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Pituitary Disorders (Pituitary gland function Disorders, Hypopituitary, Pituitary tumors) : Symptoms, Causes, Diagnosis and Treatment

What is Pituitary Disorders?

The pituitary is a small gland (about the size of a kidney bean) located at the base of the brain, just beneath the optic (eye) nerve in a bony area called the sella turcica. It is made up of the anterior (adenohypophysis) and posterior (neurohypophysis) pituitary gland. It is often called the ?master gland? because it produces a number of hormones that regulate other hormone glands in the body. The pituitary is, in turn, regulated by the hypothalamus; a portion of the brain that responds to a variety of nerve and hormonal signals from the environment and the rest of the body.

Anterior pituitary hormones include TSH (thyroid gland), ACTH (adrenal gland), GH (growth hormone), LH and FSH (reproduction) and prolactin (lactation for breast feeding). Posterior pituitary hormones include AHD (water and salt balance) and oxytocin (childbirth).

Pituitary disorders can be due to either too much, or too little pituitary hormone secretion. These disorders can result in a wide variety of different clinical conditions, depending on which hormone signal(s) are disrupted. See below for specific information about different pituitary disorders.

Pituitary Disorders is also known as Pituitary gland function Disorders, Hypopituitary, Pituitary tumors. Pituitary Disorders belongs under the category of Gland disorder. Pituitary tumors, Growth hormone deficiency, Hypopituitarism, Hyperprolactinemia, Empty Sella Syndrome, Craniopharyngioma, Acromegaly and Gigantism, Adrenal insufficiency, Cushing Disease, Diabetes Insipidus, Nelson Syndrome, Multiple Endocrine Neoplasia Type 1 (MEN1), Kallman Syndrome, Pituitary infarction and Sheehan Syndrome are some common types of Pituitary Disorders. Generally Male, Female, Child are the victim of the Pituitary Disorders. Seriousness of this disease is Serious but rare.

Symptoms of Pituitary Disorders are :

  • Vision problems, such as blurred vision, double vision or loss of peripheral vision
  • Double vision is the perception of two images of a single object seen adjacent to each other (horizontally, vertically, or obliquely) or overlapping. Diplopia is the medical term for double vision. Polyplopia is the perception of three or more images of a single object overlapping each other.

    Double vision is called "monocular" when the double image is perceived by an eye that is tested alone. In "binocular" double vision, each eye sees a single image when tested alone, but a double image is present when both eyes are open.

  • Infertility
  • Irregular menstrual cycle or Irregular periods
  • On average, The normal length of a woman?s menstrual cycle is 24 to 38 days. A period usually lasts about 2 to 8 days. So this varies between individuals. When the length of the cycle is more than 35 days, or if the duration varies then it is called irregular menstruation or irregular periods.

  • mood swings
  • Irritability
  • Oily Skin
  • Swelling on feet 
  • swelling on hands
  • Pale complexion 
  • red skin on face
  • loss of libido (sex drive)
  • Weight gain
  • Weight gain can result from an increase in body fluid, muscle mass, or fat. An increase in body fluid can come from medications, fluid and salt retention, intravenous fluid infusion, kidney or heart failure. An increase in muscle mass is commonly seen with exercising. An increase in body fat is commonly seen as a result of diet or lack of exercise as the body converts muscle to fat. An excessive weight gain is referred to as obesity. Obesity is a function of environmental (diet, exercise, lifestyle, etc.), hormonal, and inherited (genetic) factors in varying degrees. Weight gain is a normal part of pregnancy.

  • Dizziness
  • sweating
  • Excessive sweating is when you sweat more than you might expect based on the surrounding temperature or your activity level or stress. Excessive sweating can disrupt daily activities and cause social anxiety or embarrassment.

    Excessive sweating, or hyperhidrosis (hi-pur-hi-DROE-sis), can affect your entire body or just certain areas, particularly your palms, soles, underarms or face. The type that typically affects the hands and feet causes at least one episode a week, during waking hours.

  • Nausea
  • Nausea and vomiting are common signs and symptoms that can be caused by numerous conditions. Nausea and vomiting most often are due to viral gastroenteritis ? often mistakenly called stomach flu ? or the morning sickness of early pregnancy.

    Many medications can cause nausea and vomiting, as can general anesthesia for surgery. Rarely, nausea and vomiting may indicate a serious or even life-threatening problem.

  • Severe Headache
  • Headaches are a common health problem ? most people experience them at some time.

    Factors that lead to headaches may be:

    Frequent or severe headaches can affect a person?s quality of life. Knowing how to recognize the cause of a headache can help a person take appropriate action.

