7.4.3 Headache attributed to hypothalamic or pituitary hyper- or hyposecretion

Identification: Sex/Age: Female, 42 years History: Complicated childbirth with hemorrhage 5 years ago (Sheehan's Syndrome) Medication: None History of Present Illness (HPI): Main symptom: Diffuse headache for 4 months Pain characteristics: Location: Holocranial Intensity: 5/10 Quality: Constant pressure No specific aggravating factors Slight improvement with rest Associated symptoms: Intense fatigue Secondary amenorrhea Loss of axillary and pubic hair Cold intolerance Postural hypotension Physical/Neurological Examination: Physical appearance: Skin pallor, breast hypotrophy Neurological examination: Normal Vital signs: Arterial hypotension (90/60 mmHg), bradycardia (52 bpm) Complementary Exams: Magnetic Resonance Imaging of the Sella Turcica: Small and empty pituitary Laboratory: Basal cortisol: 3.2 μg/dL (low) TSH: 0.8 mIU/L (low normal) with free T4: 0.5 ng/dL (low) FSH: 2.1 mIU/mL (low) LH: 1.0 mIU/mL (low) Prolactin: 5 ng/mL (normal) IGF-1: 65 ng/mL (low)