Testing

<p>From: 'Hypopituitarism' <a href="http://www.merckmanuals.com/home/hormonal-and-metabolic-disorders/pituitary-gland-disorders/hypopituitarism">http://www.merckmanuals.com/home/hormonal-and-metabolic-disorders/pituitary-gland-disorders/hypopituitarism</a></p>

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The diagnosis is based on measuring the blood levels of hormones produced by the pituitary gland and on imaging tests done on the pituitary gland.

Fom: 'Chronic Fatigue Syndrome, A Roadmap for Testing and Treatment' <a href="https://sites.google.com/site/cfstestingandtreatmentroadmap/home">https://sites.google.com/site/cfstestingandtreatmentroadmap/home</a>

Note that <b >hypopituitarism</b> will occur in up to 30% of people who sustain a moderate or severe traumatic brain injury (TBI), and can sometimes occur even in mild TBI cases. Hypopituitarism can have symptoms very close to those of ME/CFS.<a href="http://www.dailymail.co.uk/health/article-2631263/How-doctors-failing-spot-brain-injury-30-000-cases-chronic-fatigue.html#ixzz322IbpZZe" rel="nofollow" target="_blank" >1</a> Thus there is a real danger of misdiagnosing such symptoms ME/CFS when the true cause is hypopituitarism. <br />

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If a traumatic brain injury is involved, and ME/CFS-like symptoms ensue, testing for hypopituitarism would be advised. The <b >short synacthen test</b> (also called the ACTH stimulation test) is a standard test for hypopituitarism, but this test is not very accurate, and in fact misses 40% of hypopituitarism cases. A more accurate but more complex and risky test for hypopituitarism is the <b >insulin tolerance test</b>.<br />

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A trauma to the spine can sometimes cause a <b >syringomyelia</b> to later form in the spinal cord, which may result in ME/CFS-like symptoms. Syringomyelia can be treated surgically.</p>

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Signs and symptoms <br />

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Hypopituitarism is often progressive. Although the signs and symptoms can occur suddenly, usually they tend to develop gradually. They're sometimes vague and subtle, and may be overlooked for many months or even years.<br />

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Signs and symptoms of hypopituitarism vary, depending on which pituitary hormones are deficient. The signs and symptoms may include:<br />

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Fatigue <br />

A decline in energy <br />

Muscle weakness <br />

Nausea <br />

Constipation <br />

Weight loss or gain <br />

A decline in appetite <br />

Abdominal discomfort <br />

Sensitivity to cold or difficulty staying warm <br />

Visual disturbances <br />

Loss of underarm and pubic hair <br />

Joint stiffness <br />

Hoarseness <br />

Facial puffiness <br />

Thirst and excess urination <br />

Low blood pressure <br />

Headaches <br />

If you're a man, you may also have signs and symptoms such as:<br />

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Loss of interest in sexual activity <br />

Erectile dysfunction <br />

Decrease in facial or body hair <br />

If you're a woman, you may develop:<br />

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Irregular or stopped menstrual periods <br />

Infertility <br />

Inability to produce milk for breast-feeding 

From: 'Hypopituitarism' <a href="http://www.merckmanuals.com/home/hormonal-and-metabolic-disorders/pituitary-gland-disorders/hypopituitarism">http://www.merckmanuals.com/home/hormonal-and-metabolic-disorders/pituitary-gland-disorders/hypopituitarism</a></p>

<h2 id="" >Diagnosis</h2>

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<p >Blood tests</p>

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<p >Because the pituitary gland stimulates other glands, a deficiency in pituitary hormones often reduces the amount of hormones those other glands produce. Therefore, a doctor considers the possibility of pituitary malfunction when investigating a deficiency in another gland, such as the thyroid or adrenal gland. When symptoms suggest that several glands are underactive, a doctor may suspect hypopituitarism or <a href="http://www.merckmanuals.com/home/hormonal-and-metabolic-disorders/polyglandular-deficiency-syndromes/polyglandular-deficiency-syndromes" >polyglandular deficiency syndrome</a>.</p>

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<p >An evaluation usually begins by measuring blood levels of the hormones that the pituitary gland produces (typically, thyroid-stimulating hormone, prolactin, luteinizing hormone, and follicle-stimulating hormone) and at the same time measuring levels of the hormone produced by the target organs (typically, thyroid hormone, testosterone in men, and estrogen in women).</p>

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<p >For example, a person with hypothyroidism due to failure of the pituitary gland has low levels of thyroid hormone and low or inappropriately normal levels of thyroid-stimulating hormone, which is produced by the pituitary gland. In contrast, a person with hypothyroidism due to failure of the thyroid gland itself has low levels of thyroid hormone and high levels of thyroid-stimulating hormone. Sometimes, doctors inject a synthetic version of a thyrotropin-releasing hormone, a hormone that stimulates release of thyroid-stimulating hormone and prolactin from the anterior part of the pituitary. The body's response to this injection may help doctors determine whether the pituitary or another gland is the cause of hormone deficiency.</p>

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<p >Growth hormone production by the pituitary is difficult to evaluate because no test accurately measures it. The body produces growth hormone in several bursts each day, and the hormone is quickly used. Thus, the blood level at any given moment does not indicate whether production is normal over the course of a day. Instead, doctors measure the levels of insulin-like growth factor 1 (IGF-1) in the blood. Production of IGF-1 is controlled by growth hormone, and the level of IGF-1 tends to change slowly in proportion to the overall amount of growth hormone produced by the pituitary. In infants and young children, doctors may instead measure levels of a similar substance, IGF-binding protein type 3.</p>

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<p >Because the levels of luteinizing hormone and follicle-stimulating hormone fluctuate with the menstrual cycle, their measurement in women may be difficult to interpret. However, in postmenopausal women who are not taking estrogen, luteinizing hormone and follicle-stimulating hormone levels normally are high.</p>

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<p >Production of ACTH is usually assessed by measuring the levels of its target hormone (cortisol) in response to stimuli, such as an injection of synthetic ACTH (ACTH stimulation test) or a low level of sugar in the blood after an insulin injection (insulin tolerance test). If the level of cortisol does not change and the level of ACTH in the blood is normal or low, a deficiency of ACTH production is confirmed.</p>

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<p >Once hypopituitarism is established by blood tests, the pituitary gland is usually evaluated with computed tomography (CT) or magnetic resonance imaging (MRI) to identify structural problems. CT or MRI helps reveal individual (localized) areas of abnormal tissue growth as well as general enlargement or shrinkage of the pituitary gland. The blood vessels that supply the pituitary can be examined with cerebral <a href="http://www.merckmanuals.com/home/special-subjects/common-imaging-tests/angiography" >angiography</a>.</p>

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insulin stress test or the glucagon stimulation test to check for growth hormone deficiency/ACTH deficiency (and not the short synacthen test)

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