Hyperpituitarism

What is Hyperpituitarism?

The pituitary gland is an important part of your body that creates and gives off different hormones. These hormones help to control different functions in your body. This gland has two parts: the front part and the back part. The front part makes hormones like growth hormone, thyroid-stimulating hormone, two kinds of hormones related to reproduction, ACTH (which helps your adrenal glands work properly), and prolactin (which plays a role in milk production). The back part of the pituitary gland releases vasopressin (which helps control the balance of water in your body) and oxytocin (which plays a role in childbirth and breastfeeding).

Some special cells in your brain make vasopressin and oxytocin and then send them to the pituitary gland. Other hormones from your brain stimulate the pituitary gland to make its own hormones. Then those hormones stimulate other organs in your body to make more hormones. If there are enough hormones, your body will tell the pituitary gland to stop making more.

Hyperpituitarism is when the pituitary gland releases too much of one or more of its hormones. This can often be caused by a tumor that makes hormones. If your doctor thinks you may have too much hormone in your body, they will run some tests. There might also be other hormones that are too low and need testing. MRI scans are better than CT scans at looking for tumors in the pituitary gland.

The treatment for too much pituitary hormone depends on what’s causing it and which hormones are involved. It can involve medication, surgery, or radiation therapy. If someone has too much of a hormone and it’s not treated right, it can cause a lot of health issues. If the doctor doesn’t recognize all the hormone imbalances, it could delay the best treatment and make a patient’s health worse. Therefore, it’s essential that all healthcare providers understand this condition so that they can treat it promptly and improve the patient’s life.

What Causes Hyperpituitarism?

Hyperpituitarism is a condition where the pituitary gland in your body produces too many hormones. This can happen for several reasons, but the most common reason is the growth of tumors known as pituitary adenomas. These tumors can have different sizes. If they are less than 10mm, they are called macroadenomas. If they are 10mm or bigger, they are called macroadenomas. Doctors use the kind of hormone that’s being overproduced to pinpoint the cause of the problem.

Pituitary adenomas can overproduce different types of hormones:

1. Growth hormone: When this happens, a person can develop conditions like acromegaly, which causes parts of the body to enlarge, and gigantism, which leads to extreme height. In rare cases, these conditions can be caused by other types of tumors producing too much growth hormone or growth hormone-releasing hormone.

2. Prolactin: Tumors that make too much prolactin are often found in women and are called prolactinomas. Hormone imbalances, head injuries, and certain medications can also lead to increased prolactin levels. In some cases, flirting, sex, or stimulating the nipples can raise prolactin levels too.

3. Adrenocorticotropic hormone (ACTH): Some pituitary tumors overproduce this hormone, leading to a condition called Cushing disease. This can cause a wide range of symptoms, like weight gain, easy bruising, weakness, and mood changes. It’s more common in women than men.

4. Thyrotropin hormone: It’s less common, but some pituitary adenomas overproduce thyroid-stimulating hormone, which can alter a person’s metabolism.

5. Gonadotropin: Some pituitary adenomas overproduce hormones that control the reproductive system, which can lead to menstrual irregularities in women, reduced testosterone levels in men, and early puberty in children.

And, in certain cases, multiple types of tumors can all develop at the same time, such as in a condition called Multiple Endocrine Neoplasia (MEN) type 1. This includes a pituitary adenoma, a pancreatic tumor, and a parathyroid tumor all appearing simultaneously.

Risk Factors and Frequency for Hyperpituitarism

Hyperpituitarism is a condition where there’s an excess of specific hormones due to issues with the pituitary gland. Around two-thirds of pituitary tumors can lead to this hormone overproduction. Different types of tumors contribute to the overproduction of different hormones. Here’s a breakdown of the types of tumors and how commonly they occur:

Prolactinomas (tumors that overproduce the hormone prolactin) make up 32% to 66% of all pituitary tumors.
Growth hormone-secreting tumors account for 8% to 16% of all cases.
ACTH-secreting tumors (those producing an excess of the hormone ACTH) represent 2% to 6% of all cases.
Lastly, thyrotropin-secreting tumors, which result in an overproduction of thyrotropin, are less common and make up less than 1% of all cases.

