Hypopituitarism: Pathology review

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Hypopituitarism: Pathology review

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A 38-year-old woman comes to the emergency department because of a severe headache and multiple episodes of non-bloody, non-bilious emesis for the past few hours. Review of systems is significant for fatigue, constipation, and problems with peripheral field vision for the past few months. Her last menstrual period was 4 months ago. Temperature is 37.0°C (98.6°F), pulse is 58/min, respirations are 10/min, and blood pressure is 92/64 mm Hg. Physical examination shows a lethargic female complaining of severe pain. Visual field is tunneled with doubling of vision. Head magnetic resonance imaging is shown below:

Reproduced from: Wikimedia Commons

Which of the following is the most likely diagnosis?

Memory Anchors and Partner Content


On your rounds, you admit 28-year-old Regina who presents with an 8-month history of depression, cold intolerance, fatigue, and reduced libido.

History revealed she delivered a healthy baby eight months ago, and that the delivery was complicated by a severe postpartum hemorrhage.

She has also been unable to breastfeed and hasn’t had her menstruation since giving birth. Physical examination is remarkable for bradycardia, weight loss, and delayed relaxation of her reflexes.

Then you see Alexander, a 58-year-old male with difficulty seeing things in his peripheral vision. He also describes a loss of sex drive, erectile dysfunction, and significant weight gain, all starting approximately two years ago.

The examination revealed moderate obesity, bilateral gynecomastia, and bitemporal hemianopsia.

Basal serum hormone measurements were performed, showing decreased T4 levels in Regina and decreased FSH, LH, and testosterone levels in Alexander.

Both people have hypopituitarism. So hypopituitarism refers to the decreased secretion of one, some, or all of the anterior pituitary hormones.

These hormones are ACTH, or adrenocorticotropic hormone; TSH, or thyroid stimulating hormone; GH, or growth hormone; FSH, or follicle-stimulating hormone; LH, or luteinizing hormone, and prolactin.

Posterior pituitary hormone deficiency can also occur, but it’s extremely rare. This part of the pituitary gland releases oxytocin and antidiuretic hormone, or ADH.

Hypopituitarism typically occurs because of an acquired or congenital issue where the hypothalamus or pituitary is injured. Now, the clinical picture of hypopituitarism depends on which hormone is missing.


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  3. "Pathophysiology of Disease: An Introduction to Clinical Medicine 8E" McGraw-Hill Education / Medical (2018)
  4. "CURRENT Medical Diagnosis and Treatment 2020" McGraw-Hill Education / Medical (2019)
  5. "Greenspan's Basic and Clinical Endocrinology, Tenth Edition" McGraw-Hill Education / Medical (2017)
  6. "Addison's disease and ACTH-producing pituitary microadenoma" Revista Médica Del Hospital General De México (2015)
  7. "Pituitary tumors: pathophysiology, clinical manifestations and management." Endocrine-related cancer (2001)
  8. "Diagnosis and Treatment of Hypopituitarism" BMJ (1954)

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