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Hypopituitarism C033

Document
Last amended 
7 January 2019
Current RMA Instruments
Reasonable Hypothesis SOP
11 of 2019
Balance of Probabilities SOP
12 of 2019
Changes from previous Instruments

SOP Bulletin 206

ICD Coding
  • ICD-9-CM Codes: 253.2-253.9
  • ICD-10-AM Code: E23.0
Brief description

This SOP covers pathology of the pituitary and also pathology of the hypothalamus where it causes a deficiency in pituitary hormone production.

The pituitary produces a range of hormones: growth hormone; thyroid stimulating hormone; adrenocorticotrophic hormone; follicle stimulating hormone; lutenising hormone; prolactin; antidiuretic hormone/vasopressin; and oxytocin.  Hypopituitarism can cause a deficiency in one or more or all pituitary hormones, with a wide range of possible clinical manifestations.

Confirming the diagnosis

The diagnosis requires evidence of deficiency of one or more pituitary hormones, on blood testing.  Pituitary imaging may also be undertaken.

The relevant medical specialist is an endocrinologist.

Additional diagnoses covered by SOP
  • Acute hypopituitarism
  • Chronic hypopituitarism
  • Drug induced hypopituitarism
  • Diabetes insipidus
  • Panhypopituitarism
  • Sheehan’s syndrome
Conditions excluded from SOP
  • Adrenal insufficiency*
  • Cushing’s disease*
  • Cushing syndrome*
  • Hereditable or congenital hypopituitarism

* another SOP applies

Clinical onset

The clinical presentation is variable.  Onset can be sudden or gradual and severity can be mild to severe.  Symptoms depend on the hormone/s involved and the degree of deficiency.  Clinical onset is likely to be based on the first onset of relevant symptoms.  In some patients the first evidence may be from biochemical testing that is indicated due to the presence of a disease or lesion known to affect the hypothalamus or pituitary.

Clinical worsening

Worsening may be evidenced by an increase in the frequency, severity or duration of symptoms or by biochemical evidence of worsening hormone deficiency.