Hypopituitarism physical examination

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Ahmed Elsaiey, MBBCH [2], Iqra Qamar M.D.[3]

Overview

Clinical presentation in hypopituitarism depends upon the onset, the severity of hormonal deficiency and the number of deficient hormones. Patients with hypopituitarism are ill appearing and usually look tired. Physical examination of patients with hypopituitarism is usually remarkable for the respective hormonal deficiency and present with features of that specific hormone such as hypothyroidism presents as delayed relaxation of tendon reflexes, bradycardia, coarse skin, puffy facies, and loss of eyebrows. ACTH deficiency can present with postural hypotension, tachycardia, and weight loss. Gonadotropin deficiency may present with breast atrophy, soft testes, and regression of sexual characteristics. Growth hormone deficiency can present with short stature, decreased sweating with impaired thermogenesis, and reduced muscle mass.

Clinical presentation in hypopituitarism depends upon factors as followings:

The onset:
- Acute: Sudden onset of symptoms as seen in pituitary apoplexy.
- Chronic: Slow onset, may take years to manifest such as radiation damage.
The severity of hormonal deficiency:
- Complete hormonal deficiency: May present even in normal circumstances.
- Partial hormonal deficiency: May present only in times of stress.
The number of deficient hormones:
- One hormone or some hormones are deficient.
- All of the pituitary hormones (panhypopituitarism).
Patients with sellar mass may present with a headache, diplopia, or visual loss. Physical examination of patients with hypopituitarism is usually remarkable for:

Hormonal deficiency	Finding
ACTH	Acute	Postural hypotension Tachycardia
ACTH	Chronic	Anorexia Weight loss No hyperpigmentation
TSH	Slow movement and slow speech Delayed relaxation of tendon reflexes Bradycardia Carotenemia Coarse skin Puffy face and loss of eyebrows Periorbital edema Enlargement of the tongue Diastolic hypertension Pleural and pericardial effusions Ascites Galactorrhea
Gonadotropins	Male	Soft testes Reduced muscle mass Diminished facial and body hair Fine facial wrinkles Gynecomastia Regression of sexual characteristics
Gonadotropins	Female	Breast atrophy Regression of sexual characteristics
Growth hormone	Children	Short stature
Growth hormone	Adults	Decreased sweating and impaired thermogenesis Reduced muscle mass and strength Fine facial wrinkles Increased central obesity

Patients of hypopituitarism are ill appearing and usually look tired.^[1]^[2]^[3]

↑ Fleseriu, Maria; Hashim, Ibrahim A.; Karavitaki, Niki; Melmed, Shlomo; Murad, M. Hassan; Salvatori, Roberto; Samuels, Mary H. (2016). “Hormonal Replacement in Hypopituitarism in Adults: An Endocrine Society Clinical Practice Guideline”. The Journal of Clinical Endocrinology & Metabolism. 101 (11): 3888–3921. doi:10.1210/jc.2016-2118. ISSN 0021-972X.
↑ Prabhakar VK, Shalet SM (2006). “Aetiology, diagnosis, and management of hypopituitarism in adult life”. Postgrad Med J. 82 (966): 259–66. doi:10.1136/pgmj.2005.039768. PMC 2585697. PMID 16597813.
↑ Ascoli, Paola; Cavagnini, Francesco (2006). “Hypopituitarism”. Pituitary. 9 (4): 335–342. doi:10.1007/s11102-006-0416-5. ISSN 1386-341X.
↑ Arlt W, Allolio B (2003). “Adrenal insufficiency”. Lancet. 361 (9372): 1881–93. doi:10.1016/S0140-6736(03)13492-7. PMID 12788587.