Pituitary disorders

• Pituitary disorders occur when the pituitary gland produces too many or not enough hormones. Hormones are chemicals that are released into the bloodstream. It is important that the body releases normal amounts of hormones because they send messages to cells throughout the body in order to regulate bodily functions, such as growth, metabolism, and sexual development.
• The pituitary gland is a pea-sized gland that is located at the base of the brain. It is just one of many glands involved in the endocrine system. The endocrine system is made up of several glands throughout the body that produce and secrete hormones.
• Many experts consider the pituitary gland to be the most important part of the endocrine system because it secretes hormones that regulate the functions of many other endocrine glands. As a result, patients with pituitary disorders may experience a disruption in many different bodily functions.
• The pituitary gland secretes several different hormones that are important for normal bodily functions. Growth hormone (GH) regulates bone and tissue growth. It also helps maintain a healthy balance of muscle and fat tissue in the body. Anti-diuretic hormone (ADH) helps control urine production and manages the water balance in the body. Thyroid-stimulating hormone (TSH) signals the thyroid gland to secrete other hormones that regulate the body's metabolism. Luteinizing hormone (LH) regulates testosterone production in males and estrogen production in females. Follicle-stimulating hormone (FSH) signals sperm production in males and egg development and ovulation in females. Adrenocorticotropic hormone (ACTH) stimulates the adrenal glands to produce other hormones, such as cortisol. Prolactin regulates the development of breasts and breast milk in females. Although low levels of prolactin are present in males, there is no known function of prolactin in males.
• If the pituitary gland releases too many hormones, disorders, such as acromegaly, Cushing's disease, or hyperprolactinemia, may develop. If the pituitary gland does not release enough hormones, patients develop a condition called hypopituitarism. Most pituitary disorders occur when a noncancerous tumor (abnormal growth) develops on the pituitary gland. A tumor may stimulate the gland to produce too many or not enough hormones.
• Treatment of pituitary disorders depends on the type and severity of the disorder. In general, tumors of the pituitary gland need to be surgically removed. Sometimes the entire tumor cannot be removed. In such cases, patients may also need radiation or drug therapy. Even if the tumor is removed, some patients with overactive or underactive pituitary glands may require long-term hormone replacement therapy.

• Acromegaly: Symptoms of acromegaly develop gradually over many years. The most common symptom of acromegaly is enlarged hands and feet. It may also lead to gradual changes in the shape of the face, such as an enlarged nose, thickened lips, increased gaps between the teeth, or protruding lower jaw or brow.
• Other symptoms may include coarse or oily skin, increased sweating, body odor, fatigue, muscle weakness, small outgrowths of skin tissue (called skin tags), deepened voice, severe snoring, enlarged tongue, joint pain, limited joint mobility, increased chest size, enlarged organs (e.g. heart, kidneys, and spleen), irregular menstrual cycle in women, and erectile dysfunction in men. If a tumor is causing the condition and pushing on the brain, patients may experience frequent headaches or impaired vision.
• Serious complications of acromegaly may include high blood pressure, heart disease, and spinal cord compression that causes severe pain.
• Cushing's disease: Common symptoms of Cushing's disease include weight gain (especially around the midsection and upper back), a fatty hump between the shoulders (called a buffalo hump), fatigue, muscle weakness, rounded face (often called moon face), facial flushing, thin and fragile skin that bruises easily, depression, anxiety, irritability, thicker or more visible body and facial hair (hirsutism), irregular or absent menstrual periods in females, erectile dysfunction in males, high blood pressure, acne, as well as stretch marks on the skin of the abdomen, thighs, breasts, and arms.
• Cushing's disease may be fatal if left untreated. Severe symptoms may include high blood pressure, bone loss, kidney stones, infections, and, sometimes, diabetes.
• Hyperprolactinoma: Symptoms of hyperprolactinoma depend on the severity of the condition and the gender of the patient. Both males and females may develop symptoms, such as decreased libido, headaches, impaired vision, infertility, and low bone density.
• Common symptoms in females include irregular menstrual periods, lack of menstrual periods (called amenorrhea), discharge from the breasts in women who are not pregnant or breastfeeding, and vaginal dryness.
• Common symptoms in males include erectile dysfunction, impotence, and loss of body hair. In rare cases, some males may develop enlarged breasts (a condition called gyncomastia).
• Hypopituitarism: Signs and symptoms of hypopituitarism depend on the hormone that is deficient.
• Symptoms of adrenocorticotropic (ACT) hormone deficiency may include fatigue, low blood pressure, weight loss, weakness, depression, nausea, and vomiting.
• Symptoms of thyroid-stimulating hormone (TSH) deficiency may include constipation, weight gain, sensitivity to cold, decreased energy, and muscle weakness, or aching.
• Symptoms of follicle-stimulating hormone (FSH) and luteinizing hormone (LH) deficiency include irregular or stopped menstrual periods and infertility in women. Men may experience loss of body and facial hair, weakness, decreased libido, erectile dysfunction, and infertility.
• Symptoms of growth hormone (GH) deficiency in children may include short height, fat around the waist, chubby face, and poor overall growth. In adults, symptoms may include low energy, decreased strength and exercise tolerance, weight gain, decreased muscle mass, and feelings of anxiety or depression.
• Symptoms of prolactin deficiency in women may include lack of milk production, fatigue, and loss of underarm and pubic hair. Prolactin deficiency has no known adverse effects in men and no symptoms have been seen.
• Anti-diuretic hormone (ADH) deficiency causes diabetes insipidus. Diabetes insipidus is a disorder in which the kidneys are unable to store water. As a result, patients experience increased thirst and urination.

