First symptoms of pituitary insufficiency
The clinical manifestations of hypopituitarism depend on the extent and severity of the specific pituitary hormone deficiencies. If the onset is acute, the patient may be critically ill and present with hypotension and shock, obtundation, and even coma. However, if the onset is chronic and the pituitary deficiency is mild, the patient may only endorse fatigue and malaise.
• Adrenocorticotropic hormone (ACTH) deficiency (central adrenal insufficiency): Fatigue, malaise, low-grade fever, diffuse myalgias and arthralgias, weakness, anorexia, weight loss, nausea, vomiting, abdominal pain, diarrhea, and postural lightheadedness.
• Thyroid-stimulating hormone (TSH) deficiency (central hypothyroidism): Impaired mental activity, weight gain, fatigue, weakness, cold intolerance, dysphonia, somnolence, alopecia, facial puffiness, and constipation.
• Gonadotropin deficiency (central hypogonadism): Men report decreased libido, erectile dysfunction, hot flashes, gynecomastia, and infertility. Women complain of oligo/amenorrhea, infertility, decreased libido, hot flashes, vaginal dryness, and dyspareunia.
• Growth hormone (GH) deficiency: Fatigue, weakness, increased adiposity, decreased lean mass, exercise intolerance, and impaired sleep quality.
• Prolactin (PRL) deficiency: Agalactia or hypolactia in the postpartum period.