Hypopituitarism physical examination

Hypopituitarism Microchapters
Home
Patient Information
Overview
Historical Perspective
Classification
Pathophysiology
Causes
Differentiating Hypopituitarism from other Diseases
Epidemiology and Demographics
Risk Factors
Screening
Natural History, Complications and Prognosis
Diagnosis
History and Symptoms
Physical Examination
Laboratory Findings
Electrocardiogram
X Ray
CT
MRI
Ultrasound
Other Imaging Findings
Other Diagnostic Studies
Treatment
Medical Therapy
Surgery
Primary Prevention
Secondary Prevention
Cost-Effectiveness of Therapy
Future or Investigational Therapies
Case Studies
Case #1
Hypopituitarism physical examination On the Web
Most recent articles
Most cited articles
Review articles
CME Programs
Powerpoint slides
Images
American Roentgen Ray Society Images of Hypopituitarism physical examination All Images X-rays Echo & Ultrasound CT Images MRI
Ongoing Trials at Clinical Trials.gov
US National Guidelines Clearinghouse
NICE Guidance
FDA on Hypopituitarism physical examination
CDC on Hypopituitarism physical examination
Hypopituitarism physical examination in the news
Blogs on Hypopituitarism physical examination
Directions to Hospitals Treating Hypopituitarism
Risk calculators and risk factors for 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.

Physical Examination

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
	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
	Female	Breast atrophy Regression of sexual characteristics
Growth hormone	Children	Short stature
	Adults	Decreased sweating and impaired thermogenesis Reduced muscle mass and strength Fine facial wrinkles Increased central obesity

Appearance of the patient

• Patients of hypopituitarism are ill appearing and usually look tired.

Vital Signs

• Orthostatic hypotension

Skin

• Dry skin
• Pallor
• Loss of hair
• Alabaster-like appearance

Lungs

• Dyspnea

Heart

• Bradycardia
• Atherosclerosis

Abdomen

• Rebound tenderness

Neuromuscular

• Muscle weakness
• Osteoporosis

Genitourinary

• Hypogonadism (Micropenis)
• Erectile dysfunction