The pituitary is a pea-sized gland at the base of the brain that controls the thyroid, adrenal glands, ovaries and testes, as well as growth and the body's water balance. Most pituitary problems are caused by benign (non-cancerous) growths called adenomas. They cause symptoms either by making too much of a hormone, or by pressing on the gland or nearby nerves.
Common conditions
- Prolactinoma: irregular or absent periods, milky discharge from the breasts, low sex drive, erectile problems and infertility. It is usually treated with tablets, without surgery.
- Acromegaly (excess growth hormone): enlarging hands and feet, a change in shoe or ring size, coarsening of facial features, a widening gap between the teeth, sweating, joint pain and snoring.
- Cushing's disease: excess cortisol driven by the pituitary. See adrenal disorders.
- Non-functioning pituitary tumours: headache, gradual loss of side vision, or low hormone levels.
- Hypopituitarism (low pituitary function): tiredness, low blood pressure, loss of periods or sex drive, and low thyroid hormone. It can follow tumours, surgery, head injury or severe bleeding after childbirth (Sheehan's syndrome).
- Diabetes insipidus (now called arginine vasopressin deficiency): passing large amounts of dilute urine with constant thirst, not related to blood sugar.
When to consult an endocrinologist
- A pituitary lump found on an MRI or CT scan
- Milky breast discharge, or periods stopping without pregnancy
- Changes in face, hands or feet over several years
- Low sodium, unexplained low blood pressure, or extreme tiredness after a head injury or childbirth
Emergency: a sudden, severe headache with loss of vision, double vision or drowsiness can be bleeding into a pituitary tumour (pituitary apoplexy). Go to an emergency department immediately.
Tests
- Blood tests for each pituitary hormone (prolactin, IGF-1, cortisol, thyroid and sex hormones), sometimes with stimulation or suppression tests
- A dedicated MRI of the pituitary
- Visual field testing
Treatment
Depending on the cause, treatment may be:
- Medicines, such as dopamine agonists for prolactinoma
- Surgery through the nose (transsphenoidal surgery), carried out with a neurosurgeon
- Radiotherapy in selected cases
- Lifelong replacement of missing hormones
People on hydrocortisone replacement are taught "sick-day rules" so that illness doesn't lead to an adrenal crisis.
Consulting Dr. Prasadh Rao L
Dr. Prasadh Rao L (MBBS, MD (General Medicine), DM (Endocrinology)) is an Assistant Professor of Endocrinology at Madras Medical College, where these conditions are seen and managed regularly. Treatment is planned individually, because the right choice depends on the cause, your age, other health conditions and your plans, such as pregnancy. Consultations are available at Dr. PD's Diabetes and Endocrine Speciality Clinic, Maduravoyal (Mon – Sat, 7:30 – 9:30 PM), at Dr. RK Podiatric Institute, Kolathur (4:00 – 6:30 PM), and by appointment at partner hospitals and clinics. See all locations or read the doctor’s profile.
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Written by Dr. Prasadh Rao L, MBBS, MD (General Medicine), DM (Endocrinology). Assistant Professor of Endocrinology, Madras Medical College. Tamil Nadu Medical Council Reg. No. 96520.
This article is for general information. It is not a diagnosis or a treatment plan. Please don't start, stop or change any medicine without speaking to your doctor.