When Should Hypopituitarism Be Suspected?

Key Points

• Central adrenal insufficiency lacks the hyperpigmentation and hyperkalemia associated with primary adrenal insufficiency.
• Central adrenal insufficiency should be suspected in cases of tumors or surgery in the region of the pituitary; presentation can be delayed following intracranial radiation therapy.
• In cases of shock due to suspected panhypopituitarism, intravenous levothyroxine should be accompanied by stress-dose steroids while awaiting laboratory confirmation.
• When secondary (i.e., central) hormone deficiencies are suspected, check both pituitary and target organ hormones (e.g. TSH and free T4) to determine if the hypothalamic-pituitary-target organ axis is “appropriate.” Provocation testing may be necessary to confirm.