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| __NOTOC__
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| {{Menopause}}
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| {{CMG}} {{RA}}
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| <br />
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| == Overview ==
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| Menopause should be differentiated from other diseases presenting with menstrual irregularities (oligomenorrhea/amenorrhea).<ref name="pmid9541295">{{cite journal |vauthors=Sato N, Sze G, Endo K |title=Hypophysitis: endocrinologic and dynamic MR findings |journal=AJNR Am J Neuroradiol |volume=19 |issue=3 |pages=439–44 |year=1998 |pmid=9541295 |doi= |url=}}</ref><ref name="pmid7758238">{{cite journal |vauthors=Powrie JK, Powell M, Ayers AB, Lowy C, Sönksen PH |title=Lymphocytic adenohypophysitis: magnetic resonance imaging features of two new cases and a review of the literature |journal=Clin. Endocrinol. (Oxf) |volume=42 |issue=3 |pages=315–22 |year=1995 |pmid=7758238 |doi= |url=}}</ref><ref name="pmid26262437">{{cite journal |vauthors=Honegger J, Schlaffer S, Menzel C, Droste M, Werner S, Elbelt U, Strasburger C, Störmann S, Küppers A, Streetz-van der Werf C, Deutschbein T, Stieg M, Rotermund R, Milian M, Petersenn S |title=Diagnosis of Primary Hypophysitis in Germany |journal=J. Clin. Endocrinol. Metab. |volume=100 |issue=10 |pages=3841–9 |year=2015 |pmid=26262437 |doi=10.1210/jc.2015-2152 |url=}}</ref><ref name="pmid7629223">{{cite journal |vauthors=Thodou E, Asa SL, Kontogeorgos G, Kovacs K, Horvath E, Ezzat S |title=Clinical case seminar: lymphocytic hypophysitis: clinicopathological findings |journal=J. Clin. Endocrinol. Metab. |volume=80 |issue=8 |pages=2302–11 |year=1995 |pmid=7629223 |doi=10.1210/jcem.80.8.7629223 |url=}}</ref><ref name="pmid8345854">{{cite journal |vauthors=Imura H, Nakao K, Shimatsu A, Ogawa Y, Sando T, Fujisawa I, Yamabe H |title=Lymphocytic infundibuloneurohypophysitis as a cause of central diabetes insipidus |journal=N. Engl. J. Med. |volume=329 |issue=10 |pages=683–9 |year=1993 |pmid=8345854 |doi=10.1056/NEJM199309023291002 |url=}}</ref><ref name="pmid21668725">{{cite journal |vauthors=Hsieh CY, Liu BY, Yang YN, Yin WH, Young MS |title=Massive pericardial effusion with diastolic right ventricular compression secondary to hypothyroidism in a 73-year-old woman |journal=Emerg Med Australas |volume=23 |issue=3 |pages=372–5 |year=2011 |pmid=21668725 |doi=10.1111/j.1742-6723.2011.01425.x |url=}}</ref><ref name="pmid9747750">{{cite journal |vauthors=Dejager S, Gerber S, Foubert L, Turpin G |title=Sheehan's syndrome: differential diagnosis in the acute phase |journal=J. Intern. Med. |volume=244 |issue=3 |pages=261–6 |year=1998 |pmid=9747750 |doi= |url=}}</ref>
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| <small>
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| {| class="wikitable"
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| ! rowspan="3" style="background: #4479BA; width: 200px;" | {{fontcolor|#FFF|Diseases}}
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| ! rowspan="3" style="background: #4479BA; width: 200px;" | {{fontcolor|#FFF|Onset}}
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| ! colspan="5" style="background: #4479BA; width: 200px;" | {{fontcolor|#FFF|Manifestations}}
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| ! colspan="4" style="background: #4479BA; width: 200px;" | {{fontcolor|#FFF|Diagnosis}}
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| |-
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| ! colspan="4" style="background: #4479BA; width: 200px;" | {{fontcolor|#FFF|History and Symptoms}}
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| ! rowspan="2" style="background: #4479BA; width: 200px;" | {{fontcolor|#FFF|Physical examination}}
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| ! rowspan="2" style="background: #4479BA; width: 200px;" | {{fontcolor|#FFF|Laboratory findings}}
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| ! rowspan="2" style="background: #4479BA; width: 200px;" | {{fontcolor|#FFF|Gold standard}}
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| ! rowspan="2" style="background: #4479BA; width: 200px;" | {{fontcolor|#FFF| Imaging}}
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| ! rowspan="2" style="background: #4479BA; width: 200px;" | {{fontcolor|#FFF|Other investigation findings}}
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| |-
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| ! style="background: #4479BA; width: 200px;" | {{fontcolor|#FFF| Trumatic delivery}}
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| ! style="background: #4479BA; width: 200px;" | {{fontcolor|#FFF| Lactation failure}}
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| ! style="background: #4479BA; width: 200px;" | {{fontcolor|#FFF| Menstrual irregularities}}
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| ! style="background: #4479BA; width: 200px;" | {{fontcolor|#FFF| Other features}}
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| |-
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| ![[Sheehan's syndrome]]
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| |Acute
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| |<nowiki>++</nowiki>
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| | ++
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| |[[Oligomenorrhea|Oligo]]/[[amenorrhea]]
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| |Symptoms of:
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| * [[Adrenal insufficiency]]
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| * [[Hypothyroidism]]
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| * [[Breast tissue]] [[atrophy]]
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| * Decreased [[axillary]] and [[pubic]] hair growth
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| * [[Pancytopenia]]
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| * [[Eosinophilia]]
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| * [[Hyponatremia]]
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| * Low [[fasting plasma glucose]]
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| * Decreased levels of [[anterior pituitary]] [[hormones]] in blood
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| * Clinical diagnosis
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| * Most senitive test: Low baseline [[prolactin]] levels w/o response to [[Thyrotropin-releasing hormone|TRH]]
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| |CT/MRI:
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| * Sequential changes of pituitary enlargement followed by:
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| * Shrinkage and [[necrosis]] leading to decreased sellar volume or [[empty sella]]
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| * Pituitary hormone stimulation tests ([[Metoclopramide]] and [[clomiphene citrate]] stimulation tests)
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| |-
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| ![[Lymphocytic hypophysitis]]
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| |Acute
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| |<nowiki>+/-</nowiki>
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| |<nowiki>+</nowiki>
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| |[[Oligomenorrhea|Oligo]]/[[amenorrhea]]
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| * Associated with [[autoimmune]] conditions
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| * Generalized [[headache]]
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| * Retro-orbital or Bitemporal [[pain]]
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| * Mass lesion effect such as [[Visual field defect|visual field defects]]
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| * [[Diabetes insipidus|DI]]
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| * [[Autoimmune]] [[thyroiditis]]
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| * Decreased pituitary hormones([[Gonadotropins]] most common)
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| * [[Hyperprolactinemia]](40%)
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| * [[Growth hormone|GH]] excess
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| * [[Pituitary gland|Pituitary]] [[biopsy]]: [[lymphocytic]] [[Infiltration (medical)|infiltration]]
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| * [[CT]] & [[MRI]]: Features of a [[Pituitary gland|pituitary]] [[mass]]
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| * Diffuse and homogeneous contrast enhancement
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| |[[Assay|Assays]] for:
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| * Anti-TPO
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| * Anti-Tg Ab
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| |-
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| ![[Pituitary apoplexy]]
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| |Acute
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| |<nowiki>+/-</nowiki>
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| |<nowiki>++</nowiki>
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| |[[Oligomenorrhea|Oligo]]/[[amenorrhea]]
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| |Severe [[headache]]
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| * [[Nausea and vomiting]]
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| * Paralysis of eye muscles ([[diplopia]])
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| * Changes in vision
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| * [[Visual acuity]] defects
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| * [[Cranial nerve palsies|CN palsies]] (nerves III, IV, V , and VI)
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| * Decreased levels of [[anterior]] pituitary hormones in blood.
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| * [[Magnetic resonance imaging|MRI]]
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| * [[CT]] scan without [[Contrast medium|contrast]]: Hemorrhag<nowiki/>e on [[CT]] presents as a hyperdense lesion
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| * [[MRI]]: If inconclusive [[CT]]
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| [[Blood tests]] may be done to check:
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| * [[PT]]/[[INR]] and [[aPTT]]
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| * [[Pituitary gland|Pituitary]] [[hormonal]] assay
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| |-
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| ![[Empty sella syndrome]]
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| |Chronic
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| |<nowiki>-</nowiki>
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| |<nowiki>+</nowiki>
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| |[[Oligomenorrhea|Oligo]]/[[amenorrhea]]
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| * [[Erectile dysfunction]]
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| * [[Headache]]
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| * Low [[libido]]
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| * Signs of raised [[intracranial pressure]] may be present
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| * [[Nipple discharge|Nipple]] discharge
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| * Decreased levels of pituitary hormones in the blood.
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| * [[MRI]]
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| * [[Empty sella]] containing [[Cerebrospinal fluid|CSF]]
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| * Pituitary hormone stimulation tests ([[Metoclopramide]] and [[clomiphene citrate]] stimulation tests)
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| |-
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| ![[Simmond's Disease|Simmonds' disease]]/[[Pituitary]] [[cachexia]]
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| |Chronic
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| |<nowiki>+/-</nowiki>
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| | +
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| |[[Oligomenorrhea|Oligo]]/[[amenorrhea]]
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| * [[Cachexia]]
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| * [[Premature aging|Premature]] aging
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| * Progressive [[emaciation]]
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| * Loss of body hair
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| * Decreased levels of anterior pituitary hormones in the blood.
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| * [[Magnetic resonance imaging|MRI]]
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| * Done to rule out any pituitary cause
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| * Pituitary hormone stimulation tests ([[Metoclopramide]] and [[clomiphene citrate]] stimulation tests)
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| |-
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| ! [[Primary hypothyroidism|Hypothyroidism]]
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| |Chronic
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| |<nowiki>+/-</nowiki>
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| |<nowiki>-</nowiki>
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| |[[Oligomenorrhea]]/[[menorrhagia]]
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| * Cold intolerance
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| * [[Constipation]]
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| * Dry skin
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| * [[Bradycardia]]
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| * Hair loss
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| * [[Myxedema]]
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| * Delayed relaxation phase of deep [[Tendon reflex|tendon reflexes]]
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| * Low [[T3]],[[T4]]
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| * Normal/ low [[Thyroid-stimulating hormone|TSH]]
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| * Rest of pituitary hormone levels WNL
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| * [[TSH]] levels
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| * Done to rule out any pituitary cause
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| *Assays for anti-TPO and anti-Tg Ab
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| *FNA biopsy
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| |-
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| ![[Hypogonadotropic hypogonadism]]
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| |Chronic
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| |<nowiki>-</nowiki>
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| |<nowiki>-</nowiki>
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| |[[Oligomenorrhea|Oligo]]/[[amenorrhea]]
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| * [[Hot flushes]]
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| * Energy and mood changes
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| * Decreased [[libido]]
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| * [[Breast tissue]] [[atrophy]]
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| * Decreased [[maturation]] of [[vaginal]] [[mucosa]]
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| * Low [[estrogen]], [[testosterone]]
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| * High [[FSH]]/[[Luteinizing hormone|LH]]
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| * [[FSH]]
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| * [[Luteinizing hormone|LH]]
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| * Done to rule out any pituitary cause
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| * Genetic tests ([[karyotype]])
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| * Measurement of total and free [[testosterone]] and [[17-Hydroxyprogesterone|17-hydroxyprogesterone]] concentrations
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| |-
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| !Hypoprolactinemia
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| |Chronic
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| |<nowiki>-</nowiki>
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| |<nowiki>+</nowiki>
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| |<nowiki>-</nowiki>
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| * [[Infertility]]
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| * Subfertility
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| * Puerperal agalactogenesis
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| * No workup is necessary
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| * Decreased prolactin levels
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| * Done to rule out any pituitary cause
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| * [[Prolactin]] assay in [[3rd trimester]]
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| * [[Luteinizing hormone|LH]], [[Follicle-stimulating hormone|FSH]]
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| * [[Thyrotropin]] and free [[thyroxine]]
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| |-
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| ![[Panhypopituitarism]]
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| |Chronic
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| |<nowiki>-</nowiki>
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| |<nowiki>+</nowiki>
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| |[[Oligomenorrhea|Oligo]]/[[amenorrhea]]
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| * [[Polyuria]]
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| * [[Polydipsia]]
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| * Features of [[hypothyroidism]] and [[hypoadrenalism]]
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| * [[Growth failure]]
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| * B/L [[hemianopsia]]
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| * [[Papilledema]]
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| * All pituitary hormones decreased
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| * [[Magnetic resonance imaging|MRI]]
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| * Done to rule out any pituitary cause
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| * Left hand and wrist [[radiograph]] for [[bone age]]
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| |-
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| ![[Primary adrenal insufficiency]]/[[Addison's disease]]
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| |Chronic
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| |<nowiki>-</nowiki>
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| | -
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| |<nowiki>-</nowiki>
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| * [[Hypoglycemia]]
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| * [[Hypotension]]
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| * [[Dehydration]]
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| * [[Hyperpigmentation]]
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| * loss of [[pubic]] and [[axillary]] hair
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| * [[Hyponatremia]] with/without [[hyperkalemia]]
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|
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| * [[Plasma renin activity]] to [[Aldosterone|aldosterone ratio]]
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| * Abdominal [[Computed tomography|CT]]
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| * Abdominal [[Computed tomography|CT]]
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| * Serum [[cortisol]] testing
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|
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| * Serum [[ACTH]] testing
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|
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| * Anti-adrenal [[Antibody|Ab]] testing
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| |-
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| ![[Menopause]]
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| |Chronic
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| |<nowiki>-</nowiki>
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| |<nowiki>+/-</nowiki>
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| |[[Oligomenorrhea|Oligo]]/[[amenorrhea]]
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| * [[Hot flashes]]
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| * [[Insomnia]]
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| * [[Weight gain]] and [[bloating]]
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| * Mood changes
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| * [[Vaginal atrophy]]
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| * Loss of pelvic [[muscle tone]]
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| * ↑ [[FSH]]
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| * ↓ [[Estradiol]] and [[inhibin]]
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| * [[FSH]] > [[LH]]
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| |Normal
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| * [[Endometrial biopsy]]
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| |}
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| <small>
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