Key clinical features to consider when diagnosing hypopituitarism in adults include symptoms related to the deficiency of one or more pituitary hormones, often presenting insidiously. These features commonly involve fatigue, weakness, weight loss or gain, decreased libido, infertility, cold intolerance, and hypotension due to secondary adrenal insufficiency and hypothyroidism NICE NG243,NICE CKS.
Patients may also exhibit symptoms of growth hormone deficiency such as reduced muscle mass, increased fat mass, decreased exercise capacity, and impaired quality of life Feingold et al. 2000.
Visual field defects or headaches may be present if a pituitary mass or tumour is the underlying cause NICE NG232. Additionally, features of diabetes insipidus such as polyuria and polydipsia may occur if the posterior pituitary is involved NICE NG232.
Clinical suspicion should be heightened in adults with a history of pituitary surgery, radiotherapy, traumatic brain injury, or known pituitary tumours NICE NG232. Biochemical evidence of multiple pituitary hormone deficiencies supports the diagnosis.