In anterior pituitary insufficiency, there is a partial or complete failure of anterior pituitary hormones. These hormones include control hormones that act on other endocrine glands and effector hormones that have a direct effect on organs. The failed hormones can be therapeutically substituted.
What is anterior pituitary insufficiency?
The anterior pituitary gland forms the largest portion of the pituitary gland. In this portion, important hormones are synthesized and released into the body. In terms of shape, the anterior pituitary is a typical edocrine gland, producing mainly effector and control hormones. Complete or partial failure of endocrine anterior pituitary functions is called anterior pituitary insufficiency. Control hormones such as TSH (thyroid-stimulating hormone), ACTH (adrenocorticotropic hormone), FSH (follicle-stimulating hormone), and LH l(luteinizing hormone) have regulatory effects on other endocrine organ activities. In contrast, effector hormones such as STH (somatotropic hormone), MSH (melanocyte-stimulating hormone) and prolactin act directly on a specific effector organ. In particular, the release of control hormones from the anterior pituitary is influenced by releasing and release-inhibiting hormones from the hypothalamus. If this is partially or completely disturbed, there is an anterior pituitary insufficiency, which is also called
Hypopituitarism, Simmonds disease or HVL insufficiency. Either certain hormones fail in the disease, or all hormones are affected by the insufficiency. In this context, complete from incomplete insufficiency of the anterior hypophyseal lobe is distinguished.
Causes
The primary causes of HVL insufficiency are extremely variable. The cause of anterior pituitary insufficiency is either destruction or displacement of pituitary tissue. HVL insufficiency also occurs when the pituitary gland is no longer connected to the hypothalamus. Such conditions can occur, for example, in the context of tumor diseases. Most tumors of the pituitary gland are benign tumors, such as hypophasenoma. Insufficiency can also occur after neurosurgical procedures close to the pituitary structures. The same applies if tissue has been damaged by radiation therapy. Often, failure of endocrine functions is also preceded by degenerative changes that cause the tissue to die. This may be the case, for example, in the context of stroke-related necrosis. In addition, autoimmune granulomatous processes such as those of sarcoidosis are a possible cause of anterior pituitary insufficiency. In addition, hemochromatosis and all inflammatory processes are possible triggers of insufficiency. Sometimes trauma also precedes the disease, especially injuries to the brain. Because hormone production by the anterior pituitary is influenced by the releasing and release-inhibiting hormones of the hypothalamus, failure of these hormones may also be causative for HVL insufficiency.
Symptoms, complaints, and signs
Patients with anterior pituitary insufficiency show an axis-dependent failure of various hormones and hormonally controlled processes. The human endocrine system is a tight network. If an endocrine gland fails, this failure shows effects on further endocrine glands, because hormones regulate each other. For example, when the HVL adrenocorticotropic axis fails, there is secondary adrenocortical insufficiency, which can manifest as weight loss, declining performance, hypoglycemia, nausea, waxy skin texture, and decreased skin pigmentation. When the tax hormonal axis is affected, secondary hypogonadism results. There is a decrease in secondary hair growth. Men experience a loss of libido], which may be associated with potency disorders. Women suffer from menstrual disorders or infertility. Puberty is absent. If the somatrotropic HVL axis fails, short stature may occur. In contrast, when the thyrotropic axis is involved, secondary hypothyroidism develops, showing the symptoms of hypothyroidism, such as weight gain, cold intolerance, bradycardia, or dry and rough skin. Prolactin failure plays a role especially for women and prevents breastfeeding. MSH deficiencies cause skin pigmentation to decrease.If all of the above axes are affected by failures, complete HVL insufficiency is present, which can cause pituitary coma.
Diagnosis and course of the disease
The physician makes the diagnosis of anterior pituitary insufficiency by surveying the hormonal status. Imaging takes place to determine what is causing the HVL insufficiency. In addition, the extent to which the regulating hormones of the hypothalamus are related to the insufficiency is checked as part of the diagnostic process. Thus, causative hypothalamic insufficiencies with secondary HVL insufficiencies are differentiated from primary HVL insufficiencies. The prognosis for patients with hypopituitarism depends primarily on how many axes are affected and how long the failure has been present.
Complications
Anterior pituitary insufficiency primarily causes an imbalance of hormones. This imbalance can generally have a negative impact on the patient’s health. There is usually a severe reduction in exercise tolerance and also, not infrequently, weight loss. Most sufferers also experience nausea and vomiting, and show altered skin texture. Similarly, the strength of pigmentation may also decrease. In most people, anterior pituitary insufficiency also leads to a decrease in hair and further to potency disorders, and women may be affected by menstrual disorders. In children, anterior pituitary insufficiency can lead to short stature. The skin becomes unclean and dry due to this disease. In severe cases, affected individuals may also fall into a coma. The patient’s immune system is also weakened, so various diseases occur more quickly and easily. Treatment of anterior pituitary insufficiency usually involves hormone therapy. This results in a positive course of the disease relatively quickly and the symptoms disappear. However, the affected person may be dependent on this therapy for the rest of his or her life, since a causal treatment of anterior pituitary insufficiency is not possible. However, life expectancy is not reduced with early diagnosis and treatment.
