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Pituitary gland disease

Category: Illness or disabilities

Type

Involuntary

Introduction and description

 

The pituitary gland is an endocrine gland about the size of a pea. It is not a part of the brain, but is a protrusion off the bottom of the hypothalamus. 

The anterior pituitary is also called the adenohypophysis or pars anterior. The posterior pituitary is also called the neurohypophysis.  Together they make up the pituitary gland (hypophysis).

A much more detailed description of the various parts of the pituitary gland can be found in the science section, thus it may be useful to have this page open at the same time as you are reading this.

It works via a system of feedback mechanisms, thus there is a control cycle in operation so that the hormones are always in balance.  For each hormone to activate a process, there is another to slow the process down. 

Symptoms

gigantism

The pituitary gland controls the operation of a number of other hormone producing glands which are part of the endocrine system, as such a very large number of diseases may be traceable back to damage to this gland.  Hormones secreted from the pituitary gland help control the following body processes:

  • Growth (Excess of HGH can lead to gigantism and acromegaly)
  • Blood pressure
  • Some aspects of pregnancy and childbirth including stimulation of uterine contractions during childbirth
  • Breast milk production
  • Sex organ functions in both males and females
  • The conversion of food into energy (metabolism)
  • Water and osmolarity regulation in the body
  • Water balance via the control of reabsorption of water  by the kidneys
  • Temperature regulation
  • Pain relief
  • Fight and flight responses/relaxation
  • Immunological response

Thus any or even all of these processes could go wrong if the pituitary gland is damaged.  High blood pressure, poor growth, uterine contractions producing stillborn babies, lack of breast milk when needed, production of breast milk when not needed [or in men], various forms of sexual dysfunction, various forms of metabolic disorder, constant pain, hot flushes, oedema, inability to relax, poor immune system and so on.

Types of pituitary gland disease

Broadly speaking, pituitary gland disorders may be subdivided into:

  • Pituitary gland hyposecretion (leading to hormone deficiency)
  • Pituitary gland hypersecretion (leading to hormone excess)

Pituitary gland disorders are often quite complex, because of the feedback mechanisms involved in the endocrine system. Thus although a disease of the pituitary gland may have one specific name, the effects may affect a great number of organs in the body.  The following lists some of the diseases, the charts come from the eHealthme website and are for the USA only, the numbers are not absolute numbers, but only those reported through the FDA in consequence of an Adverse drug reaction:

Acromegaly

Acromegaly is due to the pituitary gland producing excess growth hormone (GH).  The initial symptom is typically enlargement of the hands and feet. There may also be enlargement of the forehead, jaw, and nose. Other symptoms may include joint pain, thicker skin, deepening of the voice, headaches, and problems with vision. Complications of the disease may include type 2 diabetes, sleep apnea, and high blood pressure.

Cushing's disease

Cushing's disease is a cause of Cushing's syndrome characterised by damage to the anterior pituitary.  More details can be found by following the link. 

 Sheehan syndrome

Sheehan syndrome, also known as Simmond syndrome, postpartum hypopituitarism or postpartum pituitary gland necrosis, is hypopituitarism, caused by the shrinking and killing of the cells of the Pituitary gland as a consequence of blood loss or lowering of the blood pressure during childbirth.

Hypopituitarism

 Hypopituitarism is the decreased (hypo) secretion of one or more of the eight hormones normally produced by the pituitary gland at the base of the brain

Craniopharyngioma

A Craniopharyngioma is a rare neoplasm, which may be cystic, that develops from nests of epithelium derived from Rathke's pouch.  Rathke's pouch is an embryonic precursor of the anterior pituitary.  Craniopharyngiomas are typically very slow growing tumours. They arise from the cells along the pituitary stalk.

Hypophysitis

Hypophysitis refers to an inflammation of the pituitary gland. Hypophysitis is commonly known as Lymphocytic Hypophysitis because the lymphocytic infiltration is limited to the anterior pituitary.