Signs and Symptoms of Hyperpituitarism

The symptoms of hyperpituitarism, a condition where too much hormone is produced by the pituitary gland, vary depending on which particular hormone is being overproduced. These symptoms can also be influenced by the presence of a tumor in the pituitary gland, which can cause headaches and vision issues. It’s important for doctors to take a family history of endocrine tumors if they suspect hyperpituitarism.

The different hormones overproduced, and their resulting symptoms, include:

Prolactin: Symptoms of too much prolactin, or hyperprolactinemia, can include low sex drive, fertility issues, and bone weakening, or osteoporosis. In women, symptoms may also include breast milk production when not breastfeeding (galactorrhea), irregular or absent menstrual periods (oligomenorrhea and amenorrhea). In men, erectile dysfunction is a common symptom, especially if the pituitary tumor is larger (macroadenoma).
Growth Hormone: Too much growth hormone often results in a condition known as acromegaly, which can cause changes and growth in the bones and soft tissues of the body. These symptoms can include an enlarged jawbone, increased shoe size, skin thickness, and the presence of skin tags. Other signs may include heart disease, nerve pain, and carpal tunnel syndrome caused by tissue growth compressing the median nerve. There can also be metabolic changes such as diabetes, high blood pressure, high cholesterol, and sleep apnea. Joint arthritis and excessive sweating are other common symptoms. In children, this condition can lead to unusual height growth or gigantism.
Thyroid Stimulating Hormone: This leads to secondary hyperthyroidism, with symptoms such as weight loss, intolerance to heat, anxiousness, irregular menstrual cycles, and heart palpitations. This condition often presents mild to moderate symptoms and may cause an enlarged thyroid gland or goiter.
Adrenocorticotropic Hormone: Overproduction of this hormone leads to a condition called Cushing syndrome, characterized by central obesity, weak muscles, a fatty hump between the shoulders (buffalo hump), stretch marks, easy bruising, menstrual changes, high blood pressure, sugar intolerance, depression, and psychosis.
Luteinizing Hormone and Follicle-Stimulating Hormone: In adult women, overproduction of these hormones can lead to irregular menstrual cycles, ovarian hyperstimulation syndrome, and infertility. In men, symptoms include enlarged testes and low testosterone (hypogonadism). In children, these conditions may cause early onset of puberty (precocious puberty).

Testing for Hyperpituitarism

When you have a hormone imbalance, your doctor will usually do a series of lab tests to figure out what’s going on. They will look at what hormone might be too high and check if any other hormones might be too low. Usually, they’ll also take an image of your pituitary gland using a special type of scan known as an MRI. This gives a clearer picture of the pituitary gland than other types of scans, such as a CT scan.

When looking for a tumor, the doctors use a special dye called gadolinium in the MRI scan. This dye is slow to be absorbed by tumors, so they show up as dark areas on the scan.

The hormone tests are pretty specific. Let’s look a few in detail:

1. For prolactin: When you show signs of having too much prolactin, or if the doctor sees a tumor on your pituitary gland, they will measure the amount of prolactin in your blood. Generally, a level of over 200 ng/mL is a clue that there might be a tumor that produces prolactin, known as prolactinoma. If your levels are less than five times what’s considered normal, your doctor might ask you to come back for a repeat test. This is because things like stress, exercise, and drinking alcohol can temporarily bump up your prolactin levels. They’ll also test other things that can cause your prolactin levels to rise, like thyroid hormones and creatinine which measures how well your kidneys are working.

2. For growth hormone: Instead of checking how much growth hormone is in your blood, your doctor will look at something called insulin-like growth factor (IGF-1). This substance increases when there’s too much growth hormone being produced. It’s more accurate to check IGF-1 because the levels don’t change much throughout the day. An elevated IGF-1 level is a strong indication of a tumor in the pituitary gland that’s producing too much growth hormone.

