From the Guidelines
Patients with abnormal pituitary function typically present with symptoms such as headache (85%) and fatigue (66%), with visual changes being uncommon, as seen in hypophysitis associated with immune checkpoint inhibitors 1. The symptoms of abnormal pituitary function can vary widely depending on whether the gland is overactive or underactive and which specific hormones are affected.
- Common symptoms include:
- Headaches
- Fatigue
- Visual problems, particularly peripheral vision loss due to pressure on the optic chiasm
- Weakness
- Unexplained weight changes
- Disrupted menstrual cycles in women
- Hyperpituitarism may cause:
- Excessive growth (gigantism in children or acromegaly in adults)
- Cushing's syndrome (moon face, buffalo hump, abdominal striae)
- Hyperthyroidism
- Galactorrhea
- Hypopituitarism can lead to:
- Growth failure in children
- Reduced sexual function
- Hypothyroidism
- Adrenal insufficiency (causing low blood pressure, nausea, and dizziness)
- Diabetes insipidus (excessive thirst and urination) According to the most recent guidelines, evaluation of patients with suspected hypophysitis should include testing for ACTH, cortisol, TSH, free T4, and electrolytes, as well as consideration of MRI brain with or without contrast with pituitary or sellar cuts in patients with new hormonal deficiencies or severe headaches 1. In patients with abnormal pituitary function, particularly those with hypophysitis, it is crucial to evaluate for multiple endocrine abnormalities, including central hypothyroidism, adrenal insufficiency, and hypogonadism, as these conditions can have significant morbidity and mortality if left untreated 1. The management of confirmed hypophysitis includes replacement of deficient hormones, with steroids being started prior to thyroid hormone in patients with both adrenal insufficiency and hypothyroidism to avoid an adrenal crisis 1. Given the potential for long-term sequelae, including lifelong hormonal replacement, early recognition and diagnosis of abnormal pituitary function are essential to prevent morbidity and mortality 1.
From the Research
Symptoms of Abnormal Pituitary
The symptoms of abnormal pituitary can vary depending on the specific condition. Some common symptoms include:
- Cardiovascular, respiratory, endocrine, metabolic, musculoskeletal, and neoplastic comorbidities in patients with acromegaly 2
- Hormone deficiency or excess, such as growth hormone-secreting pituitary adenoma, driving excess secretion of insulin-like growth factor 1 2
- Deficiency of one or more pituitary hormones, resulting in higher risks of morbidity and mortality and decreased quality of life in patients with hypopituitarism 3
- Specific hormone deficiency, such as adrenocorticotropic hormone deficiency, growth hormone deficiency, hypogonadism, and thyroid-stimulating hormone deficiency 4, 5
- Increased morbidity, increased body fat mass, abdominal obesity, dyslipidaemia, reduced exercise capacity, impaired cardiac function, as well as reduced self-reported well-being and impaired quality of life in patients with growth hormone deficiency 6
Clinical Manifestations
The clinical manifestations of abnormal pituitary can include:
- Subtle symptoms in adult growth hormone deficiency, but potentially life-threatening in corticotropin deficiency 5
- Variety of symptoms depending on the degree of specific hormone deficiency, such as visual field defects, and symptoms of target endocrine gland function relative to the corresponding pituitary hormone deficiency 3
- Clinical signs such as acromegaly, which may result in a variety of cardiovascular, respiratory, endocrine, metabolic, musculoskeletal, and neoplastic comorbidities 2
Diagnosis and Treatment
Diagnosis and treatment of abnormal pituitary can involve:
- Biochemical tests, such as elevated serum insulin-like growth factor 1 and lack of growth hormone suppression after glucose administration, to confirm the diagnosis of acromegaly 2
- Pituitary magnetic resonance imaging to identify an underlying pituitary adenoma 2
- Transsphenoidal pituitary surgery as first-line therapy for patients with acromegaly, and medical therapies, including somatostatin receptor ligands, cabergoline, and pegvisomant, for patients with persistent disease after surgery 2
- Hormone replacement therapy to restore normal endocrine function and quality of life in patients with hypopituitarism 3, 4, 5