Pituitary gland disorders

What does the pituitary gland do?

The Pituitary gland is located in the brain and is often considered the ‘master gland’ because it secretes many hormones that regulate the release of hormones from the other glands. It releases growth hormone and other hormones which regulate the function of the thyroid gland, adrenal gland, testes and ovaries.

The hypothalamus is located above the pituitary gland and regulates the release of hormones from the pituitary gland. It is responsible for body temperature, appetite, sleep-wake cycles and moods.

What is the purpose of adrenal glands?

The adrenal glands (also known as suprarenal glands) are situated above both kidneys and are responsible for producing the hormones cortisol and aldosterone.

Adrenocorticotrophic hormone (ACTH) is secreted by the anterior pituitary gland and its function is to regulate the steroid hormone cortisol (also called glucocorticoid). Adrenal insufficiency occurs when there is inadequate production of cortisol and aldosterone (also called mineralocorticoid). 

The hormone cortisol has an important function to help the body respond to stress such as illness, infection and surgery. Cortisol is also important to maintain blood pressure, blood sugar levels, cardiovascular function and to regulate the metabolism of proteins, carbohydrates and fats.

What kinds of pituitary gland disorders can affect children?

There are various pituitary gland disorders which can affect children. These include:

  • Acromegaly: This is an overproduction of growth hormones. If left untreated, the child will be very tall and may be exposed to health conditions in life altering conditions in the future such as heart disease, high blood pressure, diabetes and colon polyps.
  • Cushing's Syndrome: This occurs as a result of an overproduction of cortisol and can be caused a tumor on the pituitary or adrenal glands. Weight gain and stunded growth can develop as a result of this, as well as high blood pressure. Over time, the child can also be vulnerable to obesity in the upper body, high blood pressure, thin skin and bone and muscle weakness.
  • Hypothyroidism: For children, an underactive thyroid can lead to problems including decreased growth and constipation but if the condition is detected in childhood or adolescence, it can be managed. An underative thyroid in infants poses a greater risk for long term damage if it is left undetected and untreated. Functioning of the thyroid gland is affected if the pituitary gland is poorly formed or if it is damaged.
  • Hypogonadism: this is a condition where little or no sex hormones are produced in the body. Hypogonadism can negatively influence puberty and the development of sex organs. It can lead to infertility or sexual dysfunction, therefore children suffering from hypogonadism will not experience puberty; girls will not menstruate or develop breasts, while boys suffer from slowed muscle and genital development.

What are the most common pituitary gland disorders?

There are multiple commonly occuring pituitary gland disorders. Alongisde Cushing’s syndrome, other pituitary gland disorders are as follows:

  • prolactinoma
  • acromegaly
  • pituitary apoplexy
  • craniopharyngioma
  • growth hormone deficiency
  • rathke’s cleft cyst
  • prolactinoma
  • empty sella syndrome
  • diabetes insipidus
  • sheehan’s syndrome

Causes of adrenal insufficiency can be classified as primary, secondary, or from chronic cortisol exposure. Primary adrenal insufficiency is also called addison’s disease and occurs when the adrenal gland fails to produce enough cortisol or aldosterone. This can be due to infection, bleeding into the adrenal glands, tumours or an autoimmune disease.

Secondary or central adrenal insufficiency occurs when the pituitary gland fails produce ACTH to signal the adrenal gland to produce enough cortisol leading to inadequate cortisol levels. This can be due to pituitary surgery, infection or pituitary tumours.

Regular and prolonged exposure to high levels of cortisol such as taking steroid medications for cancer, autoimmune disease or severe asthma can result in the adrenal glands being suppressed and therefore fails to produce enough of the body’s own cortisol hormone. Adrenal insufficiency can also be due to removal of the adrenal glands by surgery due to cancers such as neuroblastomas.

What are the signs to recognise for pituitary gland disorders?

Signs and symptoms of a pituitary gland disorder often dependo n the specific disorder and hormone that is affected. However, there are some frequently occuring signs and symptoms which include:

  • diabetes
  • hair loss
  • anxiety
  • depression
  • irregular periods
  • low energy
  • low sex drive
  • stunted growth
  • unexplained weight gain
  • changes in vision

How are pituitary gland disorders diagnosed?

There are numerous tests which can be carried out in order to diagnose pituitary gland disorders. These include:

Hormone tests

There are multiple hormone tests which can confirm a diagnosis of a pituitary gland disorer including blood, urine or saliva tests.

Dynamic tests

Dynamic tests  may increase or  suppress the productionoof certain hormones in order to test how the body responds to this. Dynamic tests include:

  • A glucose suppression test – if glucose levels do not fall, his signifies that the body is producing too mucho f the hormone.
  • Growth hormone stimulation tests – if the hormone levels do not rise to the expected levels, this is an indicator of a growth hormone deficiency.
  • Dexamethasone suppression tests – if hormone levels remain high following the test, this is an indicator of Cushing’s disease.

Imaging

Scans such as MRIs can be used in order to diagnose pituitary tumors. There are various MRI scans which can be used including rapid dynamic gadolinium-enhanced pituitary imaging, intraoperative MRI and open MRI.

Neuropathological tests

Some neuropathological tests performed in order to diagnose pituitary gland disorders include molecular pathology, cytogenetics and ultrastructural analysis.

How are pituitary gland disorders treated?

Pituitary gland disorders can be treated through hormone replacement therapy and medication. In some cases, surgery or radiation therapy is required to treat these conditions. 