    Causes

    Pituitary Disorders can be caused due to:

    Causes of pituitary disorders include:

    • Inherited genetic mutations
    • Congenital conditions (present at birth)
    • Head trauma
    • Low or lack of blood supply to the pituitary
    • Surgical or radiation treatment of a previous pituitary disorder
    • A malignant tumor (rare)
    • An unknown condition or due to causes that are not yet well understood
    • Iron overload; hemochromatosis/frequent blood transfusions

    What kind of precaution should be taken in Pituitary Disorders?

    The risk of many types of cancer can be reduced with certain lifestyle changes (such as staying at a healthy weight or quitting smoking). But pituitary tumors have not been linked with any known outside risk factors. As a result, there is no known way to prevent these tumors at this time.

    Still, for people at high risk of pituitary tumors (because of certain inherited syndromes), there may be ways to find and treat them early, before they cause problems. (See Can Pituitary Tumors Be Found Early?)

    How it can be spread?

    Does not spread

    Treatment for the Pituitary Disorders

    Diagnosis

    Pituitary tumors often go undiagnosed because their symptoms resemble those of other conditions. And some pituitary tumors are found because of medical tests for other conditions.

    To diagnose a pituitary tumor, your doctor will likely take a detailed history and perform a physical exam. He or she might order:

    • Blood and urine tests. These tests can determine whether you have an overproduction or deficiency of hormones.
    • Brain imaging. A CT scan or MRI scan of your brain can help your doctor judge the location and size of a pituitary tumor.
    • **Vision testing.**This can determine if a pituitary tumor has impaired your sight or peripheral vision.

    In addition, your doctor might refer you to an endocrinologist for more-extensive testing.

    Treatment

    Many pituitary tumors don't require treatment. Treatment for those that do depends on the type of tumor, its size and how far it has grown into your brain. Your age and overall health also are factors.

    Treatment involves a team of medical experts, possibly including a brain surgeon (neurosurgeon), endocrine system specialist (endocrinologist) and a radiation oncologist. Doctors generally use surgery, radiation therapy and medications, either alone or in combination, to treat a pituitary tumor and return hormone production to normal levels.

    Surgery

    Surgical removal of a pituitary tumor usually is necessary if the tumor is pressing on the optic nerves or if the tumor is overproducing certain hormones. The success of surgery depends on the tumor type, its location, its size and whether the tumor has invaded surrounding tissues. The two main surgical techniques for treating pituitary tumors are:

    • Endoscopic transnasal transsphenoidal approach. This usually enables your doctor to remove the tumor through your nose and sinuses without an external incision. No other part of your brain is affected, and there's no visible scar. Large tumors may be difficult to remove this way, especially if a tumor has invaded nearby nerves or brain tissue.
    • Transcranial approach (craniotomy). The tumor is removed through the upper part of your skull via an incision in your scalp. It's easier to reach large or more-complicated tumors using this procedure.

    Radiation therapy

    Radiation therapy uses high-energy sources of radiation to destroy tumors. It can be used after surgery or alone if surgery isn't an option. Radiation therapy can be beneficial if a tumor persists or returns after surgery and causes signs and symptoms that medications don't relieve. Methods of radiation therapy include:

    • Stereotactic radiosurgery. Often delivered as a single high dose, this focuses radiation beams on the tumor without an incision. It delivers radiation beams the size and shape of the tumor into the tumor with the aid of special brain-imaging techniques. Minimal radiation comes in contact with healthy tissue surrounding the tumor, decreasing the risk of damage to normal tissue.
    • External beam radiation. This delivers radiation in small increments over time. A series of treatments, usually five times a week over a four- to six-week period, is performed on an outpatient basis. While this therapy is often effective, it may take years to fully control the tumor growth and hormone production. Radiation therapy may also damage remaining normal pituitary cells and normal brain tissue, particularly near the pituitary gland.
    • Intensity modulated radiation therapy (IMRT). This type of radiation therapy uses a computer that allows the doctor to shape the beams and surround the tumor from many different angles. The strength of the beams can also be limited, which means surrounding tissues will receive less radiation.
    • Proton beam therapy. Another radiation option, this type uses positively charged ions (protons) rather than X-rays. Unlike X-rays, proton beams stop after releasing their energy within their target. The beams can be finely controlled and can be used on tumors with less risk to healthy tissues. This type of therapy requires special equipment and isn't widely available.

    The benefits and complications of these forms of radiation therapy often aren't immediate and may take months or years to be fully effective. A radiation oncologist will evaluate your condition and discuss the pros and cons of each option with you.

    Medications

    Treatment with medications may help to block excess hormone secretion and sometimes shrink certain types of pituitary tumors:

    • Prolactin-secreting tumors (prolactinomas). The drugs cabergoline and bromocriptine (Parlodel) decrease prolactin secretion and often reduce tumor size. Possible side effects include drowsiness, dizziness, nausea, nasal stuffiness, vomiting, diarrhea or constipation, confusion, and depression. Some people develop compulsive behaviors, such as gambling, while taking these medications.

