A pituitary gland is a kidney-bean-shaped gland present at the base of the brain. It is responsible for synthesising and releasing eight different hormones. Each of these hormones has distinct functions– from stimulating bone growth to stimulating the thyroid gland and releasing hormones to control metabolism. However, when the pituitary gland fails to release one or more or all of the hormones, it is known as hypopituitarism.
The blog delves deep into hypopituitarism, its causes, symptoms, diagnosis, and treatment options.
What is hypopituitarism?
The pituitary gland is attached to the hypothalamus through a stalk of blood vessels and nerves called the pituitary stalk. Through the stalk, the hypothalamus sends signals to the pituitary gland to release certain hormones. Hypothalamus is a part of the brain that controls various bodily functions, including blood pressure, heart rate, body temperature, and digestion.
When the pituitary gland fails to release one or multiple or more hormones is known as hypopituitarism. It is a rare condition that can develop due to numerous disorders and damage to the pituitary gland or hypothalamus. The symptoms of hypopituitarism may differ depending on which hormones are missing.
People with hypopituitarism may likely have to take medication for the rest of their lives. These medications assist in replacing the missing hormones.
What are the types of hormones that the pituitary gland produces?
The pituitary gland creates and secretes eight different types of hormones. They are as follows:
- Adrenocorticotropic hormone (ACTH or corticotropin): ACTH hormones signal the adrenal glands to produce cortisol, commonly known as stress hormones, that helps maintain blood pressure and blood glucose levels
- Antidiuretic hormone (ADH or vasopressin): helps control the body’s water balance and sodium levels.
- Follicle-stimulating hormone (FSH): is responsible for stimulating sperm production in men. It also signals the ovaries to produce estrogen and egg development in women.
- Growth hormone (GH): In children, growth hormone facilitates growth, whereas, in adults, the hormone helps in maintaining muscles and bones and impacts fat distribution. Additionally, GH aids in metabolism.
- Luteinizing hormone (LH): LH ensures stimulation of ovulation in women and testosterone in men.
- Oxytocin: The hormone helps women in labour to progress during childbirth and allows breast milk to flow. It is also responsible for developing bonding between the parent and the child.
- Prolactin: It affects the stimulation of breast milk production after childbirth in women.
- Thyroid-stimulating hormone (TSH) signals the thyroid to create hormones to manage metabolism and energy.
What are the different kinds of hypopituitarism?
Based on the number of hormones missing, there are three kinds of hypopituitarism. They are as follows:
- Isolated pituitary deficiency: When one pituitary hormone is not synthesised as expected is known as an isolated pituitary deficiency.
- Multiple pituitary hormone deficiencies: When two or more pituitary hormones fail to be produced, it is known as multiple pituitary hormone deficiencies.
- Panhypopituitarism: As the name suggests, all pituitary hormones fail to get secreted.
In addition to the above, three different kinds of hypopituitarism are based on the cause and the hormones affected. They are as follows:
- Primary hypopituitarism is due to damage to or disorder of the pituitary gland.
- Secondary hypopituitarism: A hypothalamus disorder or damage to the hypothalamus causes secondary hypopituitarism.
- Idiopathic hypopituitarism: In this, the cause is unknown.
What are the symptoms of hypopituitarism?
Some people may experience symptoms, while others may be asymptomatic until there is a gradual onset. In some instances, the symptoms may occur suddenly and dramatically. However, the symptoms depend on the cause, the hormones involved, and the severity of the symptoms. The following are the symptoms of each of the deficient hormones:
- ACTH deficiency: The symptoms are fatigue, decrease in blood pressure, unexplained weight loss, weakness, depression, nausea, or vomiting. The signs in a new-born are failure to thrive, low blood sugar level, seizure, and yellow skin.
- TSH deficiency: Constipation, increased weight, sensitivity to cold, lack of energy, and muscle weakness or aches are the symptoms of TSH deficiency. The signs in new-borns are low muscle tone, decreased temperature, hoarse cry, and a bloated abdomen.
- FSH and LH deficiency: Women experience irregular or stopped menstrual periods and infertility. In men, the symptoms are hair loss on the body and face, weakness, lack of sexual interest, erectile dysfunction, and infertility.
- GH deficiency: Short height, fat around the waist and face, poor overall growth, and delayed sexual development during puberty are noticeable symptoms in children. However, adults experience low energy, decreased strength and exercise tolerance, increased weight, reduced muscle weight, depression, and anxiety. A small penis in babies is also a symptom of GH deficiency.
