From the Guidelines
Symptoms that indicate pituitary function problems include headache, fatigue, visual changes, and hormonal deficiencies, such as central hypothyroidism and adrenal insufficiency, which can manifest as fatigue, weakness, and changes in menstrual cycles or sex drive. These symptoms can vary depending on whether the pituitary gland is overactive or underactive and which hormones are affected. The pituitary gland controls many bodily functions by producing hormones that regulate other endocrine glands, so dysfunction can affect multiple systems simultaneously. Specific hormone imbalances create distinct symptom patterns:
- Growth hormone issues may cause abnormal growth
- Prolactin problems can cause breast milk production or infertility
- Thyroid-stimulating hormone abnormalities lead to metabolism changes
- Adrenocorticotropic hormone imbalances affect stress response and energy
- Gonadotropin irregularities disrupt reproductive function. These symptoms often develop gradually, making them difficult to recognize without medical evaluation through blood tests measuring hormone levels 1.
According to the most recent guidelines, the diagnosis of pituitary function problems should be based on a combination of clinical evaluation, laboratory tests, and imaging studies, such as MRI of the sella 1. The management of confirmed hypophysitis includes replacement of deficient hormones, such as physiologic doses of steroids and thyroid hormone, and close monitoring of the patient's condition 1.
In patients with suspected hypophysitis, it is essential to evaluate ACTH, cortisol, TSH, free T4, and electrolytes, and consider standard-dose ACTH stimulation testing for indeterminate results 1. Additionally, MRI brain with pituitary or sellar cuts should be performed in all patients with new hormonal deficiencies and particularly those with multiple endocrine abnormalities or severe headaches and complaints of vision changes 1.
It is crucial to distinguish primary from secondary hormonal problems to ensure appropriate treatment, and to recognize that a patient has central hypothyroidism, which can prompt evaluation for secondary adrenal insufficiency 1.
Overall, the diagnosis and management of pituitary function problems require a comprehensive approach, taking into account the patient's clinical presentation, laboratory results, and imaging studies, to ensure the best possible outcomes in terms of morbidity, mortality, and quality of life.
From the Research
Pituitary Function Problems: Indicative Symptoms
The following symptoms may indicate pituitary function problems:
- Headaches: present in 76% of patients with pituitary apoplexy 2
- Visual loss: present in 62% of patients with pituitary apoplexy, and can range from moderate to severe 2
- Ocular motor nerve palsy: present in 40% of patients with pituitary apoplexy, with third cranial nerve palsies being predominant 2
- Hyperprolactinemia: can be caused by primary hypothyroidism, and may be associated with amenorrhea and galactorrhea 3, 4
- Hypopituitarism: can be caused by pituitary apoplexy, and may result in acute hypopituitarism 2
- Growth hormone deficiency: can be associated with pituitary abnormalities, and may be accompanied by other hormone deficiencies 5
- Hypothyroidism: can cause pituitary enlargement and hyperprolactinemia, and may be associated with other symptoms such as menorrhagia 3, 4
- Vision problems: can occur in patients with hypothalamic-pituitary sarcoidosis, and may include optic neuropathy 6
- Diabetes insipidus: can be caused by hypothalamic-pituitary sarcoidosis, and may be associated with other symptoms such as polydipsia 6
Specific Symptoms Associated with Pituitary Function Problems
Some specific symptoms that may indicate pituitary function problems include:
- Bitemporal hemianopia: a type of visual field loss that can be caused by pituitary tumors or other lesions 2, 4
- Galactorrhea: spontaneous flow of milk from the breast, which can be caused by hyperprolactinemia 3, 4
- Amenorrhea: absence of menstruation, which can be caused by hyperprolactinemia or other hormone imbalances 3, 4
- Polydipsia: excessive thirst, which can be caused by diabetes insipidus 6
- Impaired thirst: a decrease in the sensation of thirst, which can be caused by hypothalamic-pituitary sarcoidosis 6