History
Assessment of pituitary function, history of:

• Pituitary or hypothalamic lesions
• Cranial radiation
• Head trauma or head surgery
• Gonadal dysfunction
• Craniofacial abnormalities
• Empty sella
• Inflammatory or granulomatous disease
• Pregnancy-related hemorrhage or hypotension
• Initial symptoms may be nonspecific and of insidious onset, depending on severity of hormone deficiency: Fatigue, hypotension, cold intolerance
• Pituitary failure secondary to tumors may present with symptoms related to mass effect: Headache, visual impairment, hypothalamic dysfunction
• Symptoms are related to specific hormone deficiency:
  • Corticotropin (ACTH): Hypotension, hypoglycemia, nausea, vomiting, extreme fatigue, asthenia, anorexia, pallor, weight loss:
    • In children: Failure to thrive, hypoglycemia
  • Thyrotropin: Tiredness, cold intolerance, constipation, weight gain, hair loss, dry skin, bradycardia, hoarseness, mental lethargy
  • Gonadotropin: Sexual dysfunction, loss of libido, infertility:
    • In men: Impotence, decreased muscle and bone mass
    • In women: Amenorrhea, dyspareunia
    • In children: Delayed puberty
  • Growth hormone: Commonly deficient when other hormones are deficient. Fatigue, decreased muscle mass and strength, increased visceral fat, general malaise:
    • In children: Growth retardation
  • Prolactin: Inability to lactate

• Hypotension
• Pituitary failure secondary to tumors: Visual impairment:
  • Corticotropin (ACTH): Hypotension, anorexia, pallor, weight loss
  • Thyrotropin: Weight gain, hair loss, dry skin, bradycardia, hoarseness
  • Gonadotropin: Delayed puberty
  • Growth hormone: Decreased muscle mass and strength, increased visceral fat, growth retardation

• Stigmata specific to hormone deficiencies
• Visual field defects
• Children:
  • Congenital malformations and syndromes, especially malformations of the head and genitalia
  • Growth retardation and delayed puberty