Pituitary insufficiency is an underactivity of the pituitary gland. Because the pituitary gland produces messenger substances for other hormone glands, there is a general hormone deficiency when there is insufficiency. The causes are either in the pituitary gland itself or in the hypothalamus.
What is pituitary insufficiency?
In pituitary insufficiency, not enough hormones are produced in the anterior lobe of the pituitary gland. Secretion of stimulating hormones for the thyroid, adrenal cortex, and gonads is thus limited. These hormones are in particular growth hormones, LH, TSH, FSH and ACTH. With the stimulation of the adrenal cortex, gonads and thyroid thus reduced, fewer hormones are produced in these glands as well. The most important hormones of the adrenal cortex include the stress hormones adrenaline and noradrenaline. The best known hormones of the thyroid gland are thyroxine and calcitonin, while in the gonads mainly the sex hormones are produced. Pituitary insufficiency is therefore associated with a correspondingly large number of complaints. The entire hormonal balance becomes unbalanced in the course of the disease, since the secretion of the pituitary gland regulates the release of various hormones. A special form of insufficiency is pituitary coma. In this case, a sudden loss of function of the pituitary gland causes the thyroid gland and adrenal cortices to stop working from one second to the next.
Causes
Various phenomena can be considered as causes of pituitary insufficiency. Tumors in this area or in the hypothalamus, for example, can impair the secretion of pituitary hormone. Inflammations in the pituitary gland or hypothalamus can also cause insufficiency. Likewise, autoimmune diseases and strokes sometimes lead to pituitary insufficiency. Causative injuries are also conceivable. In particular, traumatic brain injury can play a role in insufficiency. Many of these traumas are birth traumas resulting from breech birth. However, injuries can also occur as a result of surgery or radiation to brain tumors. Another cause of hypopituitarism may be brain necrosis, such as occurs in Sheehan’s syndrome. In some cases, the cause of pituitary insufficiency remains unclear. This means that, at the current state of research, by no means all the correlations are known and the disease has not yet been conclusively investigated. Pituitary coma is usually always caused by an accident or sudden injury to the pituitary gland.
Symptoms, complaints, and signs
The symptoms of pituitary insufficiency are varied. Usually, only the anterior lobe is affected by the insufficiency. Less commonly, insufficiency exists for the entire pituitary gland. Growth disorders such as short stature are one of the leading symptoms. Since the hormone deficiency slows down the fat metabolism, obesity may also occur. In women, these symptoms are usually accompanied by disturbances in the menstrual cycle, since the sex hormone estrogen is no longer produced in sufficient quantities. The secondary sexual characteristics may also be inhibited in their development due to this hormone deficiency. Diabetes insipidus often occurs in addition. In this disease, there is an increased feeling of thirst. Patients urinate more frequently. Which symptoms a patient with pituitary insufficiency exhibits in addition to these leading symptoms can vary significantly. Basically, the occurring disorders result from the physiological effect of the respective hormone deficiency of gonadal, adrenocortical and thyroid hormones. In pituitary coma, in addition to listlessness, there is a slow pulse. Body temperature drops and the affected person loses consciousness.
Diagnosis and course of the disease
Diagnosis of hypopituitarism begins with an extensive medical history. Based on the medical history, the doctor can, for example, find out about treatments or diseases that may have caused the hypofunction. In the blood, the doctor determines the amount of growth hormone, LH and FSH, thyroid-stimulating hormone, adrenocorticotropic hormone and prolactin. In addition, a urine or blood test is performed to determine sex hormones, thyroid hormones, and glucocorticoids. By means of a stimulation test, the physician narrows down the localization of the damage.If the disorder originates from the hypothalamus, then the stimulation test leads to the production of hormones. The hypothalamus messengers to stimulate the pituitary gland are given into the body during this test. Imaging may be ordered to further determine the cause. The prognosis for pituitary insufficiency is usually favorable, as the phenomenon is now readily treatable. However, pituitary coma can be life-threatening.