• Acromegaly: The standard diagnostic test for acromegaly is a growth hormone suppression test. During the procedure, a sample of blood is taken from the patient before and after he/she drinks a special fluid made with sugar (called glucose). In healthy individuals, the sugar will cause the levels of growth hormone to decrease. However, patients with acromegaly will continue to have high levels of growth hormone even after consuming sugar.
• Cushing's disease: Patients with high levels of cortisol in the body are diagnosed with Cushing's disease. Urine, blood, and saliva tests are conducted to determine if the patient has elevated levels of cortisol in the body. Patients who have excessive cortisol levels will then undergo body scans that produce pictures of their internal organs (called imaging studies) to determine if a tumor inside the body is causing the condition.
• Hyperprolactinemia: Patients with hyperprolactinemia will have high levels of prolactin in their blood. Other tests usually include computerized tomography (CT) scans or magnetic resonance imaging (MRI) scans of the brain. These imaging studies will help the healthcare provider determine if a tumor is causing the condition. Healthcare providers usually suspect that the condition is drug-induced if the patient is taking a medication known to suppress dopamine levels. Healthcare providers may also perform a blood test to determine if the patient has low levels of thyroid hormones, which may also cause hyperprolactinemia.
• Hypopituitarism: Blood tests are used to diagnose hypopituitarism. Patients with low or non-existent levels of one or more hormones have the condition. In addition, imaging studies, including CT scans and MRI scans, may be used to detect tumors or abnormalities in the pituitary gland.