3. For ACTH: If your doctor suspects Cushing syndrome, which typically means your body is producing too much cortisol, they would confirm this with lab tests. To determine the cause of the high cortisol, they would measure ACTH levels.

4. For thyroid-stimulating hormone: High levels of thyroid-stimulating hormone along with high levels of thyroid hormone suggest secondary hyperthyroidism.

5. For gonadotropin hormones: Testosterone, estradiol, luteinizing hormone (LH), and follicle-stimulating hormone (FSH) are checked for deficiencies due to pituitary tumor. Rarely, FSH and LH can be high due to a gonadotropin-secreting tumor.

Understanding these tests can help you discuss your condition better with your doctor and make more informed decisions about your healthcare.

Treatment Options for Hyperpituitarism

Hyperpituitarism treatment depends on what’s causing it and which hormones are affected. The disease must be treated differently depending on the specific conditions associated with it such as acromegaly (unusual growth in the hands or feet) or Cushing Syndrome (a hormonal disorder).

Medication

In the case of prolactinomas – a specific type of pituitary gland tumor – long-term treatment with medicine (like bromocriptine and cabergoline) can work well. This type of treatment is usually chosen over surgery unless the patient is in immediate danger. These medications, known as dopamine agonists, can lower prolactin levels in the blood, reduce the flow of breast milk when not nursing, restore normal hormonal balance, and sometimes even decrease the size of the tumor. Other medications that may be used can vary and include somatostatin analogs and competitive receptor antagonists.

Medicines can also serve a supporting role in the treatment of Cushing’s disease, but the main method of treatment is usually surgery. Some medications that may be used include adrenal enzyme inhibitors like metyrapone, aminoglutethimide, and ketoconazole. In patients with an overproduction of growth hormone, somatostatin analogs, like octreotide, have shown to be effective in reducing it.

Surgery

In most cases of pituitary adenoma – with the exception of prolactinomas – surgery is usually the preferred form of treatment. The surgery is done to remove the pituitary gland and any tumor but can be a difficult procedure due to the gland’s location in the body. Nowadays, less invasive procedures, such as transsphenoidal surgery, are becoming more popular. Unfortunately, because many patients with pituitary tumors are diagnosed late, fully removing the large tumors is often not possible.

With small tumors causing acromegaly, surgeons can often improve the patient’s condition in 80-90% of cases. With larger tumors, the success rate is around 40-60%. Similarly, for ACTH-secreting pituitary adenomas (that affect the adrenal glands), improvement is seen in about 80-90% of patients. However, it’s important to note that 2-8% of growth-hormone secreting pituitary adenomas return within 5 years. For this reason, medical professionals should re-check growth hormone levels and perform an oral glucose tolerance test about 12 weeks after surgery. Regular MRIs should also be done to check for any changes in the tumor.

Radiation Therapy

Conventional radiation therapy may be an additional option to reduce tumor size and hormone levels, along with surgery and medication. However, this method of treatment can potentially damage the pituitary gland and cause hypopituitarism – a condition in which the pituitary gland does not produce normal amounts of some or all of its hormones.

If a person has hyperpituitarism, a condition where the pituitary gland produces too much hormone, there are several potential causes. These depend on the specific hormone that is being overproduced. Here are some possibilities:

For hyperprolactinemia (too much prolactin):

Prolactinomas, which are tumors that produce prolactin
Destruction of the hypothalamus in the brain
Stimulation of the nipples or chest wall
Pregnancy
Certain medications, like antipsychotics

For hypercortisolism (too much cortisol):

Corticotropinomas, which are tumors that secrete a hormone leading to cortisol production
Tumors in the adrenal glands
Tumors outside the pituitary gland that produce ACTH
Thymic or bronchial carcinoids, which are types of lung cancer

For elevated growth hormone levels:

Somatotropinomas, which are tumors that produce growth hormone
GHRH-secreting tumors, which release a hormone causing growth hormone production
Certain types of lung cancer, such as bronchial carcinomas and carcinoids
Certain conditions like MEN type-1 or tuberous sclerosis

