Hypopituitarism
Page most recently updated 7 September 2026
This page focuses on the reported psychiatric associations, which may be the initial presenting manifestation, and on other clinical features that may assist the psychiatrist or primary care physician in identifying the underlying diagnosis, considered through the lenses of the diagnostic lenses framework.
Hypopituitarism is an endocrine disorder characterized by deficient production of one or more pituitary hormones, resulting in multisystemic effects.
It can present with psychiatric features such as depression, anxiety, apathy, irritability, cognitive impairment, fatigue, behavioural change, and, less commonly, psychosis. Neuropsychiatric manifestations may be particularly prominent when deficiencies of the adrenal, thyroid, or gonadal axes are present.
Other characteristic features include headache and visual disturbance when a pituitary or sellar lesion is responsible, as well as symptoms related to specific pituitary hormone deficiencies. Severe ACTH deficiency may cause hypotension, hypoglycaemia, hyponatraemia, and adrenal crisis, while severe TSH deficiency may produce marked slowing and cognitive dysfunction.
From a multisystemic lens perspective, clinical features in other body systems include (but are not limited to):
· Cardiovascular: hypotension, reduced cardiac output, bradycardia, and other cardiovascular manifestations related to adrenal or thyroid hormone deficiency may occur.
· Renal/electrolytes: hyponatraemia and, particularly with concomitant ACTH deficiency, hypoglycaemia and impaired free-water clearance may occur.
· Gastrointestinal: anorexia, nausea, constipation, and weight change may occur, particularly with secondary adrenal or thyroid hormone deficiency.
· Endocrine: deficiencies of ACTH, TSH, LH/FSH, GH, and ADH may produce features of secondary adrenal insufficiency, central hypothyroidism, hypogonadism, growth hormone deficiency, or diabetes insipidus. Menstrual irregularity, amenorrhoea, reduced libido, infertility, and loss of secondary sexual characteristics may occur with gonadotropin deficiency.
· Hematologic: anaemia may occur, particularly in association with hypothyroidism or hypogonadism.
· Musculoskeletal: reduced bone density, muscle weakness, fatigue, and loss of muscle mass may occur, particularly with prolonged hypogonadism or growth hormone deficiency.
Early diagnosis is important to identify and replace deficient pituitary hormones, prevent potentially life-threatening adrenal insufficiency and other endocrine complications, identify underlying pituitary or sellar disease, and improve potentially reversible psychiatric, cognitive, and systemic manifestations.
Selected references and further reading — Multisystemic lens
Cardinal RN, Bullmore ET. The diagnosis of psychosis. Cambridge: Cambridge University Press; 2011.
Sachdev PS, Keshavan MS, editors. Secondary schizophrenia. Cambridge: Cambridge University Press; 2010.
Levenson JL, editor. The American Psychiatric Association Publishing textbook of psychosomatic medicine and consultation-liaison psychiatry. 3rd ed. Washington (DC): American Psychiatric Association Publishing; 2019.
Stern TA, Beach SR, Smith FA, Freudenreich O, Vranceau AM, Fava M, editors. Massachusetts General Hospital handbook of general hospital psychiatry. 8th ed. Philadelphia: Elsevier; 2025.
Arciniegas DB, Yudofsky SC, Hales RE, editors. The American Psychiatric Association Publishing textbook of neuropsychiatry and clinical neurosciences. 6th ed. Washington (DC): American Psychiatric Association Publishing; 2018.
Agrawal N, Faruqui R, Bodani M, editors. Oxford textbook of neuropsychiatry. Oxford: Oxford University Press; 2020.
Boland R, Verduin M, editors. Kaplan and Sadock's comprehensive textbook of psychiatry. 11th ed. Philadelphia: Wolters Kluwer; 2024.
Loscalzo J, Fauci AS, Kasper DL, Hauser SL, Longo DL, Jameson JL, editors. Harrison's principles of internal medicine. 22nd ed. New York: McGraw Hill; 2025.