How to diagnose hypopituitarism. Learning the features of secondary hormonal deficiencies.

Hypopituitarism has many causes and various clinical presentations. Diagnosis depends on history taking, clinical suspicion, and an understanding of the hypothalamic-pituitary-target organ axes for proper interpretation of laboratory data. In the patient described in the case report, 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 normal thyrotropin measurements, but they were inappropriately low for the low T4 concentrations, indicating pituitary thyrotropin deficiency. Given the patient's obstetric history and overall clinical course, hypopituitarism resulting from postpartum pituitary necrosis was suspected. Magnetic resonance imaging of the pituitary was performed, and she was treated with glucocorticoids, T4 replacement, and estrogen-progesterone replacement. We expected her to do well. In general, the long-term outlook for patients with hypopituitarism is excellent, once the problem is diagnosed. Clinical signs and symptoms should be completely relieved by adequate hormone-replacement therapy, and with proper long-term follow-up and special attention during intercurrent illness, there should be no adverse outcomes.