 

Intrasellar arachnoid cysts

Intrasellar  means within the sella turcica. Thus by extension an Intrasellar arachnoid cyst is a cyst in the sella turcica -  the bony structure at the base of the skull in which the pituitary gland rests.  The end result is compression of the gland.  Cysts are usually formed around parasites, thus this is just a form of encysted parasitical invasion, albeit a dangerous one.

Intrasellar abscess

Intrasellar abscesses present as a swollen area containing an accumulation of pus, indicating infection.  Research has shown that patients with this problem tend to have had a history of pituitary surgery within the preceding 10 months. The common defining symptom is headaches.  This may mean that the infection was either obtained during surgery, or that it is a pre-existing infection that has simply flared up again.  [Note that giving antibiotics when the pathogen is unknown is a very unwise strategy].

Pituitary apoplexy

Pituitary apoplexy is bleeding into or impaired blood supply of the pituitary gland. The most common initial symptom is a sudden headache, often associated with rapidly worsening vision or double vision caused by the compression of nerves surrounding the gland. This is followed in many cases by acute symptoms caused by lack of secretion of essential hormones, predominantly adrenal insufficiency.  Many people who have had a pituitary apoplexy develop pituitary hormone deficiencies and require long-term hormone supplementation.

 

Pituitary adenomas

An adenoma is tumour that is not cancerous. Adenomas start in the gland-like cells of epithelial tissue  - the thin layer of tissue that covers organs, glands, and other structures within the body.
Chiasmal syndrome is the set of signs and symptoms that are associated with lesions of the optic chiasm, manifesting as various impairments of the sufferer's visual field according to the location of the lesion along the optic nerve. Pituitary adenomas are the most common cause; however, chiasmal syndrome may be caused by other medical conditions such as multiple sclerosis and neurofibromatosis – attacks to the nervous system itself.

Other

The word lesion is used to describe a region in an organ or tissue which has suffered damage through injury or disease, such as a wound, ulcer, abscess, or tumour.  Thus it is a more general term and occasionally the term Pituitary mass lesion or simply Pituitary lesion may be used.

Causes

All the pathogens that cause the other diseases on this site are implicated in Pituitary gland disease – viruses, fungi, parasites [which tend to result in cysts], bacteria, and other toxins.  Nutritional deprivation can have an effect, as can radiation, especially close to the head. 

The formation of the pituitary gland in a fetus, is an exceptionally tricky event:

The adenohypophysis and neurohypophysis originate from the combination of 2 events occurring during the fourth week of life, the development of Rathke pouch and of a neuroectodermal evagination of tissue from the floor of the diencephalon. PMID:  16785842

As such congenital defects can result if this process is disrupted by the causes listed below. 

But there appears to be one pharmaceutical that causes untold disease in this area in fetuses, children and adults - the corticosteroid or immunosuppressant.

Immunosuppressants

the striations of Cushing's disease

Immunosuppressants suppress the immune system.  They only exist because the medical profession employ symptom based medicine and not cause based medicine.  Their theory goes that if the symptom is annoying – and annoying symptoms are usually a consequence of the immune system working – then the solution is to suppress the immune system, not heal or cure the disease.  Of course by suppressing the immune system the cause of the disease will undoubtedly spread and you will die – usually sooner rather than later.  But for reasons I am unable to understand, the medical profession do not seem to understand that they are not here to kill people.

The distribution of infected cells in 13 necropsies on adults with cytomegalovirus disease is reported and discussed in relation to the local damage caused by the infection and predisposing factors. The distribution, with lung as the most common site, but other organs such as thyroid, liver, and colon not infrequently involved, agrees fairly well with other series. No heavy infection confined to one organ was found, and it is concluded that a truly localized infection in the adult probably does not occur.
Evidence of destructive inflammatory changes attributable to the virus was scanty; a lymphocyte and plasma cell infiltrate was sometimes found, and microglial nodules were found in a case with inclusions in the brain. In one case heavy cytomegalovirus infection in the colon was associated with, and probably caused, marked colonic ulceration which led to the death of the patient.
 THE MAJOR PREDISPOSING FACTOR TO INFECTION IN THIS SERIES WAS CORTICOSTEROID THERAPY:
eight of the 13 patients had been treated with steroids. ….. It is concluded that most adult patients with cytomegalovirus infection have impaired immune mechanisms, and that heavy infection may lead to a clinically serious disease.  PMID: 4301686

So here we have an example of Pituitary gland disease caused by CMV, a virus which gets everywhere in the body, but only there because the doctor had prescribed immunosuppressants. 