When should you see a doctor?
Anterior pituitary insufficiency is primarily manifested by hormonal symptoms. Individuals who suddenly suffer from unusual weight loss or feel sick and dull for no apparent reason should consult their primary care physician. Medical advice is also required if performance decreases without a cause being identified. Nausea and vomiting, hypoglycemia and pain attacks are symptoms that must be clarified by a doctor in any case. Medical advice is required at the latest when external changes are added to the signs mentioned. A doctor should be consulted immediately if reduced skin pigmentation or a waxy skin structure can be observed. Affected children should be taken to a doctor if puberty is unusually long in coming. Women suffering from menstrual irregularities or infertility should discuss this with a gynecologist. Although these symptoms do not necessarily indicate anterior pituitary insufficiency, they still need to be clarified and treated if necessary. Tumor patients are particularly susceptible to HVI and should inform the appropriate physician when typical symptoms occur.
Treatment and therapy
Anterior pituitary insufficiency is treated depending on the cause. In addition to surgical treatment options, drug therapy options are available, usually corresponding to hormonal replacement therapy. Surgery is mainly performed for causative tumor diseases. Actively inflammatory processes are treated with anti-inflammatory drugs. In autoimmune diseases, on the other hand, the administration of immunosuppressants is indicated, which prevents the patient’s immune system from causing even more damage to the glandular tissue. In cases of causative tumors, removal of the tumor can restore the full range of functions of the anterior pituitary gland. In contrast, when tissue has been damaged by inflammation, trauma or necrosis, full regeneration is less likely. If necessary, affected individuals receive lifelong hormone replacement of the axes that have failed as a result of the insufficiency.If control hormones of the anterior pituitary lobe have failed, certain hormones are no longer produced in other glands. In this case, hormone substitution does not involve giving the patient the HVL control hormones. Rather, the hormones that are no longer produced by other glands due to the failed control are substituted, such as testosterone, thyroxine, somatotropin, or cortisol.
Prevention
Anterior pituitary insufficiency is preventable only to the extent that tumors, trauma, inflammation, and other injury to the pituitary gland and hypothalamus can be prevented.
Follow-up
Complete recovery is not always possible after treatment of anterior pituitary insufficiency. Patients must therefore often take hormone substitutes for the rest of their lives. These are intended to prevent deficiency symptoms. Regular check-ups are required in consultation with the physician. This involves a precise examination of the hormone situation, which enables help to be given at an early stage. Patients need sufficient patience and discipline for the therapy as well as for the aftercare. Only if they adhere to the doctor’s recommendations is a steady improvement possible. On the one hand, the focus is on taking the medication correctly, and on the other hand, the check-ups must be carried out on schedule. The so-called adherence to therapy is also indispensable for long-term aftercare. Especially in stressful phases, hormone fluctuations can otherwise occur, which have a negative effect on the state of health. As part of safety in the aftermath of the disease, affected individuals should always carry their emergency ID card with them. There is also an emergency kit that is useful in difficult situations. During the often lengthy recovery phase, patients should also take this kit with them on day trips or longer journeys in order to be prepared for emergencies. Follow-up care mainly refers to the reduction of health risks.
Here’s what you can do yourself
If the anterior pituitary gland is insufficient, this primarily means that the patient must be patient and highly compliant with treatment. In order to prevent the various consequences of an insufficiency of the anterior pituitary lobe from occurring, the prescribed medication (hormones) must be taken reliably in accordance with the doctor’s instructions. This is especially true if the hormones are prescribed in the form of sprays, gels or even injections. Furthermore, the current hormone levels must be regularly remeasured and checked. The adherence to therapy required for this – or “compliance” as the medical profession calls it – requires a lot of time and consistency, but this is the only way to avoid major failure symptoms. It is advisable here to keep a detailed record of the blood tests and their results. If patients come under unforeseen stress, hormone levels should be remeasured as soon as possible. In case of emergency, pituitary insufficiency patients should always carry an emergency ID card and an emergency kit. This should not be forgotten, especially when traveling on vacation or day trips. Patients with anterior pituitary insufficiency who have lost their body hair often suffer greatly from this cosmetic impairment. But eyebrows in particular can now be filled in with appropriate products or redrawn with permanent makeup.