For elevated gonadotropins (hormones that regulate reproductive organs):

Primary Hypogonadism, a failure of the testicles or ovaries
Tumors in the testicles or ovaries
Polycystic ovary syndrome, a hormonal disorder in females
Ovarian hyperstimulation syndrome, a response to excess hormones

What to expect with Hyperpituitarism

The future health condition or ‘prognosis’ for hyperpituitarism, a condition where the pituitary gland produces too much hormone, often due to a tumor, largely depends on the size of the tumor and the excess hormone present. The prognosis is generally excellent if the tumor is entirely removed or only minimal tissue remains and it can be controlled with medications.

Both medication and a type of surgery known as ‘transsphenoidal surgery’, which is performed through the nose and sinus cavity to reach the pituitary gland, are treatment options for different types of tumors. These treatment methods have reported good clinical outcomes, meaning patients typically recover well.

Possible Complications When Diagnosed with Hyperpituitarism

Hyperpituitarism, or excessive hormone production by the pituitary gland, can lead to a variety of complications. These depend both on which hormone is being overproduced and on the size of the pituitary tumor, which can grow quite large (macroadenoma) and cause visual problems or other neurological symptoms.

For example, people with acromegaly, typically caused by a pituitary tumor, often have other health problems. These can include heart failure, gastrointestinal issues, cancer, and diabetes.

Also, individuals with Cushing disease, another condition related to pituitary gland functioning, can experience issues like hypertension (high blood pressure), diabetes, heart problems, and osteoporosis (weakening of the bones).

Other complications from elevated hormone levels due to pituitary tumors can include arrhythmias (irregular heartbeats) and osteoporosis. If the pituitary tumor is secreting gonadotrophins, fertility issues may arise, particularly if the condition is not diagnosed or treated in time.

The following can be potential complications of hyperpituitarism:

Visual problems
Neurological symptoms
Heart failure
Gastrointestinal problems
Cancer
Diabetes
Hypertension
Osteoporosis
Arrhythmia
Infertility issues

Preventing Hyperpituitarism

Doctors should teach patients about the possible health problems that may come up if their body makes too much of a certain hormone. Along with this, they also need to tell patients what signs to look out for if these health problems occur and when they should get medical help. The signs could range from mild to severe, suggesting the presence of severe health issues. This is crucial because understanding these signs can help patients get the help they need right away, which can prevent further severe health issues in the future.

Frequently asked questions

Hyperpituitarism is when the pituitary gland releases too much of one or more of its hormones, often caused by a tumor that makes hormones.

Around two-thirds of pituitary tumors can lead to this hormone overproduction.

The signs and symptoms of hyperpituitarism, a condition where too much hormone is produced by the pituitary gland, can vary depending on which particular hormone is being overproduced. However, the presence of a tumor in the pituitary gland can also influence the symptoms. Here are the signs and symptoms associated with the overproduction of different hormones in hyperpituitarism: 1. Prolactin: - Low sex drive - Fertility issues - Bone weakening (osteoporosis) - Breast milk production when not breastfeeding (galactorrhea) in women - Irregular or absent menstrual periods (oligomenorrhea and amenorrhea) in women - Erectile dysfunction in men, especially with larger pituitary tumors (macroadenoma) 2. Growth Hormone: - Acromegaly: Changes and growth in bones and soft tissues of the body - Enlarged jawbone - Increased shoe size - Skin thickness - Presence of skin tags - Heart disease - Nerve pain - Carpal tunnel syndrome caused by tissue growth compressing the median nerve - Metabolic changes such as diabetes, high blood pressure, high cholesterol, and sleep apnea - Joint arthritis - Excessive sweating - Unusual height growth or gigantism in children 3. Thyroid Stimulating Hormone: - Secondary hyperthyroidism - Weight loss - Intolerance to heat - Anxiousness - Irregular menstrual cycles - Heart palpitations - Enlarged thyroid gland or goiter 4. Adrenocorticotropic Hormone: - Cushing syndrome - Central obesity - Weak muscles - Fatty hump between the shoulders (buffalo hump) - Stretch marks - Easy bruising - Menstrual changes - High blood pressure - Sugar intolerance - Depression - Psychosis 5. Luteinizing Hormone and Follicle-Stimulating Hormone: - Irregular menstrual cycles, ovarian hyperstimulation syndrome, and infertility in adult women - Enlarged testes and low testosterone (hypogonadism) in men - Early onset of puberty (precocious puberty) in children It's important for doctors to take a family history of endocrine tumors if they suspect hyperpituitarism, as this can provide additional clues for diagnosis.