Viruses

 

The CMV as a cause is mentioned above, but any number of other viruses are also implicated.  In the following example, the Epstein-Barr virus is the culprit, having entered through the nose and as a consequence also caused cancer of the nose:

Nasopharyngeal carcinoma is endemic in Southern China and the majority of patients present with local symptoms due to the tumor….. This report describes two unusual cases of occult nasopharyngeal carcinoma in which the patients initially presented with endocrine manifestations.
The first patient presented with Cushing's syndrome … Nasolaryngoscopy showed a growth in the left nasal fossa and biopsy revealed a poorly differentiated nasopharyngeal carcinoma….. The second patient presented with .. widespread fibrosis suggestive of Paget's disease. Three months later, she developed third cranial nerve palsy. Computed tomography investigation revealed a soft tissue mass filling the sphenoid and ethmoid sinuses. Biopsy showed a poorly differentiated nasopharyngeal carcinoma. …Radio-labeled in situ hybridization showed that Epstein-Barr virus .. was present in these tumour cells and the bone lesions were in fact metastases. PMID: 8640657

 Vaccines

 

As viruses are capable of causing pituitary gland disease, then it follows that the viruses to be found in vaccines – those that are ‘attenuated’ /live are also likely to do so if they exhibit either latency [the ability to lie low and reappear at times of low immunity] or are administered via a nasal spray.  By pushing a virus up the nose – particularly one like the influenza virus, - there is a high probability that the virus enters the brain. And research has shown that it can, and does:

Here, we describe the case of a 22-year-old man who was in good health until 2 months prior to admission, presented with acute development of polyuria and polydipsia, and showed increased urinary volume up to 9000 mL/day. ... Endocrinological findings revealed CDI, but his arterial pituitary function appeared normal. Magnetic resonance imaging revealed significant enlargement of the pituitary stalk. He was diagnosed as type A influenza.  ….. The available epidemiological information …. strongly suggested that the patient was infected with the A/H1N1 influenza virus.  PMID: 21828935


 

Brain injury and surgery

Whenever brain injury is described, it tends to be associated with trauma, but surgery, including plastic surgery can have the same effects.  The following paper shows that blood circulatory problems – cutting off the blood supply to the gland is a major cause [hypoxia – see below].

Traumatic Brain Injury (TBI) is a well-known public health problem worldwide and is a leading cause of death and disability, particularly in young adults. Besides neurological and psychiatric issues, pituitary dysfunction can also occur after TBI, in the acute or chronic phase. The exact prevalence of post-traumatic hypopituitarism is difficult to assess due to the wide heterogeneity of published studies and bias in interpretation of hormonal test results in this specific population. Predictive factors for hypopituitarism have been proposed and are helpful for the screening. The pathophysiology of pituitary dysfunction after TBI is not well understood but the vascular hypothesis is privileged. Activation of pituitary stem/progenitor cells is probably involved in the recovery of pituitary functions. Those cells also play a role in the induction of pituitary tumors, highlighting their crucial place in pituitary conditions. PMID:  26776284

Bacterial infection

Bacteria can work their way into the brain via the nose or via the blood supply.  Studies in adults and case reports in children have shown that hypothalamo-pituitary dysfunction can occur after bacterial meningitis, caused by the bacteria causing the meningitis.

This next example is unusual but interesting.  A tuberculoma is a clinical manifestation of tuberculosis which conglomerates tubercles into a firm lump, and so can mimic cancer tumors of many types in medical imaging studies. Tuberculosis is caused by a bacteria.  With the passage of time Mycobacterium tuberculosis (also called Bacillus Koch) can transform into crystals of calcium. These can affect any organ but one of those organs is the brain.  We may have the link here between this and brain sand - Corpora arenacea (or brain sand) are calcified structures in the pineal gland and other areas of the brain such as the choroid plexus.

