Signs of pituitary insufficiency

Are there any signs on physical examination that suggest pituitary insufficiency?

Other than delayed relaxation of deep tendon reflexes in patients with overt hypothyroidism (Woltman’s sign), there are no specific or pathognomonic findings on physical examination in patients with hypopituitarism.

• ACTH deficiency: Postural hypotension, tachycardia, pallor, alopecia, and areolar hypopigmentation. Women with longstanding ACTH deficiency often have loss of pubic and axillary hair.

• TSH deficiency: Bradycardia, alopecia, facial/periorbital puffiness, madarosis (loss of the tail of the eyebrows), dysphonia, hypercarotenemia, and delayed relaxation of deep tendon reflexes (Woltman’s sign).

• Gonadotropin deficiency: If the onset of hypogonadism is prepubertal, both men and women will acquire eunuchoid features, including deficient secondary sex characteristics and excessive growth of the long bones. If the onset is postpubertal, men may have pallor, fine facial wrinkling, scarce body and facial hair, gynecomastia, increased adiposity and decreased muscle mass, and smaller and softer testicles. Women may have alopecia, hirsutism, reduced breast tissue mass, and vaginal atrophy.

• GH deficiency: Fine facial wrinkling, increased adiposity, and decreased muscle mass. The onset of GH deficiency before growth plate closure will cause short stature.

• PRL deficiency: Postpartum agalactia.


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