AboutPituitary

Question:
WhatisthePituitarygland?
Soyourmindisracingandyourheartispounding
somanyquestionssomuchtotakeinwheretostart?
Letsstartwiththebasics.
Atypicaldictionarydefinitionof"Pituitarygland"readssomethinglike:The
pituitarygland,orhypophysis,isasmallductlessglandoftheendocrinesystem
thatsecreteshormonesdirectlyintothebloodstream.Itisaboutthesizeofapea
andislocatedatthebaseofthebraininasmall,bonycavitycoveredbyatough
andinflexiblemembrane.

TheEndocrineSystem
Theendocrinesystemisanintegratedsystemofsmallorgansthatinvolvethereleaseofextracellular
signalingmoleculesknownashormones.Theendocrinesystemisinstrumentalinregulatingmetabolism,
growth,developmentandpuberty,tissuefunction,andalsoplaysapartindeterminingmood.Thefieldof
medicinethatdealswithdisordersofendocrineglandsisendocrinology,abranchofthewiderfieldofinternal
medicine.
Endocrineglandsregulateyourbodychemistrybyreleasinghormonesdirectlyintothebloodsystem,which
stimulateorinhibitactivityinthetargetcells.Theyarelikeremotecontroldevicesforyourbody'smanycells
andsystems.Itwouldbefartoocomplicatedtocommunicatewitheachcellinthebodydirectly,soinstead
thebraincontrolssimilartypesofcellsusinghormonesreleasedintothebloodstream.Togiveyouan
exampleofhowthisworks,imagineyoursuddenriseinheartratewhendangerthreatensoranemergency
situationarisesthisiscausedbyanother'remotecontrol'hormone:adrenaline.Thishormone,releasedby
theadrenalglandontopofyourkidney,hasaveryimmediateandnoticeableeffectonyourbody.The
hormonesreleasedfromthepituitaryglandarewaylessdramaticandnotnearlyasinstantaneous,butwork
inasimilarfashionandarecriticaltoyouroverallhealthandwellbeing.

Thepituitaryglandissometimescalledthe"master"glandoftheendocrinesystem,becauseitcontrolsthe
functionsofalltheotherendocrineglands.This"MasterGland"rolemakesthepituitaryglandquite
important,despiteitssmallsize.
Themedicaltermishypophysis(fromtheGreek,"lyingunder")whichreferstothegland'spositiononthe
undersideofthebrain.Theterm"pituitary"isinreferencetosecretion,buthascometobesynonymouswith,
andeasiertosay,than"hypophysis".
Thehypothalamusisthebottompartofthebrainthatconnectsandcommunicateswiththepituitaryglandvia
nervefibers.Thisareaofthebrainfunctionsasthemaincontrolcenterfortheautonomicnervoussystemby
regulatingsleepcycles,bodytemperature,appetite,etc.,andthatactsasanendocrineglandbyproducing
hormones,includingthereleasingfactorsthatcontrolthehormonalsecretionsofthepituitarygland.
Regulatinggrowthhormonesarewhatpeoplecommonlyassociatethepituitaryglandwith.Toolargean
amountofthesehormonescausesgiantism,aconditionwherefacialfeatures,hands,etc.become
abnormallylarge.Toolittlecausesdwarfism,wheretheoverallstatureofapersonisverysmall.Whilethe
pituitaryglandisresponsibleforregulatinggrowthhormones,italsosendssignalstothethyroidgland,
adrenalglands,ovariesandtestes,directingthemtoproducethyroidhormone,cortisol,estrogen,
testosterone,andmanymore.Thesehormoneshavedramaticeffectsonmetabolism,bloodpressure,
sexuality,reproduction,andothervitalbodyfunctions,includingprolactinformilkproduction.

Thepituitaryglanditselfismadeupofthreesections

Anteriorlobe
GrowthHormone
Prolactintostimulatemilkproductionaftergivingbirth
ACTH(adrenocorticotropichormone)tostimulatetheadrenalglands
TSH(thyroidstimulatinghormone)tostimulatethethyroidgland
FSH(folliclestimulatinghormone)tostimulatetheovariesandtestes
LH(luteinizinghormone)tostimulatetheovariesortestes

Intermediatelobe
Melanocytestimulatinghormonetocontrolskinpigmentation

Posteriorlobe
ADH(antidiuretichormone)toincreaseabsorptionofwaterintothebloodbythekidneys
Oxytocintocontracttheuterusduringchildbirthandstimulatemilkproduction
Eachlobeofthepituitaryglandproducescertainhormones,eachwithaspecificfunction.Pituitaryproblems
arisewhentoomuchortoolittleofthesehormonesareproduced.Whenanimbalanceoccurs,itcanleadto
morethanadozendisordersoftheendocrinesystem.Deficiencyofthyroidhormone,adrenalcortical
hormone(cortisol)orantidiuretichormone(vasopressin)israpidlylifethreatening.Inpatientswith
abnormalitiesoftheotherhormones,qualityoflifeissignificantlycompromised.
Soyoucanseewhythepituitaryglandissoimportant!

