Hypopituitarism
Hypopituitarism
DDx
Hypothalamic
I
E
W
G
D
Hands
BSL
low GH, TSH, FSH, LH, ACTH
Na for DI
DDx
Hypothalamic
- Congenital
- Prader-Willi
- Septo-optic dysplasia (SOD)
- Holoprosencephaly
- CHARGE
- Acquired
- Infiltration
- Iron deposition (haemochromatosis, thalassemia)
- Sarcoidosis
- Langerhans cell histiocytosis
- Anorexia nervosa
- Injury (acquired brain injury, surgery, or radiation)
- Infiltration
- Congenital
- Genetic
- Septo-optic dysplasia
- Holoprosencephaly
- Acquired
- Iron deposition (Fe overload)
- Tumour
- Injury (trauma, surgery, radiation)
I
- Prepubescent voice
E
W
G
- short stature (hypothyroid, GH def, hypopit) if normal = adequate Rx)
- Tall stature (chiasmal tumour, Hypogonadotrophic hypogonadism)
- Ht velocity
- decreased (hypopit, hypothyroid, GH def, malnutrition) (normalised in Rx)
- US:LS
- increased (hypothyroidism)
- decreased (hypogonadotrophic hypogonadism)
- Arm span >4cm more than Ht (hypogonadotrophic hypogonadism)
- Ht velocity
- failure to thrive (TBI, HPE, tumours, diencephalic syndrome, congenital adrenal insufficiency CAI)
- obesity (hypothyroidism, hypogonadotrophic hypogonadism, GH deficiency)
- HC
- Macrocephaly (tumour, hydrocephalus)
- Microcephaly (ABI, HPE
- delayed puberty
D
- Eunuchoid (hypogonodotrophic hypogonadism)
- Prader-Willi
- Holoprosencephaly
- CHARGE
Hands
- Supernumerary, Hypoplastic digits (SOD)
- Finger prick (BSL testing)
- bradycardia (ICP, hypothyroidism)
- tachycardia (DI, ACTH def, CAI
- hypertension (ICP)
- hypotension (CAI, DI)
- Skin fold / muscle bulk (diencephalic syndrome)
- Axillary hair / odour (pubertal delay)
- Scar (tumour resection, VP shunt)
- dry hair (hypothyroidism)
- acuity (SOD, pit tumour, HPE, CHARGE)
- fields (bitemporal hemianopia > craniopharyngioma)
- Sunsetting (ICP)
- Papilloedema (ICP)
- CNVI palsy (ICP)
- Hypoplastic optic discs (SOD)
- hypotelerism (midline defect, PW, HPE)
- Squint (SOD, HPE, CHARGE, PW)
- Nystagmus (SOD)
- Coloboma (CHARGE)
- Cleft (midline defect)
- delayed relaxation (hypothyroid)
BSL
low GH, TSH, FSH, LH, ACTH
Na for DI