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Pituitary Health Monitoring Log

Daily Tracking Sheet for Pituitary Condition Management

Endocrinology

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Template Content

Last updated: Mar 24, 2025

Patient Information

Name: _________________ Date of Birth: __________ Diagnosis: _____________

Daily Symptom Tracker

Symptoms (Rate 0-10)

  • Headache intensity: ____
  • Fatigue level: ____
  • Visual changes: ____
  • Nausea: ____

Medications

Medication Dose Time Taken Notes

Hormone Levels Tracking

Monthly Records

Date: _______________

  • Prolactin: _____ ng/mL (Normal range: 2-18)
  • Growth Hormone: _____ ng/mL
  • TSH: _____ mIU/L (Normal range: 0.4-4.0)
  • Cortisol: _____ μg/dL (Morning)

Physical Changes

  • Weight: _____ lbs
  • Blood pressure: /
  • Changes in appearance: _________________

Additional Notes

Mood changes: ____________________ Menstrual cycle (if applicable): ____________ Other symptoms: __________________

Next Appointment

Date: _______________ Time: _______________ Provider: ____________

Bring this completed log to each appointment

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