Whatcausesthepituitarytomalfunction?
Tumors(typicallybenign),inflammation,infectionsandinjurycancausetheglandtomalfunction,aswellas
metastasisorspreadofothertumorstothepituitary(butthisisveryrare).Radiationtherapytothebraincan
alsocausenormalpituitarycellstomalfunction.
Theproblemwithpituitarydisordersisthattheyarehardtodiagnosebecausetheycancauseawide
spectrumofsymptoms,andareoftenconfusedwithotherdisorders.Duetoitslocationnearthebrain,
symptomsmayappearbothhormonalandneurological,makingdiagnosisofpituitarydiseasedifficult.
Diagnosisisdependentonanalyzingsymptoms,signsonexamination,bloodtestsandMRIfindingsasdirect
accesstothepituitarycanonlybereachedviasurgery.Toooftenpituitaryglanddysfunctionisnotsuspect,
andtumorscangoundetected.
So,whydowecare?Unfortunately,researchshowsoneoutofeveryfivepeopleworldwidehasapituitary
tumor.Thatisaprettyalarmingstatistic.Wedonotknowwhytumorsaresoprevalentbecausebefore
Octoberof2002fundingforbenignbraintumorresearchwasvirtuallynonexistent.Whatweneedtodonow
israiseawarenessofpituitarydisorderssothattheyarenotmisdiganosed,allowingpituitarytumorsgoing
undetected.

WhatisapituitaryTumor?
Apituitarytumorisanabnormalgrowthofpituitarycells.Pituitarytumorscanproducespecifichormones,
suchasprolactin(causinginfertility,decreasedlibido,andosteoporosis),growthhormone(causing
acromegaly),ACTH(causingCushing's),TSH(causinghypothyroidism),orbenonfunctionalandnotproduce
hormonesatall.Thesetumorsbehaveaccordingtotheircelloforiginandarenamedforthespecificcell
typeaffected.Forexample,ifatumororiginatesinaprolactinproducingcell,thepatientdevelopsa

prolactinomaaprolactinsecretingpituitarytumorthatiscommonandusuallytreatable.Highprolactinlevels
suppressproductionofthepituitaryhormones(luteinizinghormoneandfolliclestimulatinghormone)that
stimulateproductionofestrogenortestosterone.Menwiththesetumorshavelowtestosteronelevelsand
losetheirsexdriveandeventuallytheirmasculinecharacteristicssuchasfacialhair,musclemass,develop
erectiledysfunctionandlowspermcount.Womenwithprolactinproducingtumorsoftendonotovulate,
experiencelowestrogenlevels,andceasehavingmenstrualperiods.Inbothcases,patientswithlowsex
hormonesdeveloposteoporosis.Itisimportanttorememberthatmostpituitarytumorsarebenignand
cancerisveryrare.Theyhavevariablepatternsofgrowthandaffectdifferentpeopleinvastlydifferentways.
Somearesmallandincidental,whileothersaresmallbutcausehormoneexcess.Othersmayberapidly
growingmasslesions.Thepointistheyneedearlydetectionandtreatment.
Enoughdoomandgloomtypicallyifdiagnosedearlyenoughtheprognosisforrecoveryfrompituitary
tumorsisexcellent.Ifnot,sometumorscangrowintomuchbiggerproblems,rangingfromdiscomfortto
death.
Soearlydetectioniskey.

Whyisearlydiagnosissuchaproblem?
Inasignificantminorityofpatientsdiagnosisisnotmadeuntiltheindividualhasdevelopeddebilitatingorlife
threateningsymptomsofheartdiseaseoradrenal(uncommon),gonadaland/orthyroidinsufficiency.Evenin
the21stcenturydeathfromalargepituitarytumororhormonaldeficiencystilloccurs,albeitrarely.Early
diagnosisisusuallyareflectionofahighindexofsuspiciononthepartofaphysician.Unfortunately,many
doctorshavebeentaughtthatpituitarydiseaseisrare,soitisnotattheforefrontoftheirlistofpossible
diagnoses.PNAisouttochangeallofthat.
Whichbringsusbacktoyounowwonderinghowcanyougetproperlydiagnosed.Ifyouaresuspiciousof
pituitarydiseaseyoushouldgetbloodandurinaryhormonelevelscheckedand,ifindicated,abrainMRI,
keepinginmindthatmicroadenomasmaynotshowuponthexrays.Combinationsofthreeormoreofthe
followingmaysuggestthepossibilityofapituitarytumor:sexualdysfunction,depression,galactorrhea,
infertility,growthproblems,osteoporosis,obesity(specificallycentral),severevisionproblems,easybruising,
achingjoints,carpeltunnelsyndrome,disruptedmenses,earlymenopause,muscleweakness,fatigue.Soif
yoususpectpituitarydysfunctionyoushouldgettestedatahospitalwithaNeuroendocrineUnitorPituitary
TestingFacility,preferablyboth.Pituitarybloodtestscanbeverycomplicatedandmustbeperformedby
speciallytrainedtechnicianswhocanconductdynamichormonetestingandpreciselytimedbloodsampling,
administertestingagents,andhavespecialexpertiseinmeasuringpituitaryhormones.Itsnotasimple
process,whichiswhyproblemsoftengoundetected.

