In station 5 you may be asked to assess a patient with headache, bumping into things etc.


History (3 minutes):


  • Timing questions: when did symptoms start, did they come on suddenly/gradually, are they getting worse, intermittent (eg. times of stress)/constant symptoms
  • Headache
  • Change in vision- bumping into things, double vision, blurring
  • Gonadotropin deficiency: reduced sex drive, no/irregular periods, difficulty conceiving, hot flushes, reduced breast size, reduced body hair
  • GH deficiency: weight gain
  • TSH deficiency: feeling cold, dry skin, hair loss, tired, constipated, puffy face, weight gain
  • ACTH deficiency (secondary adrenal insufficiency): dizzy on standing, tired, weak, off food, weight loss, nausea, vomiting, abdo pain NB: no hyperpigmentation and no salt wasting compared with primary adrenal insufficiency
  • PMH (pituitary surgery, radiation, cancer, head injury), Fx, Dx, Sx


Examine (3 minutes):


  • Weight, reduced body hair, pale
  • Neuro exam including cranial nerves (bitemporal visual field defect)
  • Fundoscopy
  • Systemic examination


ICE and Explanation (2 minutes)







Deficiency of one/several/all of the anterior pituitary hormones

The secretion of gonadotropins and growth hormone is more likely to be affected than ACTH and thyroid-stimulating hormone (TSH).


Causes of hypopituitarism:


  1. Pituitary tumour: often non-functioning macroadenoma but can be adenoma secreting prolactin/GH/ACTH/TSH with compression of remaining tissues
  2. Iatrogenic (pituitary surgery/radiation therapy to pituitary or hypothalamus for CNS/nasopharyngeal malignancies)
  3. Compression/infiltration due to meningioma/craniopharyngioma/metastasis/sarcoid/tuberculoma/haemochromatosis/abscess
  4. Pituitary apoplexy (acute infarction of a pituitary adenoma)
  5. Head injury and stroke and meningitis
  6. Infarction of pituitary (Sheehan Syndrome)
  7. Empty sella syndrome




FBC, U+E (low Na), Glucose (low)

9am cortisol (low), TFTs (TSH can be low/normal/high, low T4), LH (low), FSH (low), morning testosterone (low), oestradiol (low), IGF-1 (low), prolactin (low or raised)

CT/MRI head/pituitary




Hormone replacement (hydrocortisone, levothyroxine, sex hormones, growth hormone)

Surgery: transphenoidal surgery if mass effect




Written by Dr Sarah Kennedy


Resources used to write this document include those listed in the references section of this webpage and also: