Diagnosing unsuspected hypopituitarism in adults from suggestive thyroid function test results

Ann Clin Biochem 2008;45:70-75
© 2008 Association for Clinical Biochemistry


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Original Article

David Preiss ,
Louise Todd and
Maurizio Panarelli

Department of Biochemistry, Glasgow Royal Infirmary, Castle Street, Glasgow G4 0SF, UK

Corresponding author: Dr David Preiss. Email: davidpreiss{at}doctors.org.uk

Background: The typical pattern of thyroid function tests (TFTs) associatedwith hypopituitarism consists of subnormal free T4 (fT4) ortotal T4 and normal or marginally elevated thyroid-stimulatinghormone (TSH). A previous study calculated an incidence of hypopituitarismof 3.2 cases/100,000/year by following up abnormal TFTs. Theaim of this study was to verify the incidence of unsuspectedhypopituitarism diagnosed by reflective testing on such samplesin a Scottish population.

Methods: Prospective audit of TFT results over 15 months. Individualswith suitable results (fT4 < 9 pmol/L, TSH < 10 mU/L)were identified by the laboratory information system at theBiochemistry Department, Glasgow Royal Infirmary, serving apopulation of 200,000. fT4 (repeat analysis following assayrecalibration), total T3, testosterone (males), luteinizinghormone, follicle-stimulating hormone, prolactin and cortisolwere analysed on appropriate samples.

Results: Three hundred and eleven suitable results from 266 adult individualswere identified from a total of 73,650 TFT results, leadingto the diagnosis of 10 new cases (age range 28–90 years)of hypopituitarism (approximately 4 cases/100,000/year). Ninepatients now attend endocrine clinics. Pituitary imaging wasabnormal in five cases (2 large pituitary tumours, one macroadenoma,2 empty sellae), normal in three cases and two patients werenot scanned.

Conclusions: A significant number of cases of unsuspected hypopituitarismcan be diagnosed by reflective testing on appropriate samples.fT4 should be an integral part of frontline TFTs as TSH alonecannot assist in the identification of possible hypopituitarism.Laboratories are in an excellent position to assist in earlyidentification of hypopituitarism, which may lead to improvedoutcomes in such patients.

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