• General: If a tumor is causing the pituitary disorder, it will need to be surgically removed. Sometimes, the entire tumor cannot be removed because there may be a high risk of damaging the internal organs that the tumor is growing on. In such cases, patients may also need radiation or drug therapy. Some patients with either acromegaly or hypopituitarism may require long-term hormone replacement therapy.
• Patients should tell their healthcare providers if they are taking any other drugs (prescription or over-the-counter), herbs, or supplements because they may interact with treatment. Patients should take all medications exactly as prescribed.
• Surgery: Surgery may be performed to remove tumors that are causing the pituitary disorder. Once the tumor is removed, the levels of hormones in the body usually return to normal or near-normal. Drug therapy may also be needed after surgery.
• In most cases, a surgical procedure, called transsphenoidal surgery, is performed to remove the tumor. During this procedure, the surgeon removes the pituitary gland through the nose. This type of surgery has fewer complications because other parts of the brain are not touched during the procedure.
• However, some patients, especially those who have very large tumors, may need to have transcranial surgery. During this type of surgery, the pituitary tumor is removed through part of the skull.
• Radiation therapy: Sometimes the surgeon is unable to remove the entire tumor. In such cases, radiation therapy is often recommended to remove the rest of the tumor. During therapy, which usually lasts several weeks, high-energy waves are used to kill the tumor cells. However, many pituitary tumors recur within five years after surgical removal.
• Dopamine agonists: Patients with hyperprolactinemia may receive medications called dopamine agonists. These medications act like the brain chemical dopamine, which regulates the production of prolactin. Dopamine agonists, such as bromocriptine (Parlodel®) and cabergoline (Dostinex®), help reduce the amount of prolactin that is produced. They may reduce symptoms of the disorder and reverse infertility. If the dopamine agonist effectively shrinks the tumor, patients may be able to stop taking the medication. Patients will need to have their prolactin levels monitored regularly.
• Side effects may include dizziness, nausea, stuffy nose, and difficulty concentrating. The risk of side effects is reduced if patients start treatment with low doses that are gradually increased over time.
• Octreotide: Adults with acromegaly or children with gigantism may receive injections of synthetic hormones, such as octreotide (Sandostatin® or Sandostatin LAR®), to reduce the amount of growth hormone that is released. Patients typically receive a short-acting injection to determine if the medication is safe and effective in the patient. If it is successful, patients will receive injections once a month for life.
• Growth hormone antagonists: If other treatments are unsuccessful, patients with acromegaly or gigantism may take medications called growth hormone antagonists that block the effect of growth hormone on body tissues. Medications, such as pegvisomant (Somavert®), are injected into the patient. Although this treatment reduces symptoms, it does not lower the amount of growth hormone in the blood, and it does not reduce the size of the tumor.
• Corticosteroids: Corticosteroids such as hydrocortisone or prednisone, may be taken by mouth to replace the adrenal hormones that are not being produced because of an adrenocorticotropic hormone (ACTH) deficiency.
• Thyroid hormones: Man-made hormones, such as levothyroxine (Levoxyl® or Synthroid®) or liothyronine (Cytomel®), may be taken by mouth to replace low levels of thyroid hormones caused by thyroid-stimulating hormone (TSH) deficiencies. Patients take this medication daily with food. In addition, some patients may take dessicated thyroid (Armour® Thyroid), also called thyroid extract. Dessicated thyroid is made from pig or cow thyroid hormones.
• Sex hormones: Patients with low levels of follicle-stimulating hormone (FSH) or luteinizing hormone (LH) may receive man-made sex hormones. Females receive a combination of estrogen and progesterone, while males receive testosterone.
• Desmopresin: Patients with anti-diuretic hormone (ADH) deficiency may take a man-made hormone, called desmopresin (DDAVP®), by mouth or nasal spray.
• Growth hormone: Patients with low levels of growth hormone (GH) may receive injections with a man-made growth hormone called somatropin (Genotropin®).

Note
: There is currently insufficient available evidence on the safety and effectiveness of integrative therapies for the treatment or prevention of pituitary disorders. The integrative therapies listed below should be used only under the supervision of a qualified healthcare provider, and should not be used in replacement of other proven therapies or preventive measures.

