- Problem at level of pituitary/hypothalamus → low ACTH
- Meds→ chronic glucocorticoids (most common), surgery, tumor, hypo-perfusion (Sheehan's: post-partum bleeding→ shock), infiltrative (e.g. Sarcoid), infection, XRT, trauma
- Sub-acute feeling poorly in general, n, v, weakness
- Weight loss, muscle aches
- Headaches and bitemporal visual field cuts if related to pituitary mass/bleeding
- Orthostatic sx/dizziness
- Decreased libido in women
- If receiving chronic steroids, symptoms may occur if stopped to quickly and/or superimposed acute illness
- May have symptoms related to decreased production of other hormones: e.g. low TSH (and T4), low LH (and testosterone)
- Hypotension: frankly low BP and/or orthostatic
- Loss of axillary & pubic hair in women
- Primary AI: Sometimes darkening of mucous membranes, skin folds, & pressure points
- Can appear cushingoid if on chronic glucocorticoids (e.g. prednisone)
- Low cortisol, low ACTH
- Hyponatremia, but not hyperkalemia (aldosterone production preserved)
- Might also have low TSH (and T4), low LH (and testosterone)