A 50-year-old woman presented with a headache and nausea. A sellar and suprasellar mass was detected on MRI; … the pituitary stalk was slightly thickened. Laboratory tests revealed severe growth hormone, luteinizing hormone, follicle-stimulating hormone and thyroid-stimulating hormone deficiencies. A pathological examination of the tumor showed scattered granulomas with central necrosis and Langhans giant cells. … we diagnosed the patient with pituitary tuberculoma presenting with pituitary dysfunction.   PMID:  25986265

Parasites

 

Parasites can cause pituitary gland disease, often appearing as cysts, however, under normal circumstances, the pituitary gland itself is the regulator of the fight against parasites. 

In other words, if it is damaged in any way, then it cannot respond as well to parasites and parasites may then develop a hold in the body.  Thus, there has to be some initial malfunction in order that parasites can either enter the body or attack the pituitary gland itself.

Macrophage migration inhibitory factor (MIF) is a pleiotropic cytokine produced by the pituitary gland and multiple cell types, including macrophages (Mø), dendritic cells (DC) and T-cells. Upon release,  MIF modulates the expression of several inflammatory molecules, such as TNF-α, nitric oxide and cyclooxygenase 2 (COX-2). …. Several reports have demonstrated that MIF plays either a protective or deleterious role in the immune response to different pathogens. Here, we review the role of MIF in the host defense response to some important protozoan infections.  PMID:  22110378

This said, against the very virulent parasites, even this mechanism can fail.

We investigated immunoneuroendocrine interactions in vivo and in vitro following infection by Trypanosoma cruzi, the causative agent of Chagas disease. In a first set of experiments, we studied the hypothalamus-pituitary-adrenal axis. Nests of parasites were seen in the adrenal gland, whereas T. cruzi-specific PCR gene amplification product was found in both the adrenal and pituitary glands of infected mice. … the data summarized above clearly reveal that neuroendocrine axes are altered in experimental Chagas disease.  PMID:  17192573

And

Plasmodium spp. and Trypanosoma brucei spp. cause damage in pituitary gland, ….  PMID:  26573517

and

Abnormal thyroid function is strongly associated with mortality in severe non-thyroidal illness. We have assessed the pituitary-thyroid axis serially in 18 Thai adults with severe falciparum malaria and in 18 matched controls. The admission total serum thyroxine (T4) concentrations of the patients were significantly lower than those of controls and remained depressed until after fever and parasite clearance. Two patients who died in hospital had admission serum T4 concentrations less than 35 nmol/litre. PMID: 2260159

Although the implications are that the thyroid gland itself can be attacked by the parasite, the possibility also exists – since pituitary and thyroid are linked via a hormone cycle – that disruption of the thyroid may be pituitary related and the parasite can attack the pituitary.

Fungal infection

 

Most fungal infections seem to take a hold via the nose and thus inhalation of spores.  If you look at the diagram you can see that the nasal organs are extremely close to the pituitary gland, hence if one is unwise enough to use nasal sprays or antihistamines for example, to unblock a nose that has blocked itself to prevent you from pathogens, then the pathogens will get through.  There is thus an obvious case here for ensuring the home environment is fungi free and well aired [and that you don’t use pharms].  In this next example the fungus had compressed the pituitary gland causing Galactorrhea -  a milky nipple discharge unrelated to the normal milk production of breast-feeding and again caused by inappropriate prolactin secretion from the damaged pituitary

A 37-year-old female presented with bilateral galactorrhea and occipital headaches of several weeks. …… [tests] revealed nasal polyps and fungal debris in the sphenoid sinus, … There was bony erosion of the sella and clivus. Pathology and microbiology were consistent with fungal sinusitis caused by Curvularia species. Prolactin levels normalized four weeks after surgery with resolution of symptoms. … Functional endoscopic sinus surgery alone was able to reverse the patient's pituitary dysfunction.  PMID:  26998375

