102    CHAPTER 4 Hypothalamus and Pituitary Gland

C. Laboratory and other findings These may include ane-
mia (related to thyroid and androgen deficiency and chronic
disease), hypoglycemia, hyponatremia (related to hypothyroid-
ism and hypoadrenalism, which cause inappropriate water
retention, not sodium loss), hypercalcemia (related to adrenal
insufficiency with volume contraction and hemoconcentration),
and low-voltage bradycardia on electrocardiographic testing.
Hyperkalemia, which is common in primary adrenal failure, is
not present. Adult GH deficiency is associated with decreased
red blood cell mass, increased LDL cholesterol, and decreased
bone mass.
Diagnosis
A. Assessment of target gland function (Figure 4–18) If
endocrine hypofunction is suspected, pituitary hormone

Clinical history and examination

Endocrine-hypofunction suspecteda

Thyroid function tests Rapid ACTH

Serum testosteroneb stimulation test
IGF-1

Normal

Low No disease Impaired cortisol response

Serum TSH, LH, FSH Plasma ACTH

Elevated

Primary target
gland failure

Low or normal Low or normal

Hypopituitarism

Insulin hypoglycemia, TRH, GnRH,

or clomiphene tests

Confirm diagnosis, extent of hypofunction,

and level of abnormality
aEvaluate GH in children (see text).
bMeasure prolactin if hypogonadism suspected.

FIGURE 4–18 Diagnostic evaluation of hypothalamic-pituitary-target gland hypofunction.

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