    • ACTH-producing tumors (Cushing syndrome). Mifepristone (Korlym, Mifeprex) is approved for people with Cushing syndrome who have type 2 diabetes or glucose intolerance. Mifepristone does not decrease cortisol production, but it blocks the effects of cortisol on your tissues. Side effects may include fatigue, nausea, vomiting, headaches, muscle aches, high blood pressure, low potassium and swelling.

      The newest medication for Cushing syndrome is pasireotide (Signifor), and it works by decreasing ACTH production from a pituitary tumor. This medication is given as an injection twice daily. It is recommended if pituitary surgery is unsuccessful or cannot be done. Side effects are fairly common, and may include diarrhea, nausea, high blood sugar, headache, abdominal pain and fatigue.

    • Growth hormone-secreting tumors. Two types of drugs are available for these types of pituitary tumors and are especially useful if surgery has been unsuccessful in normalizing growth hormone production. One type of drugs known as somatostatin analogs, which includes drugs such as octreotide (Sandostatin) and lanreotide (Somatuline Depot), causes a decrease in growth hormone production and may shrink the tumor. These are given by injections, usually every four weeks.

      These drugs can cause side effects such as nausea, vomiting, diarrhea, stomach pain, dizziness, headache and pain at the site of injection. Many of these side effects improve or even go away with time. They can also cause gallstones and may worsen diabetes mellitus.

      The second type of drugs, pegvisomant (Somavert), blocks the effect of excess growth hormone on the body. This drug, given by daily injections, may cause liver damage in some people.

    Replacement of pituitary hormones

    If a pituitary tumor or surgery to remove it decreases hormone production, you'll likely need to take replacement hormones to maintain normal hormone levels. Some people who have radiation treatment also need pituitary hormone replacement.

    Possible complication with Pituitary Disorders

    Although most pituitary tumors are benign (non-cancerous), some pituitary tumors do cause complications. You may be able to prevent these complications if you recognize the symptoms of a pituitary tumor and get treatment for it early on.

    One of the most serious pituitary tumor complications is blindness. This can happen if a tumor puts too much pressure on your optic nerves. These nerves are very close to your pituitary gland. Not everyone who has a pituitary tumor will have vision problems, however. Tumor growth and vision loss usually happen very gradually.

    Other potential pituitary tumor complications include:

    • diabetes insipidus: This type of diabetes?not to be confused with type 1 or type 2 diabetes, which causes an increase in your blood glucose level?is mostly associated with larger pituitary tumors (called macroadenomas). Diabetes insipidus happens when your pituitary gland and the gland found just above it, the hypothalamus, don't produce enough vasopressin, a hormone that's in charge of maintaining the body's water balance. The most common symptom is constant thirst, which can lead to frequent bathroom stops from drinking so many fluids. This is because without vasopressin, the kidneys aren't able to hold onto water as they should and you get dehydrated, triggering you to be thirsty. This condition can also be a complication of some pituitary tumor treatments.
    • permanent hormone deficiency: It's possible for a pituitary tumor to cause a permanent hormone imbalance. If this happens, you may need to take medication to replace the depleted hormone. For example, if your pituitary tumor causes a thyroid-stimulating hormone (TSH) deficiency, you may need to take thyroid hormone replacement to get your thyroid levels back to normal.
    • pituitary apoplexy: This is a rare but serious complication that causes sudden bleeding into the pituitary tumor. Pituitary apoplexy typically needs immediate treatment?usually corticosteroids or surgery. Symptoms include a severe headache and vision problems, such as double vision or vision loss. You can also have symptoms of hypopituitarism (when your pituitary gland releases low amounts of certain hormones). Symptoms of hypopituitarism can include excessive thirst (from diabetes insipidus), lightheadedness (from adrenal insufficiency), and cold intolerance (from hypothyroidism).

    These are just some of the possible symptoms and complications you may experience if you have a pituitary tumor, but many people with pituitary tumors don't experience any problems.

    However, if you have been diagnosed with a pituitary tumor and you notice sudden, unusual changes in your health, you should ask your doctor if they could be related to your pituitary tumor. Getting proper treatment for your pituitary tumor can prevent complications from getting worse.

    References:

    1 https://endocrinology.medicine.ubc.ca/endocrine-conditions/pituitary-disorders/ 2 https://labtestsonline.org/conditions/pituitary-disorders 3 https://pituitary.org/knowledge-base/disorders 4 https://medlineplus.gov/pituitarydisorders.html 5 https://www.hormone.org/your-health-and-hormones/glands-and-hormones-a-to-z/glands/pituitary-gland 6 https://www.emoryhealthcare.org/pituitary/conditions/index.html 7 https://www.empoweryourhealth.org/endocrine-conditions/pituitary#treatment 8 https://www.mayoclinic.org/diseases-conditions/pituitary-tumors/diagnosis-treatment/drc-20350553

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