Pituitary disease

What Is Pituitary Disease?

A pituitary disease can refer to many medical conditions that affect the normal functioning of the pituitary gland. The pituitary gland is a hormone-producing (endocrine) gland that is present below the hypothalamus at the base of the human brain. The hormones produced by the pituitary gland help in various body functions such as growth, metabolism and energy management, body temperature, pain, thyroid gland function, renal function, sex organ functions, pregnancy, childbirth, and lactation. Several conditions that may be inborn or acquired can affect pituitary disease.

Is this condition a medical emergency?

Certain types of pituitary disease may lead to medical emergencies if not diagnosed and managed well.

Types of this condition

A pituitary disease may be of the following types

• An Overproduction of hormones
  • Acromegaly: Excessive production of the growth hormone, resulting in an overgrowth of the bones
  • Cushing’s disease: Excess production of cortisol, a steroid hormone
  • Syndrome of Inappropriate Antidiuretic Hormone: Excess production of the antidiuretic hormone
  • Hyperpituitarism: When the pituitary gland produces one or more hormones in excess
• An Underproduction of hormones
  • Growth hormone deficiency
  • Diabetes Insipidus: Underproduction of the hormone called vasopressin, resulting in excess production of urine by the kidneys
  • Pickardt Fahibusch Syndrome
  • Hypopituitarism: An underproduction of 1 or 2 pituitary hormones
  • Panhypopituitarism: An underproduction of all the pituitary hormones
• Inflammation of the pituitary gland
  • Hypophysitis: Inflammation of the pituitary gland
  • Autoimmune Hypophysitis: Inflammation of the pituitary gland caused by the body’s immune system attacking the pituitary gland
• Tumors of the pituitary gland: Which in turn may manifest as overproduction or underproduction of pituitary hormones
  • Malignant tumours
  • Noncancerous tumors
• Pituitary Apoplexy: Blood supply to the pituitary gland is affected and may be seen as bleeding into the gland or impairment of blood supply

Causes

A pituitary disease can have many causes as follows

• Over Production of pituitary hormones
  • Benign tumors called pituitary adenomas are primarily responsible
  • Cancers from the lung, gastrointestinal tract, and genitourinary tract that have spread to the pituitary gland
  • The central nervous system causes such infections (meningitis, encephalitis), bleeding, tumors, hydrocephalus, multiple sclerosis, autoimmune diseases
  • Lung infections
  • Drugs: Clofibrate, anticonvulsants, antidepressants, antipsychotics
  • Genetic or hereditary causes
  • Sarcoidosis
• Under Production of pituitary hormones
  • Tumors such as pituitary adenoma
  • Genetic and hereditary causes
  • Congenital disease
  • The central nervous system causes such infections (meningitis, encephalitis), bleeding, tumors, hydrocephalus, multiple sclerosis, autoimmune diseases
  • Chronic kidney disease
  • Radiation therapy
  • Intracranial tumors
  • Autoimmune disease
  • Ischemia or hemorrhage affecting the pituitary gland
  • Cranial surgery or head trauma
  • Pregnancy, postpartum hemorrhage
  • Bites of Russell’s Viper

Symptoms & Signs

The symptoms and signs greatly vary and depend on the disease type and the hormones affected. Some of the symptoms and signs include

• Overproduction of pituitary hormones
  • Headaches
  • Hirsutism
  • Visual defects or double vision
  • Decreased libido, impotence in men
  • Amenorrhea, galactorrhea, and infertility in women
  • Muscle weakness
  • Tiredness and fatigue
  • Easy bruisability
  • Respiratory difficulties
  • Obesity
  • Moon face
  • Hypertension
  • Diabetes
  • Cataract, glaucoma
• Underproduction of pituitary hormones
  • Decreased height and growth in children
  • Obesity
  • Increased cardiovascular disease
  • Muscle weakness
  • Lethargy
  • Decreased libido, impotence, and shrinking of testes in men
  • Delayed puberty, decreased libido, pain during intercourse, and breast atrophy in women

Investigations

The following investigations are generally done to establish the diagnosis 

• Laboratory tests
  • CBP & ESR
  • Thyroid Profile
  • Liver and Renal Function tests
  • Complete Metabolic Panel
  • Serum Prolactin Levels
  • Growth Hormone Levels
  • Serum Insulin-like Growth Factor 1 (IGF -1) levels
  • Oral Glucose tolerance test
  • Dexamethasone suppression test
  • Metapyrone test
  • Serum levels of ACTH
  • Serum FSH, and LH
  • Serum testosterone levels
  • Urinary free cortisol
• Imaging tests
  • CT scan
  • MRI
• Procedures
  • Visual field testing
  • Petrosal Sinus venous sampling for ACTH and TSH

Diagnosis

A diagnosis of pituitary disease, its type, and underlying cause is established based on medical history, clinical evaluation, and investigation results.

Treatment options 

The treatment depends on the type of disease that is present and the underlying cause. Medical and/or surgical interventions may be required to manage pituitary disease.

Medical management

Medical management may include the following

• Hormone Overproduction
  • Dopamine agonists: Excess Prolactin and excess growth hormone
  • Somatostatin Analogs: excess growth hormone
• Hormone under production
  • Synthetic Thyroid Supplements: For thyroid under production
  • Cortisol: For adrenocorticosteroid deficiency
  • Testosterone: For androgenic hormone deficiency
  • Estrogen/Progesterone: For female hormone deficiency
  • Growth Hormone replacement: Growth hormone deficiency
  • Vasopressin Analogs: In diabetes insipidus

Interventional including surgery and indications for surgery

Interventional management of pituitary disease may include the following

• Transsphenoidal surgery: For the management of tumors that are causing pituitary disease
• Endonasal Endoscopic Surgery: This is a minimally invasive surgery that may also be done for the management of pituitary tumors

Radiation

Radiotherapy may be done for the management of pituitary issues and is usually done as Pituitary Radiotherapy and used for the management of

• Acromegaly
• Cushing’s disease

Complications 

Several complications can arise if pituitary disease is not detected early and managed well. Some of these complications include

• Neurological deficits and dysfunction
• Severe fluid and electrolyte disturbances
• Increased risk of severe cardiovascular disease
• Shock
• Death

Prognosis

The prognosis of pituitary problems depends on the disease type and the underlying cause. This disease is caused by noncancerous tumours that are detected early, managed well, and have a good prognosis. Pituitary problems caused by cancerous or metastatic tumors have a poor prognosis.

When to contact the doctor or hospital/how to identify the emergency or complications

It is advisable to seek medical attention if the symptoms and signs of pituitary issues are noticed

Indications for hospitalization if required

The need for hospitalization depends on the type of pituitary problems that is present. Hospitalization may be needed if surgical intervention is required to manage pituitary issues.

Suggested clinical specialist/Departments to consult for this condition

Specialists from the Department of Endocrinology will treat Pituitary Problems