Ifatumorisfound,whatarethenextsteps?
Itdependsonthetypeoftumorandhowfarithasinvadedintothebrain,aswellasthepatient'sageand
overallhealth.Ingeneralthreekindsoftreatmentareused:surgery(physicallyremovingthetumorduringan
operation),radiationtherapy(usinghighdosexrays/protonbeamstokilltumorcells)anddrugtherapyto
shrinkandsometimeseradicatethetumor.Drugscanalsoblockthepituitaryglandfrommakingtoomuch
hormone.Surgeryisacommontreatment,anditisalmostalwayssuccessfulifperformedbyaskilledand
specializedneurosurgeon.Thesmallerthetumor,thegreaterthechancethesurgerywillbesuccessful.
Largetumorsincreasetheriskofsurgeryandaregenerallyassociatedwithalowerprobabilityofcure.
Earlydiagnosisandtreatmentisthekey.

Postsurgeryrecoveryinmostpatientsisshort.Patientsoftenreportimmediaterelieffromsymptomsafter
TransphenoidalHypophysectomyandlittlepain.Someleavethehospitalthesameday!
Radiationtherapymaybeusedifmedicationandsurgeryfailstocontrolthetumor.Radiationtherapyuses
highenergyxraystokillcancercellsandabnormalpituitarycellsandshrinktumors.Thetypeandsizeof
tumordictatetreatment,andtherearemany.Therearemorethanadozenverydifferentdisordersthat
resultfrompituitarytumorsanddisease.
OKsonowmaybesomeofthatadrenalineisinyoursystemcausingabitofpanicsohowcanyoutellifyou
haveaproblem?

Potentialsymptoms
IfatumorformsinanACTHsecretingpituitarycell,itcouldresultintheoverproductionofcortisol(Cushing's
Disease)ortheunderproductionofcortisol(adrenalinsufficiency,oftenreferredtoasSecondaryAddison's
Disease).Cushing'sisaconditioncharacterizedbyexcessivefataccumulationincentralpartsofthebody
(obesity,includingaroundedorfatfilledface),diabetes,hypertension,alowserumpotassium,thinningand
bruisingofskin,andosteoporosis.
Symptomsofadrenalinsufficiencyincludedehydration,lowbloodpressureandsodiumlevel,andexcessive
weightloss.PrimaryAddison'sDiseaseiscausedwhentheadrenalglandsfailtorespondtodirectionsfrom
thepituitaryandhypothalamus.
Ifthetumorformsinagrowthhormoneproducingcell,itcanoverproducegrowthhormone.Tumorsthat
formfromgrowthhormoneproducingcellscausetwodifferentclinicalpictures.Iftheyoccurinchildren
beforethegrowthplatesinlongboneshaveclosed,excessivegrowthhormonewillcausegigantism.Ifthe
growthhormoneexcessoccursduringadulthoodthereisexcessiveenlargementofthehands,feet,andjaw,
aswellassofttissueswellingofmanytissues(acromegaly).Acromegalyisassociatedwithanincreased
probabilityofdevelopingdiabetesmellitus,heartattack,hypertension,andcertaintypesofcancerincluding
malignancyofthecolon.Mostcommonlythefacialchangesdevelopsubtlyandmaynotbenoticedbythe
patientorhis/herfamily.
OK,whathappensafteratumorisremovedortreated?Theremaybepermanentlossofsomeorallpituitary
hormones,animbalancethatcanbetreatedwithHormoneReplacementTherapy.HRTcanreplacethyroid,
growth,testosterone,oradrenalhormoneswhenthosemadebythepituitarytostimulatetheendocrine
glandsarenolongerproduced.Itcanbelifesavingtherapyforthemanymillionsofpatientswhoneedto
replacehormonestheynolongermake.Whichistosaythereisqualityoflifeaftertreatment!
Sonowyouknowwhythepituitaryglandissoimportant,andwhyifyoususpectpituitarydysfunctionyou
shouldhaveyourselfcheckedspecificallyforit.
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