Does hypopituitarism caused by an adenoma result in chronic hormone deficiency or is it more likely to be an episodic deficiency i have a macroadenoma causing hypopituitarism deficiency in, fsh/lh and acth and i' am currently taking medication for cortiso

Although : Although hypopituitarism is not episodic, you may indeed be hypothyroid. In the presence of a macroadenoma one cannot rely on the tsh. A low end of normal free thyroxine would, in my view, suggest that you are indeed hypothyroid especially if you have symptoms and have other hormonal deficiencies. I would tend to supplement you with thyroid hormone. You also may be growth hormone deficient. Growth hormone deficiency may cause fatigue.

Good : Good question. Your case is certainly complex and if indeed you have a fsh/lh and acth deficiencies, then you may likely have a genetic mutation in either lhx4 or prop1 gene. These mutations often cause TSH deficiency as well and as such, you may indeed have an element of central hypothryoidism that can difficult to ascertain especially if interpeted by a non endocrinologist. In central hypothryoidism, TSH can be falsey normal and sometimes even high due to acylation defect caused by concomitant trh deficiency and as such may give a picture similar to what you are describing (i.E normal TSH with low normal free/total t4). I suggest that you get a second opinion. In the meantime, make sure your anaesthesia team is aware of your condition as you will need periopertaive intravenous Hydrocortisone to maintain bp, glucose and perfusion. Good luck. Cayce t. Jehaimi, M.D., faap pediatric endocrinology & diabetes the children's hospital of southwest florida fort myers, fl usa.