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Suspect hypopituitarism if there are manifestations suggestive of deficiency
in more than one endocrine system.
The presence of CNS pressure manifestations is suggests that pituitary
tumors are the cause. Local pressure manifestations include headache, visual
field defects, optic atrophy, cranial nerve palsies, Korsakoff-like syndrome
with recent memory loss (pressure on the 3rd ventricle) and hyperphagia
or thirst sensations which may result from hypothalamic involvement.
Once suspected a blood sample is drawn for hormonal analysis and hydrocortisone
100mg given once followed by 50mg 6 hours later and then regular replacement
of the dose (20-30mg divided over two daily doses). This is done to avoid
the risk of adrenal insufficiency or coma that may complicate the confirmatory
1. Basal hormone levels of FSH, LH, GH, PRL, testosterone, oestradiol,
progesterone, cortisol, thyroxine (T4) and tri-iodothyroxine (T3). It is
of importance to note that the presence of normal gonadal function makes
the presence of multiple pituitary defects unlikely.
2. Combined pituitary stimulation test:
A bolus of insulin (0.15 u/kg), GnRH (100 ug) and TSH (200 ug) is given
intravenously and blood glucose, GH, FSH, LH, TSH and cortisol are serially
measured for 2 hours. Levels below normal are characteristic of hypopituitarism.
3. CAT scan or MRI of the brain to exclude pituitary tumors.
Long term replacement therapy and restoration of fertility. Steroids
are replaced before thyroid hormones to avoid precipitating acute adrenal
insufficiency by increasing the metabolic rate if thyroxine is given first.
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