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Chloe de Crecy


  • Originates from hypothalamus vs anterior pituitary. Time course: acute vs insidious.
  • Hypothalamic: mass (benign vs malignant), radiation, infiltrative dz (sarcoid), infections (TB), TBI, stroke
  • Pituitary: mass (adenoma, cysts), surgery, radiation, infiltrative dz (hypophysitis, hemochromatosis), infection, infarction, apoplexy, genetic mutations, empty sella


  • Not all hormones are always affected. Secretion of GH and gonadotropins more likely affected than ACTH and TSH.
  • Consult Endocrine
HPA Axis Symptoms Testing Replacement
CRH – ACTH – Cortisol (Adrenals) Fatigue, weight loss, hypoglycemia AM cortisol (decreased)
ACTH (decreased)
Cosyntropin Stim test
Hydrocortisone (~15-25mg total daily)
TRH – TSH – T4/T3 (Thyroid) Fatigue, cold intolerance, constipation, bradycardia, skin changes, anemia, delayed reflexes TSH, T4, T3 (all decreased) Levothyroxine
GnRH – LH/FSH - Estrogen, androgens (Gonads) Hypogonadism
F: anovulation, hot flashes, vaginal atrophy, decreased bone density
M: decreased energy/libido, low energy, decreased muscle mass, decreased spermatogenesis
F w/ amenorrhea: LH, FSH, estradiol, medroxyprogesterone challenge (withdrawal bleeding)
F: estradiol (+ progestin if uterus)
M: Testosterone (injection, gel, patch) or hCG if trying to conceive
GHRH – Growth hormone – liver, fat Children: short stature
Adults: decrease in lean body mass, decrease in bone density, dyslipidemia
IGF-1 (decreased) Recombinant growth hormone
Dopamine (inhibitor) – Prolactin – mammary glands Inhibited lactation Not done Not done