Hypopituitarism

Panhypopituitarism or partial pituitary failure. Diagnosis usually requires dynamic testing with insulin or glucagon stress to detect deficiency of either one or more anterior or posterior pituitary hormones.

General examination

To diagnose hypopituitarism, a detailed and full general examination is mandatory in the initial assessment of a patient. 

Blood pressure

A postural drop in BP may be found in glucocorticoid deficiency, or in dehydration with diabetes insipidus.

Skin and hair

Fine wrinkling of the skin occurs in hypopituitarism.

Pallor may also occur with a normocytic normochromic anaemia with glucocorticoid deficiency.

Doughy pallid 'myxoedematous' skin may be seen with loss of thyroid function.

Doughy skin with soft tissue swelling also occurs in growth hormone excess.

Loss of secondary sexual hair may occur in gonadotropin deficiency.

Café au lait patches, skin tags and axillary freckling may indicate associated syndromes, for example multiple endocrine neoplasia 2, McCune Albright syndrome or neurofibromatosis.

Body habitus, height, weight, waist hip ratio and BMI

Increased waist hip ratio may occur with GH deficiency and with excessive glucocorticoid replacement therapy.

Increased weight may also occur with under replacement of thyroid hormone.

Musculature

Muscle wasting may occur in gonadotropin and glucocorticoid deficiency.

Proximal myopathy and slow relaxing reflexes may occur with loss of thyroid function. Proximal myopathy may also occur with glucocorticoid excess.

Gonadal status

Musculature, skin, secondary sexual characteristics and testicular examination all form part of the assessment of hypogonadism.

Thyroid status

Specifically seek signs of hypothyroidism.