Ask what changed and how quickly. Fatigue, weakness, nausea, weight change, menstrual disruption, reduced libido, erectile dysfunction, infertility, cold intolerance, or reduced exercise tolerance may reflect hypopituitarism, but they are nonspecific. The accompanying pattern is more revealing. Headache with new peripheral visual loss, diplopia, ptosis, or impaired eye movement suggests mass effect near the optic chiasm or cavernous sinus. Galactorrhea, menstrual irregularity, infertility, and reduced sexual function may point to hyperprolactinemia. Enlarging hands or feet, widening tooth gaps, sleep apnea, sweating, headaches, and glucose intolerance raise concern for acromegaly. Easy bruising, proximal muscle weakness, facial rounding, new hypertension, diabetes, and recurrent infection may suggest cortisol excess. Medication and supplement history is part of the hormone panel. Ask specifically about: - Oral, inhaled, intranasal, topical, or injected glucocorticoids - Antipsychotics, metoclopramide, and other dopamine-blocking medications - Immune checkpoint inhibitor therapy, especially ipilimumab - Biotin-containing multivitamins and hair, skin, or nail products Glucocorticoids are the most common cause of secondary adrenal insufficiency. They suppress ACTH production and may make cortisol and ACTH results difficult to interpret. Do not advise a patient to...