• Arginine (L-arginine)
  : L-arginine helps maintain the body's fluid balance (urea, creatinine), and aids in wound healing, hair growth, sperm production (spermatogenesis), blood vessel relaxation (vasodilation), and fights infection. Intravenous arginine can be used for growth hormone reserve evaluation in people with suspected growth hormone deficiencies. Examples of these deficiencies include panhypopituitarism, growth/stature abnormalities, gigantism/acromegaly, or pituitary adenoma.
• Avoid if allergic to arginine. Avoid with a history of stroke or liver or kidney disease. Avoid if pregnant or breastfeeding. Use cautiously if taking blood-thinners, blood pressure drugs, antidiabetic drugs, or herbs or supplements with similar effects. Blood potassium levels should be monitored. L-arginine may worsen symptoms of sickle cell disease.
• Chasteberry
  : Chasteberry may inhibit prolactin secretion, and thus has been suggested as a potential therapy in hyperprolactinemia, a condition characterized by elevated serum prolactin levels. Although preliminary evidence is promising, additional study is warranted in this area.
• Avoid if allergic or hypersensitive to members of the Vitex (Verbenaceae) family or any chasteberry components. When taken in recommended doses, chasteberry appears to be well tolerated with few side effects. Use cautiously in patients taking oral contraceptives or hormone replacement therapy Use cautiously with dopamine agonists or antagonists. Avoid with hormone sensitive cancers or conditions (like ovarian cancer or breast cancer). Avoid if pregnant, breastfeeding or if undergoing in vitro fertilization.
• Probiotics
  : Probiotics are beneficial bacteria that are sometimes called friendly germs. They help maintain a healthy intestine and aid in digestion. They also help keep harmful bacteria and yeasts in the gut under control. Most probiotics come from food sources, especially cultured milk products. Probiotics can be taken as capsules, tablets, beverages, powders, yogurts, and other foods. There is evidence that young children (ages 6-36 months) who receive infant formula with Bifidobacteria Bb12 supplementation may achieve faster growth than without supplementation.
• Probiotics are generally considered safe and well-tolerated. Avoid if allergic or hypersensitive to probiotics. Use cautiously if lactose intolerant. Caution is advised when using probiotics in neonates born prematurely or with immune deficiency.
• Calcium
  : Calcium is the most abundant mineral in the human body, and it has several important functions. Growth of very low birth weight infants correlates with calcium intake and retention in the body. It is possible that human milk fortifiers commonly used may not have enough levels of calcium for infants of very low birth weight. Bone mineralization is also lower in very low birth weight infants at theoretical term than infants born at term. Use of a formula containing higher levels of calcium has been suggested for improvement of mineral metabolism in very low birth weight infants.
• Avoid if allergic or hypersensitive to calcium or lactose. High doses taken by mouth may cause kidney stones. Avoid with high levels of calcium in the blood, high levels of calcium in urine, high levels of parathyroid hormone, bone tumors, digitalis toxicity, ventricular fibrillation, kidney stones, kidney disease, or sarcoidosis (inflammation of lymph nodes and various other tissues). Calcium supplements made from dolomite, oyster shells, or bone meal may contain unacceptable levels of lead. Use cautiously with achlorhydria (absence of hydrochloric acid in gastric juices) or irregular heartbeat. Calcium appears to be safe for pregnant or breastfeeding women; talk to a healthcare provider to determine appropriate dosing during pregnancy and breastfeeding.
• Copper
  : Copper is a mineral that occurs naturally in many foods, including vegetables, legumes, nuts, grains, fruits, shellfish, avocado, beef, and animal organs, (e.g. liver and kidney). Severe copper deficiency may slow growth. Adequate intake of micronutrients, including copper and other vitamins may be important for childhood growth promotion as measured by length gains.
• Avoid if allergic or hypersensitive to copper. Avoid use of copper supplements during the early phase of recovery from diarrhea. Avoid with hypercupremia, occasionally observed in disease states, including cutaneous leishmaniasis, sickle-cell disease, unipolar depression, breast cancer, epilepsy, measles, Down syndrome, and controlled fibrocalculous pancreatic diabetes (a unique form of secondary diabetes mellitus). Avoid with genetic disorders affecting copper metabolism such as Wilson's disease, Indian childhood cirrhosis, or idiopathic copper toxicosis. Avoid with HIV/AIDS. Use cautiously with water containing copper concentrations greater than 6mg/L. Use cautiously with anemia, arthralgias, or myalgias. Use cautiously if taking oral contraceptives. Use cautiously if at risk for selenium deficiency. The U.S. Recommended Dietary Allowance (RDA) is 1,000 micrograms for pregnant women. The U.S. RDA is 1,300 micrograms for nursing women.
• Licorice
  : Shakuyaku-kanzo-to, an herbal medicine containing licorice, has been used for neuroleptic-induced hyperprolactinemia (elevated levels of prolactin). However, additional studies are needed in this area.
• Avoid licorice if allergic to licorice, any component of licorice, or any member of the Fabaceae (Leguminosae) plant family. Avoid with congestive heart failure, coronary heart disease, kidney disease, liver disease, fluid retention, high blood pressure, or hormonal abnormalities. Avoid if taking diuretics. Licorice can cause abnormally low testosterone levels in men or high prolactin or estrogen levels in women. This may make it difficult to become pregnant and may cause menstrual abnormalities.
• Qi gong
  : Qi gong is a type of traditional Chinese medicine (TCM) that is thought to be at least 4,000 years old. It is traditionally used for spiritual enlightenment, medical care, and self-defense. Children are capable of receiving instruction in internal Qi gong as a health promotion activity, and it may have some behavioral benefits. However, it is still unclear whether Qi gong may be beneficial for childhood growth promotion. More research is needed.
• Qi gong is generally considered to be safe in most people when learned from a qualified instructor. Use cautiously with psychiatric disorders.
• zinc
  : Evidence suggests that supplementation with zinc plus iron (but not with zinc alone) may improve linear growth in stunted infants with low hemoglobin.
• Zinc is generally considered safe when taken at the recommended dosages. Avoid zinc chloride because evidence of safety and effectiveness are currently lacking. Avoid with kidney disease. Use cautiously if pregnant or breastfeeding.

• In general, most cases of pituitary disorders cannot be prevented.
• Patients should use certain medications, including tranquilizers (such as Stelazine®), gastroesophageal reflux disease (GERD) drugs (such as Reglan®), and high blood pressure drugs (such as Aldomet®), cautiously. These medications may lead to hyperprolactinemia.