Hyperpituitarism can occur due to the growth of tumors known as pituitary adenomas, which can overproduce hormones. Other factors such as hormone imbalances, head injuries, certain medications, and stimulating the nipples can also contribute to increased hormone levels and the development of hyperpituitarism.

The doctor needs to rule out the following conditions when diagnosing Hyperpituitarism: 1. Prolactinomas, destruction of the hypothalamus in the brain, stimulation of the nipples or chest wall, pregnancy, and certain medications (like antipsychotics) for hyperprolactinemia (too much prolactin). 2. Corticotropinomas, tumors in the adrenal glands, tumors outside the pituitary gland that produce ACTH, and thymic or bronchial carcinoids (types of lung cancer) for hypercortisolism (too much cortisol). 3. Somatotropinomas (tumors that produce growth hormone), GHRH-secreting tumors (which release a hormone causing growth hormone production), certain types of lung cancer (such as bronchial carcinomas and carcinoids), and certain conditions like MEN type-1 or tuberous sclerosis for elevated growth hormone levels. 4. Primary Hypogonadism (a failure of the testicles or ovaries), tumors in the testicles or ovaries, polycystic ovary syndrome (a hormonal disorder in females), and ovarian hyperstimulation syndrome (a response to excess hormones) for elevated gonadotropins (hormones that regulate reproductive organs).

To properly diagnose Hyperpituitarism, a doctor would order the following tests: 1. Blood tests to measure hormone levels: - Prolactin levels to check for prolactinoma - Insulin-like growth factor (IGF-1) levels to check for excess growth hormone - ACTH levels to confirm Cushing syndrome - Thyroid-stimulating hormone levels to check for secondary hyperthyroidism - Testosterone, estradiol, luteinizing hormone (LH), and follicle-stimulating hormone (FSH) levels to check for deficiencies or abnormalities 2. Imaging tests: - MRI scan of the pituitary gland to visualize any tumors or abnormalities - Use of gadolinium dye in the MRI scan to identify tumors that appear as dark areas These tests help determine the specific hormone imbalances and identify any tumors or abnormalities in the pituitary gland.

Hyperpituitarism is treated based on the underlying cause and the hormones that are affected. Treatment options include medication, surgery, and radiation therapy. Medications such as dopamine agonists, somatostatin analogs, and adrenal enzyme inhibitors may be used to lower hormone levels and restore hormonal balance. Surgery is usually the preferred treatment for most cases of pituitary adenoma, except for prolactinomas. Transsphenoidal surgery is a less invasive procedure that is becoming more popular. Radiation therapy may also be used to reduce tumor size and hormone levels, but it can potentially damage the pituitary gland and cause hypopituitarism.

The potential side effects when treating Hyperpituitarism can include: - Visual problems - Neurological symptoms - Heart failure - Gastrointestinal problems - Cancer - Diabetes - Hypertension (high blood pressure) - Osteoporosis (weakening of the bones) - Arrhythmia (irregular heartbeats) - Infertility issues

The prognosis for hyperpituitarism depends on the size of the tumor and the excess hormone present. If the tumor is completely removed or only minimal tissue remains and it can be controlled with medications, the prognosis is generally excellent. Treatment options such as medication and transsphenoidal surgery have reported good clinical outcomes, and patients typically recover well.

An endocrinologist.