is then considered the maintenance dose, and it should become a regular part of daily life. […] When hormone replacement treatment is first started, it may take time to determine the patients response and to find the best dose. Thus, frequent visits with the endocrinologist and repeated blood tests may be needed.

• #103 Hypopituitarism (Panhypopituitarism) Differential Diagnoses

  https://emedicine.medscape.com/article/122287-differential

  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 post therapy. Blood could be drawn to measure serum cortisol and ACTH prior to initiating glucocorticoid therapy. […] 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.

• #104 Panhypopituitarism: What It Is, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/23935-panhypopituitarism

  Hormone level tests include: […] The treatment for panhypopituitarism greatly depends on how deficient each pituitary hormone is and the cause of the condition. […] Your healthcare team will determine what the best treatment plan is for you. […] In some cases, panhypopituitarism is reversible by treatment of the underlying cause, such as surgically removing a pituitary adenoma that was compressing the pituitary gland without causing damage. […] But in most cases, the hormone deficiencies from panhypopituitarism require lifelong treatment.

• #105 Hypopituitarism: What It Is, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/22102-hypopituitarism

  Hormone replacement therapy: This aims to restore the deficient pituitary hormone(s) to normal levels. […] Theres no cure, but hypopituitarism is treatable. […] In most cases, hypopituitarism requires close, lifelong monitoring of the hormones affected. […] If youve been diagnosed with hypopituitarism, you may want to ask your healthcare provider the following questions: […] What kind of hypopituitarism do I have? […] What are my treatment options? […] Most cases require lifelong treatment and monitoring of your hormones, so its important to see your provider regularly.

• #106 Generalized Hypopituitarism – Endocrine and Metabolic Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/endocrine-and-metabolic-disorders/pituitary-disorders/generalized-hypopituitarism

  Generalized hypopituitarism refers to endocrine deficiency syndromes due to partial or complete loss of anterior lobe pituitary function. […] Diagnosis involves imaging tests and measurement of pituitary hormone levels basally and after various provocative stimuli. […] Clinical features are often nonspecific, and the diagnosis must be established with certainty before committing the patient to a lifetime of hormone replacement therapy. […] Evidence of structural pituitary abnormalities and of hormonal deficiencies should be sought with imaging and laboratory tests. […] Patients should undergo high-resolution CT or MRI, with contrast agent as required (to rule out structural abnormalities, such as pituitary adenomas). […] Initial evaluation should include testing for TSH and ACTH deficiencies, because both conditions are potentially life threatening.

• #107 Hypopituitarism – Wikipedia

  https://en.wikipedia.org/wiki/Hypopituitarism

  Hypopituitarism is the decreased (hypo) secretion of one or more of the eight hormones normally produced by the pituitary gland at the base of the brain. […] The diagnosis of hypopituitarism is made by blood tests, but often specific scans and other investigations are needed to find the underlying cause, such as tumors of the pituitary, and the ideal treatment. […] The diagnosis of hypopituitarism is made on blood tests. Two types of blood tests are used to confirm the presence of a hormone deficiency: basal levels, where blood samples are taken usually in the morning without any form of stimulation, and dynamic tests, where blood tests are taken after the injection of a stimulating substance. […] Generally, the finding of a combination of a low pituitary hormone together with a low hormone from the effector gland is indicative of hypopituitarism.

• #108 Diagnosis and treatment of hypopituitarism: an update – PubMed

  https://pubmed.ncbi.nlm.nih.gov/16508719/

  Diagnosis and treatment of patients with hypopituitarism needs careful clinical evaluation and individual optimization. […] Diagnosis of hypopituitarism can be straightforward by measuring reduced basal hormone levels. […] Frequently, dynamic stimulation tests are indicated in equivocal basal hormone levels or to diagnose partial hormone deficiencies. […] Knowledge of the use and limitations of these dynamic tests is mandatory for proper interpretation. […] In the present overview, the principles of diagnosis and treatment of hypopituitarism are discussed.

• #109 Hypopituitarism – Knowledge @ AMBOSS

  https://www.amboss.com/us/knowledge/hypopituitarism/

  Hypopituitarism is diagnosed by measuring specific hormone levels (depending on the underlying hormone deficiency) and with cranial imaging (in order to identify damage to the pituitary gland and/or hypothalamus). […] Each hormone deficiency must be tested individually because the pattern of hormone deficiency may vary. […] If a hormone deficiency is identified, cranial imaging (preferably MRI) is indicated to identify the cause (e.g., pituitary adenoma). […] Imaging of the pituitary is indicated in all patients to determine the underlying cause. […] MRI brain is the preferred imaging modality. […] Testing is required if treatment is planned and optional if treatment is not planned and hormonal deficiencies exist in 3 pituitary axes. […] Routine testing is not performed in the investigation of hypopituitarism.

• #110 An Update on Advances in Hypopituitarism: Etiology, Diagnosis, and Current Management

  https://www.mdpi.com/2077-0383/13/20/6161

  This article provides an updated review of hypopituitarism (HP), an endocrine disorder characterized by a deficiency of one or more pituitary hormones. […] Diagnosis is based on clinical evaluation and hormonal testing, with identification of the specific hormonal deficiencies essential for effective treatment. […] The complexity of diagnosing HP, especially in cases with atypical presentations or underlying conditions, highlights the importance of comprehensive evaluation and individualized hormone replacement therapy to improve patient outcomes and quality of life. […] Evaluation of pituitary hormone function should be performed in all patients with symptoms or suspicion of HP, in those at risk of HP (radiation therapy, cranio-encephalic trauma, brain injury, etc.), or in those with known hypothalamic–pituitary disease.

• #111 Pituitary Health – Management Of Hypopituitarism

  https://pituitarysociety.org/hypopituitarism/

  Sometimes, a stimulation test is necessary to determine if there is a hormone deficiency. This is particularly true when evaluating cortisol or GH deficiencies. […] Hormone deficiency is treated by replacing the deficient hormones. The goals of treatment are to improve symptoms and to replace the deficient hormone or hormones at a level that is as close to physiologically correct as possible. […] If the pituitary gland is permanently damaged, proper hormone replacement usually requires life-long treatment. The optimal dose is then considered the maintenance dose, and it should become a regular part of daily life. […] When hormone replacement treatment is first started, it may take time to determine the patients response and to find the best dose. Thus, frequent visits with the endocrinologist and repeated blood tests may be needed.

• #112 Panhypopituitarism: What It Is, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/23935-panhypopituitarism

  Hormone level tests include: […] The treatment for panhypopituitarism greatly depends on how deficient each pituitary hormone is and the cause of the condition. […] Your healthcare team will determine what the best treatment plan is for you. […] In some cases, panhypopituitarism is reversible by treatment of the underlying cause, such as surgically removing a pituitary adenoma that was compressing the pituitary gland without causing damage. […] But in most cases, the hormone deficiencies from panhypopituitarism require lifelong treatment.

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