MBBS OSCE · General Medicine

OSCE — Hypopituitarism

Eight-minute OSCE station on Hypopituitarism: focused history, examination priorities, investigations, emergency and definitive management.

8 min stationVerification in progress
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NEET-PGINICETUSMLEPLAB

Brief (to candidate)

You will assess a patient with a presentation consistent with Hypopituitarism.[1] You have 8 minutes to take a focused history, outline examination, investigations, and management including red flags.

Clinical context

Hypopituitarism is the partial or complete deficiency of one or more anterior pituitary hormones (GH, PRL, ACTH, TSH, LH/FSH); loss of all anterior hormones is panhypopituitarism. It is caused most commonly by a pituitary adenoma, surgery or radiation, Sheehan syndrome (postpartum ischaemic necrosis), pituitary apoplexy, infiltrative disease (sarcoidosis, haemochromatosis, Langerhans cell histiocytosis), autoimmune hypophysitis (including immune-checkpoint inhibitors), genetic mutations (PROP1, POU1F1), or traumatic brain injury. Each hormone deficiency produces distinct features: ACTH deficiency causes secondary adrenal insufficiency (fatigue, postural hypotension, hypoglycaemia, hyponatraemia, NO hyperpigmentation, NO hyperkalaemia); TSH deficiency causes secondary hypothyroidism; LH/FSH deficiency causes hypogonadism; GH deficiency causes reduced muscle mass and (in children) growth failure; prolactin deficiency causes failure of lactation. Mass effect: bitemporal hemianopia, headache, cranial nerve palsies. Diagnosis: low target hormone with low or inappropriately normal trophic hormone, then pituitary MRI. Management: replace hydrocortisone FIRST (always before levothyroxine), then levothyroxine, sex steroids, GH, and desmopressin for diabetes insipidus; pituitary apoplexy is an emergency needing IV hydrocortisone and neurosurgical assessment.[1][2]

Candidate tasks

  1. Clarify onset, severity, associated features, and red-flag symptoms. [1]
  2. State focused examination priorities.
  3. List first-line investigations and any named score/criteria.
  4. Give immediate resuscitation steps.
  5. Outline definitive management with doses/routes where standard.
  6. Name complications and disposition (ward / HDU / theatre / discharge safety-net).
  7. Mention one special-population modifier (pregnancy, child, elderly, CKD).

Examiner checklist

DomainPass behaviours
DefinitionCorrect working diagnosis language
AssessmentFocused, prioritised, red flags sought
InvestigationsAppropriate first-line + interpretation
Emergency careABC / time-critical actions first
Definitive careSpecific drugs/procedures, not generic phrases
SafetyFatigue, hypotension and hyponatraemia after pituitary surgery or radiation — ad
SafetySudden severe (thunderclap) headache with visual loss and ophthalmoplegia — pitu
SafetyPostpartum woman who cannot lactate, with fatigue and hypotension — Sheehan synd
CommunicationClear plan and safety-netting

Model outline

Lead with the working diagnosis and life threats. Resuscitate before definitive tests when unstable. Use guideline-standard therapy with named agents and doses. Document escalation criteria and follow-up. A safe candidate is specific, structured, and never delays critical care for non-urgent imaging.[3][4]

References4Show
  1. [1]Yeliosof O, Gangat M. Diagnosis and management of hypopituitarism Curr Opin Pediatr, 2019.PMID 31082937
  2. [2]Iglesias P. An Update on Advances in Hypopituitarism: Etiology, Diagnosis, and Current Management J Clin Med, 2024.PMID 39458112
  3. [3]Fleseriu M, Hashim IA, Karavitaki N, et al. Hormonal Replacement in Hypopituitarism in Adults: An Endocrine Society Clinical Practice Guideline J Clin Endocrinol Metab, 2016.PMID 27736313
  4. [4]Rajasekaran S, Vanderpump M, Baldeweg S, et al. UK guidelines for the management of pituitary apoplexy Clin Endocrinol (Oxf), 2011.PMID 21044119
OSCE — Hypopituitarism · MBBS OSCE · NeetVellum