HOW TO DIAGNOSE HYPOPITUITARISM - LEARNING THE FEATURES OF SECONDARY HORMONAL DEFICIENCIES

Hypopituitarism has many causes and various clinical presentations. Di agnosis depends on history taking, clinical suspicion, and an understa nding of the hypothalamic-pituitary-target organ axes for proper inter pretation of laboratory data. In the patient described in the case rep ort, amenorrhea and inability to lactate were early clinical clues to a possible pituitary problem, but she felt otherwise fairly well over the years and did not seek evaluation. Thyroid-function tests showed n ormal thyrotropin measurements, but they were inappropriately low for the low T-4 concentrations, indicating pituitary thyrotropin deficienc y. Given the patient's obstetric history and overall clinical course, hypopituitarism resulting from postpartum pituitary necrosis was suspe cted. Magnetic resonance imaging of the pituitary was performed, and s he was treated with glucocorticoids, T-4 replacement, and estrogen-pro gesterone replacement. We expected her to do well. In general, the lon g-term outlook for patients with hypopituitarism is excellent, once th e problem is diagnosed. Clinical signs and symptoms should be complete ly relieved by adequate hormone-replacement therapy, and with proper l ong-term follow-up and special attention during intercurrent illness, there should be no adverse outcomes.