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Current RMA Instruments
|Reasonable Hypothesis SOP||11 of 2019 as amended|
|Balance of Probabilities SOP||12 of 2019 as amended|
Changes from previous Instruments
- ICD-9-CM Codes: 253.2-253.9
- ICD-10-AM Code: E23.0
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
- Sheehan’s syndrome
Conditions excluded from SOP
- Adrenal insufficiency*
- Cushing’s disease*
- Cushing syndrome*
- Hereditable or congenital hypopituitarism#
- Hypogonadism* (hypopituitarism SOP may apply in addition to hypogonadism SOP)
* another SOP applies
# non-SOP condition
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.
Worsening may be evidenced by an increase in the frequency, severity or duration of symptoms or by biochemical evidence of worsening hormone deficiency.