Symptoms
Symptoms are highly variable and depend on which hormones are affected:
Growth Hormone Imbalances: Acromegaly (in adults, marked by enlarged hands, feet, and facial features), gigantism (in children, excessive height), or growth hormone deficiency (fatigue, decreased muscle mass, in children, slow growth).
Prolactin Imbalances: Galactorrhea (milk production in non-pregnant women or men), irregular menstrual cycles or infertility in women, erectile dysfunction and decreased libido in men.
ACTH Imbalances: Cushing's disease (weight gain, especially in the face and upper back, high blood pressure, easy bruising).
TSH Imbalances: Symptoms of hyperthyroidism (weight loss, anxiety, rapid heart rate) or hypothyroidism (weight gain, fatigue, constipation).
ADH Imbalances: Diabetes insipidus (excessive thirst and urination).
Visual Disturbances: Double vision or loss of peripheral vision (if a pituitary tumor presses on the optic nerves).
Headaches: Common with larger pituitary tumors.
Fatigue: A general symptom that can occur with many pituitary hormone imbalances.
Nausea: Due to tumor growth or pressure.
Causes
Pituitary Adenomas: These are the most common cause; benign tumors arising from the pituitary gland itself. The specific type of adenoma determines which hormone(s) are overproduced.
Other Tumors: Craniopharyngiomas, meningiomas, and metastatic cancer can also affect the pituitary.
Pituitary Apoplexy: Sudden hemorrhage or infarction (loss of blood supply) of the pituitary gland, often associated with a pre-existing adenoma.
Inflammatory Conditions: Sarcoidosis, tuberculosis, or other inflammatory diseases can infiltrate the pituitary.
Traumatic Brain Injury: Can damage the pituitary gland.
Genetic Factors: Some rare genetic syndromes predispose individuals to pituitary tumors.
Empty Sella Syndrome: The pituitary gland is flattened or absent within the sella turcica, often asymptomatic but sometimes associated with hormone deficiencies.
Medicine Used
Medications depend on the specific pituitary disorder:
Prolactinomas: Dopamine agonists (e.g., bromocriptine, cabergoline) to suppress prolactin production and shrink the tumor.
Acromegaly: Somatostatin analogs (e.g., octreotide, lanreotide) or growth hormone receptor antagonists (e.g., pegvisomant) to reduce growth hormone levels.
Cushing's Disease: Medications to block cortisol production (e.g., ketoconazole, metyrapone, osilodrostat), or less commonly, pasireotide for ACTH-secreting tumors.
Hypopituitarism (Hormone Deficiencies): Hormone replacement therapy (e.g., levothyroxine for hypothyroidism, hydrocortisone for adrenal insufficiency, testosterone or estrogen for sex hormone deficiencies, growth hormone injections).
Diabetes Insipidus: Desmopressin (synthetic ADH).
Is Communicable
Pituitary disease is not communicable. It is not caused by an infectious agent and cannot be spread from person to person.
Precautions
Precautions depend on the specific condition and treatment:
Adherence to Medication: Strict adherence to prescribed medications is crucial for managing hormone imbalances.
Regular Monitoring: Regular blood tests to monitor hormone levels and imaging studies (MRI) to monitor tumor size are important.
Medical Alert Identification: Individuals with adrenal insufficiency should wear a medical alert bracelet or carry a card indicating their condition.
Vision Monitoring: If a tumor is pressing on the optic nerves, regular eye exams are necessary.
Lifestyle Modifications: Depending on the specific condition (e.g., Cushing's), lifestyle changes may be recommended, such as dietary modifications and exercise.
Managing Side Effects: Awareness of potential medication side effects and strategies to manage them (e.g., nausea, fatigue).
How long does an outbreak last?
Pituitary disease is not an outbreak and therefore does not "last" a specific amount of time like an infection would. It is a chronic condition that can persist for a lifetime, with symptoms and treatment varying over time. In pituitary apoplexy, it's an acute event with long term recovery and aftereffects
How is it diagnosed?
Medical History and Physical Exam: Assessment of symptoms, family history, and general health.
Hormone Blood Tests: Measurement of various pituitary hormones (e.g., growth hormone, prolactin, ACTH, TSH, FSH, LH) and their target hormones (e.g., cortisol, thyroid hormones, testosterone, estrogen).
Imaging Studies: MRI of the pituitary gland is the primary imaging modality to visualize tumors or other abnormalities. CT scans may be used in some cases.
Visual Field Testing: To assess for optic nerve compression.
Stimulation/Suppression Tests: Specialized tests to assess pituitary hormone function (e.g., oral glucose tolerance test for acromegaly, cosyntropin stimulation test for adrenal insufficiency).
Timeline of Symptoms
The timeline of symptoms varies greatly depending on the specific pituitary disorder:
Slowly Progressive Symptoms: Many pituitary adenomas cause symptoms that develop gradually over months or years (e.g., acromegaly, prolactinomas).
Sudden Onset Symptoms: Pituitary apoplexy can cause sudden headache, vision changes, and hormone deficiencies.
Fluctuating Symptoms: Some conditions may have periods of exacerbation and remission (e.g., Cushing's disease).
Important Considerations
Multidisciplinary Approach: Management often involves a team of specialists, including endocrinologists, neurosurgeons, ophthalmologists, and radiation oncologists.
Long-Term Management: Pituitary disease often requires lifelong monitoring and treatment.
Surgical Options: Transsphenoidal surgery (through the nose) is a common approach to remove pituitary tumors. Craniotomy (opening the skull) is sometimes necessary for larger or more complex tumors.
Radiation Therapy: May be used to shrink tumors that cannot be completely removed surgically or to prevent regrowth.
Impact on Quality of Life: Pituitary disorders can significantly impact quality of life due to hormone imbalances and their associated symptoms.
Fertility Issues: Pituitary disorders can affect fertility in both men and women, and specific treatments may be needed to restore fertility.
Psychological Impact: Hormone imbalances can affect mood and cognitive function, and psychological support may be beneficial.