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Element Endocrinology and Diabetes

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Pituitary  Disorders

What hormones are produced by the pituitary gland?

Your pituitary gland is a small, delicate gland located roughly 1-2 inches behind the bridge of your nose. It acts as the conductor for several other glands and physiologic systems in the body. It is attached to the hypothalamus of the brain via a bundle of nerve tissue known as the stalk.

The gland produces hormones such as:

  • Anterior Pituitary Gland Hormones
  • Adrenocorticotropic hormone (ACTH)
  • Growth Hormone
  • Thyroid Stimulating Hormone (TSH)
  • Prolactin
  • Luteinizing Hormone (LH) and Follicle Stimulating Hormone (FSH)

Posterior Pituitary Gland Hormones:

  • Oxytocin
  • Vasopressin (also known as antidiuretic hormone)

What are the different types of pituitary disorders?

Pituitary Adenomas (or tumors)

Pituitary adenomas are overgrowths of cells in the pituitary gland. Most are benign meaning they are not a malignant cancer. Sometimes these growths are associated with overproduction of a specific pituitary hormone which can can determined through careful laboratory and clinical evaluation. Imaging with pituitary directed MRI is often necessary.

Infiltrative disease

There are rare diseases that can compromise pituitary function due to the buildup of infectious or noninfectious processes. Infections of the pituitary are very rare. Noninfectious infiltrative diseases may be related to the buildup of iron (hemochromatosis) or copper (Wilson’s disease)  in the pituitary gland.

Acromegaly

Acromegaly is caused by an overgrowth of the cells of the pituitary that produce growth hormone. Excess growth hormone can cause development of a number of medical issues such as:

  • Weight gain
  • Increase in the size of extremities and portions of the head and face
  • Fat redistribution
  • Thickening of skin
  • Diabetes mellitus

Growth Hormone Deficiency

Growth hormone deficiency usually results from traumatic insults to the pituitary gland. This insult can be from radiation therapy to the brain, traumatic brain injury, or related to pituitary tumor.

Cushing’s Disease

Cushing’s disease is caused by an overproduction of ACTH from the pituitary gland. This causes too much cortisol to be produced by the adrenal glands which can lead to poor health. Some signs and symptoms of Cushing’s Disease are:

  • Weight gain, especially in the abdomen
  • Fat deposits in the upper back, face, and between the shoulders
  • Thin arms and legs
  • Stretch marks
  • Thin skin
  • Easy bruising
  • Slow-healing cuts

Secondary Adrenal Insufficiency

Secondary adrenal insufficiency is caused by insults to the pituitary gland cells that produce ACTH. This can be due to compression and damage from an adenoma, infiltrative disease, or medications a person may use.

If you have secondary adrenal insufficiency disease, you may experience:

  • Chronic fatigue
  • Weight loss
  • Abdominal pain
  • Muscle weakness
  • Joint pain
  • Nausea, diarrhea, or vomiting

Central Hypothyroidism

Central hypothyroidism is a rare condition usually related . It is different from primary hypothyroidism in that there is no direct pathology of the thyroid gland. In secondary or central hypothyroidism, the thyroid is not receiving the signal from the pituitary gland to produce thyroid hormone. This most often is related to trauma to the pituitary gland but can also occur for non-traumatic reasons. Symptoms include those observed with primary hypothyroidism.

Hyperprolactinemia and Prolactinoma

The pituitary gland produces a hormone called prolactin. Usually, outside of pregnancy, levels of this hormone are low. Sometimes pituitary tumors can produce too much prolactin. For women, this can cause irregular or absent menstrual cycles (oligomenorrhea and amenorrhea). For men, symptoms can be more vague. Sometimes, these tumors can be large and cause injury to adjacent structures.

  • Fatigue
  • Hot Flashes
  • Decreased libido
  • Loss of menstrual cycle
  • Irregular menstrual cycle
  • Loss of muscularity
  • Loss of peripheral vision
  • Headaches

Diabetes insipidus 

Damage to the posterior pituitary gland usually occurs following surgery and can happen with very rare tumors affecting the pituitary gland and hypothalamus. Symptoms include:

Severe dehydration

Frequent urination with high urinary volumes > 3-4  liters per day

Pituitary cancer is rare, so most tumors are benign.

How are pituitary disorders evaluated?

Evaluation generally involved a combination of biochemical studies and imaging studies. Dr. Fiacco determines which laboratory studies are appropriate and if imaging of the pituitary gland is necessary based on careful history and physical examination.

How are pituitary disorders treated?

Treatment strategies depend on the type of pituitary disorder. In most cases, however, treatment options include medications, hormone replacement therapy, surgery, and radiation therapy. You may need surgery and/or radiation therapy to treat a pituitary growth depending on the size and if it produces hormone.

If you have questions about your symptoms or you need ongoing care for a pituitary disorder, call Element Endocrinology and Diabetes to book an appointment today.