- Prolactin deficiency: Women experience a lack or reduced milk supply. Men do not suffer from any symptoms.
- ADH deficiency: Increased thirst and urination are two symptoms of ADH deficiency. In new-borns, the symptoms are vomiting, unexplained episodes of fever, extreme crying, constipation, weight loss, and frequent wet diaper. Children experience difficulty with toilet training and loss of bladder control and are easily fatigued.
- Oxytocin hormone deficiency: A decrease in oxytocin makes milk letdown a challenge and results in a difficult breastfeeding experience for mothers. It may also lead to symptoms of depression.
What causes hypopituitarism?
There are numerous reasons for hypopituitarism. In most cases, it is due to a pituitary gland tumour. As the tumour increases, it compresses and damages the pituitary tissue, affecting hormone production. In some cases, the tumour can also affect the optic nerves, causing visual disturbances.
Other causes are as follows:
- Head injuries
- Brain surgery
- Radiation treatment to the head or neck
- Stroke, brain bleeding or pituitary gland disorder
- Certain medications, including narcotics, high-dose corticosteroids, or certain cancer drugs known as checkpoint inhibitors
- Inflammation of the pituitary gland
- Brain infection, including meningitis or infections that spreads to the brain, such as tuberculosis or syphilis.
- Diseases that affect multiple organs include sarcoidosis, Langerhans cell histiocytosis, and hemochromatosis.
- Severe blood loss during childbirth may cause pituitary gland damage
Sometimes, the condition is due to genetics. In such cases, hypopituitarism develops at birth or in early childhood. There are cases of hypopituitarism with no cause for its development.
When to seek medical help?
A person with noticeable symptoms of hypopituitarism and sudden onset of severe headaches, visual disturbance, confusion, or a drop in blood pressure needs immediate medical assistance.
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What are the risk factors for developing hypopituitarism?
The following conditions are some risk factors for hypopituitarism:
- Previous history of cancer and radiation therapy: Certain cancer treatments, such as radiation, may damage the pituitary gland
- Brain or head injury: Nearly 27% of people experiencing a traumatic brain injury may develop hypopituitarism after five months to a year.
- Sickle cell anaemia
- Type 1 diabetes: When patients poorly manage their type 1 diabetes, it results in nerve and vascular damage. It also contributes to hypopituitarism.
- Genetics: Sometimes, certain genetic mutations cause hypopituitarism.
- Pregnancy and childbirth: Pregnant women can develop a rare condition known as lymphocytic hypophysitis that can cause hypopituitarism. In addition, during delivery, severe blood loss may lead to pituitary damage. It is known as Sheehan syndrome.
How is hypopituitarism diagnosed?
If the healthcare provider suspects hypopituitarism, they may prescribe one or all tests to diagnose the condition accurately. The following are the tests:
- Blood tests measure hormone levels
- Stimulation or dynamic testing is another test that measures the patient’s hormone levels. The test is performed under the endocrinologist’s supervision. In this test, the doctor checks the hormone levels after the patient takes certain medications that stimulate hormone production.
- Brain imaging: MRI and CT scan of the brain detects the pituitary tumour or any other gland-related issues.
- Vision test: Detect any pituitary tumour growth that presses on the optical nerve impairing sight or visual fields.
What are the treatment options for hypopituitarism?
An endocrinologist can manage the condition. As the disease affects different hormones, there is no set course of treatment plan. Therefore, the goal is to maintain hormone levels without harming the patient’s health.
The treatment plan may involve hormone-replacing medication, surgery to remove the tumour, and in some cases, radiation therapy. The doctor constantly monitors if the treatment is working and, if need be, adjusts the medications accordingly.
Hypopituitarism is a rare condition. However, if left untreated can cause severe health issues and may result in a fatality. The prognosis for any individual with hypopituitarism is good with medical intervention. Therefore, if they get the proper treatment, an affected person can continue to lead a healthy life.
Frequently Asked Questions (FAQs)
Is there a cure for hypopituitarism?
No, hypopituitarism is not curable. However, there are several treatment options.
Can I prevent hypopituitarism?
Hypopituitarism is not preventable.
Can hypopituitarism lead to death?
Failure to get proper treatment for the sudden and severe onset of hypopituitarism may lead to medical emergencies and, in some instances, death. Therefore, if a person notices symptoms, meet the doctor soon.