 04-13-2023
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Pituitary gland disorders

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Professor Sze May Ng OBE - Paediatric endocrinology, diabetes & metabolism

Created on: 03-21-2023

Updated on: 04-13-2023

Edited by: Aoife Maguire

What does the pituitary gland do?

The Pituitary gland is located in the brain and is often considered the ‘master gland’ because it secretes many hormones that regulate the release of hormones from the other glands. It releases growth hormone and other hormones which regulate the function of the thyroid gland, adrenal gland, testes and ovaries.

The hypothalamus is located above the pituitary gland and regulates the release of hormones from the pituitary gland. It is responsible for body temperature, appetite, sleep-wake cycles and moods.

What is the purpose of adrenal glands?

The adrenal glands (also known as suprarenal glands) are situated above both kidneys and are responsible for producing the hormones cortisol and aldosterone.

Adrenocorticotrophic hormone (ACTH) is secreted by the anterior pituitary gland and its function is to regulate the steroid hormone cortisol (also called glucocorticoid). Adrenal insufficiency occurs when there is inadequate production of cortisol and aldosterone (also called mineralocorticoid). 

The hormone cortisol has an important function to help the body respond to stress such as illness, infection and surgery. Cortisol is also important to maintain blood pressure, blood sugar levels, cardiovascular function and to regulate the metabolism of proteins, carbohydrates and fats.

What kinds of pituitary gland disorders can affect children?

There are various pituitary gland disorders which can affect children. These include:

  • Acromegaly: This is an overproduction of growth hormones. If left untreated, the child will be very tall and may be exposed to health conditions in life altering conditions in the future such as heart disease, high blood pressure, diabetes and colon polyps.
  • Cushing's Syndrome: This occurs as a result of an overproduction of cortisol and can be caused a tumor on the pituitary or adrenal glands. Weight gain and stunded growth can develop as a result of this, as well as high blood pressure. Over time, the child can also be vulnerable to obesity in the upper body, high blood pressure, thin skin and bone and muscle weakness.
  • Hypothyroidism: For children, an underactive thyroid can lead to problems including decreased growth and constipation but if the condition is detected in childhood or adolescence, it can be managed. An underative thyroid in infants poses a greater risk for long term damage if it is left undetected and untreated. Functioning of the thyroid gland is affected if the pituitary gland is poorly formed or if it is damaged.
  • Hypogonadism: this is a condition where little or no sex hormones are produced in the body. Hypogonadism can negatively influence puberty and the development of sex organs. It can lead to infertility or sexual dysfunction, therefore children suffering from hypogonadism will not experience puberty; girls will not menstruate or develop breasts, while boys suffer from slowed muscle and genital development.

What are the most common pituitary gland disorders?

There are multiple commonly occuring pituitary gland disorders. Alongisde Cushing’s syndrome, other pituitary gland disorders are as follows:

  • prolactinoma
  • acromegaly
  • pituitary apoplexy
  • craniopharyngioma
  • growth hormone deficiency
  • rathke’s cleft cyst
  • prolactinoma
  • empty sella syndrome
  • diabetes insipidus
  • sheehan’s syndrome

Causes of adrenal insufficiency can be classified as primary, secondary, or from chronic cortisol exposure. Primary adrenal insufficiency is also called addison’s disease and occurs when the adrenal gland fails to produce enough cortisol or aldosterone. This can be due to infection, bleeding into the adrenal glands, tumours or an autoimmune disease.

Secondary or central adrenal insufficiency occurs when the pituitary gland fails produce ACTH to signal the adrenal gland to produce enough cortisol leading to inadequate cortisol levels. This can be due to pituitary surgery, infection or pituitary tumours.

Regular and prolonged exposure to high levels of cortisol such as taking steroid medications for cancer, autoimmune disease or severe asthma can result in the adrenal glands being suppressed and therefore fails to produce enough of the body’s own cortisol hormone. Adrenal insufficiency can also be due to removal of the adrenal glands by surgery due to cancers such as neuroblastomas.

What are the signs to recognise for pituitary gland disorders?

Signs and symptoms of a pituitary gland disorder often dependo n the specific disorder and hormone that is affected. However, there are some frequently occuring signs and symptoms which include:

  • diabetes
  • hair loss
  • anxiety
  • depression
  • irregular periods
  • low energy
  • low sex drive
  • stunted growth
  • unexplained weight gain
  • changes in vision

How are pituitary gland disorders diagnosed?

There are numerous tests which can be carried out in order to diagnose pituitary gland disorders. These include:

Hormone tests

There are multiple hormone tests which can confirm a diagnosis of a pituitary gland disorer including blood, urine or saliva tests.

Dynamic tests

Dynamic tests  may increase or  suppress the productionoof certain hormones in order to test how the body responds to this. Dynamic tests include:

  • A glucose suppression test – if glucose levels do not fall, his signifies that the body is producing too mucho f the hormone.
  • Growth hormone stimulation tests – if the hormone levels do not rise to the expected levels, this is an indicator of a growth hormone deficiency.
  • Dexamethasone suppression tests – if hormone levels remain high following the test, this is an indicator of Cushing’s disease.

Imaging

Scans such as MRIs can be used in order to diagnose pituitary tumors. There are various MRI scans which can be used including rapid dynamic gadolinium-enhanced pituitary imaging, intraoperative MRI and open MRI.

Neuropathological tests

Some neuropathological tests performed in order to diagnose pituitary gland disorders include molecular pathology, cytogenetics and ultrastructural analysis.

How are pituitary gland disorders treated?

Pituitary gland disorders can be treated through hormone replacement therapy and medication. In some cases, surgery or radiation therapy is required to treat these conditions. 

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Paediatric endocrinology, diabetes & metabolism

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