Complications
First and foremost, pituitary insufficiency results in impaired growth and thus in short stature. In most cases, this manifests itself already in the young years of the patient. Furthermore, disorders of the metabolism also occur, so that most patients also suffer from obesity and thus also from overweight. In women, there are disturbances of menstruation and other sexual disorders and thus a delayed onset of puberty. Diabetes does not set in, which is why most patients suffer from increased thirst. Patients also experience a drastic decrease in exercise tolerance and may experience a loss of consciousness due to physical exertion. This is often also associated with pallor and with a very low pulse. Pituitary insufficiency can be treated in different ways, and the treatment option usually depends on the cause of the disease. In most cases, either the tumor or the inflammation must be removed, although there are no particular complications. The earlier the disease is diagnosed and treated, the higher the chances of complete recovery for the patient.
When should you go to the doctor?
Since pituitary insufficiency does not lead to an improvement of the symptoms and thus not to a self-healing, a doctor must be consulted in any case with this disease. The symptoms can vary greatly, so that no general prediction can be made about them. However, if they occur over a long period of time and complicate the life of the affected person, an examination by a doctor should always be carried out. Disturbances in growth may be indicative of the disease. Many patients suffer from short stature and disturbed fat metabolism, so that obesity can also occur. Likewise, diabetes may indicate the disease. A physician should be consulted if the patient suffers from a slowed pulse and decreased exercise tolerance. In the first instance, a general practitioner can be consulted for pituitary insufficiency. This doctor can examine the complaints and further diagnose the disease. Further treatment usually requires examinations by other specialists.
Treatment and therapy
Treatment of hypopituitarism depends on the cause of the disease. Tumors, for example, must be removed in surgery. Depending on the malignancy, surgery may be combined with radiation therapy. For inflammatory processes, cortisone is usually administered to allow the inflammation to subside. If the cause of the insufficiency cannot be further determined, hormone replacement therapy is usually resorted to. The hormones to be taken depend largely on the extent of the insufficiency. Above all, the intake of correctly dosed glucocorticoids is vital. The dosage of these stress hormones must be increased as soon as the patient is under stress. Failure to increase the dose may have life-threatening consequences. All patients with glucocorticoid deficiency should carry an emergency identification card in case of an emergency. The use of growth hormones is also frequently included in the treatment of hypopituitarism. The same is true for the administration of sex hormones. As a rule, the missing hormones are taken for life in cases of pituitary insufficiency of unexplained cause. Only prolactin deficiency and oxytocin deficiency do not require hormone replacement.
Prevention
Pituitary insufficiency can be indirectly prevented, for example, by adequately clarifying craniocerebral trauma.
Follow-up
In cases of pituitary insufficiency, follow-up care begins four to six weeks after the date of surgery. After the actual therapy, drug treatment takes place. In connection with this, close monitoring of the patient’s medication regimen and health status is required.Thus, adjustments to the individual dose occur over time. Basically, after a few years, no noticeable changes appear in those affected. If the disease is related to an infection, for example a pituitary gland inflamed by bacteria, it is important to strengthen the immune system. This type of aftercare focuses on the improved healing process and also serves as prevention. Strengthening the immune system can be ensured by a balanced diet with plenty of natural foods. Also useful are regular physical activities. Optimally, there is a frequent alternation between periods of tension and relaxation. In this way, patients can reduce the accumulated stress hormones particularly well. At the same time, active relaxation helps to successfully combat pathogenic germs. In the course of a better body feeling, the patients learn to be mindful. This plays an essential role in the healing process. Thus, efficient aftercare ensures stable health and a better sense of well-being.
Here’s what you can do yourself
The pituitary gland or pituitary gland has a significant influence on the control of various body functions. It can be considered as one of the most important hormonal control centers of the body. It performs its control function through the production of control hormones or directly effective hormones. This means that pituitary insufficiency, depending on its severity, has significant effects on certain bodily functions and on the psyche. An identified pituitary insufficiency should be treated as quickly as possible in the sense of combating the cause. Self-help measures are virtually unknown. If the disease is due to an inflammation of the pituitary gland by bacteria or other pathogenic germs, a strengthening of the immune system can support the healing process and has a preventive effect against a new infection. The immune system can be strengthened by a varied diet that includes natural foods, as well as by regular exercise and by constantly alternating between periods of tension and relaxation. For example, stress hormones, which can accumulate during the course of the day if no active relaxation phases have been interposed, can be reduced more effectively by light exercise than by relaxing on the sofa. The immune system is thus strengthened and can fight pathogenic germs much more effectively. An adaptation of behavior in everyday life to pituitary insufficiency consists in consciously noticing the symptoms present and, above all, avoiding dangerous situations that may arise due to various – hormonally induced deficits.