And

A 55-year-old woman presented with headache, dizziness, and decreased visual acuity. Magnetic resonance imaging revealed a sellar mass with sphenoid sinus extension. …. The mass was resected and diagnosed with aspergillosis pathologically. …. aspergillus sellar abscess can result in hyperprolactinemia and should be considered in the differential diagnosis of a sellar mass, even in immunocompetent patients. PMID: 25675014

And here the woman is going blind from fungal infection

Cryptococcus spp is a common fungal infection and frequent cause of meningitis in immunocompromised patients; however, immunocompetent patients are also at risk of infection. Visual loss often occurs via elevated intracranial hypertension but can rarely occur through direct optic nerve, chiasm, or tract invasion. We report a case of a 38-year-old woman who presented with decreased acuity in both eyes. She had generalized visual field constriction in the right eye and temporal hemianopsia in the left eye. … Retroactive staining of the pituitary biopsy was positive for mucicarmine, a component of the polysaccharide capsule of Cryptococcus spp. PMID:  26425249

Organ transplant patients have to take immunosuppressants, otherwise their body rejects the organ.  Furthermore, some stents are coated with immunosuppressants [not all], as such both these types of patient are vulnerable to infection, of all sorts, for example:

This is the first case report, to our knowledge, of pituitary aspergillosis in the setting of an organ transplant.  PMID:  24093964

 Throw out mouldy food, it is not worth the risk

 

Pharmaceuticals

Pharmaceuticals can have a marked effect on the pituitary gland.  In this example, the use of Sulfonylureas in Diabetes was causing hypertension and affecting ADH and GH – possibly leading to obesity and other knock-on effects.

Within a few years of diagnosis, patients with Type 2 Diabetes Mellitus (T2DM) develop hypertension. ….A comprehensive literature search was carried out on PubMed, EMBASE and Cochrane databases and articles published between January 1970 to June 2015 were reviewed.  RESULTS: Sulfonylureas due to their action on SUR1 in pituitary gland may release growth hormone and anti-diuretic hormone; action on SUR2B acting upon smooth muscle may interfere with vasodilatation, thereby causing hypertension.  PMID:  26767545

 

The eHealthme site collects the Adverse Drug reports submitted by doctors to the FDA and SEDA in the USA.  It then summarises them for ease of use.  There is no entry for Pituitary gland disease as a whole but a number of entries for various types of Pituitary gland disease.  Thus in order to find out which pharmaceuticals are implicated in these various types

  • Follow the LINK to the eHealthme website
  • Using the ‘All conditions’ index find the appropriate entry
  • Now scroll down until you get to the section marked ‘Drugs that could cause

The list shows you all the drugs implicated in CAUSING each of these types as well as the number of people who have made a complaint to their doctor and had their case reported by him.  Note that it is up to the doctor whether he reports or not.  As of October 2016:

  • About 250 pharmaceuticals were implicated in causing Pituitary tumours
  • About 250 pharmaceuticals were implicated in causing Hyperprolactinaemia
  • About 200 pharmaceuticals were implicated in causing Hypopituitarism
  • About 100 pharmaceuticals were implicated in causing Acromegaly
  • About 500 pharmaceuticals were implicated in causing Cushing’s syndrome
  • About 100 pharmaceuticals were implicated in causing Prolactinoma
  • About 15 pharmaceuticals were implicated in causing Lymphocytic hypophysitis
  • About 100 pharmaceuticals were implicated in causing Prolactin-secreting ademoma of the pituitary

Other conditions mentioned are Pituitary enlargement; Pituitary haemorrhage; Malignant pituitary tumour; and Pituitary cyst

Hypoxia

 

Blood loss which causes a loss in blood pressure can cause the cells in the pituitary gland to die [necrosis], which results in an underactive pituitary gland – called hypopituitarism.  Furthermore any drop in blood pressure can have the same effect.  As we saw above, childbirth may result in blood loss and fall in blood pressure, but then so can surgery, car accidents, various forms of physical trauma and shock, if it is prolonged.  A narrowing of arteries or any constriction in arteries from say a brain tumour also limits blood flow.

 

The hypophyseal portal system is a system of blood vessels in the brain that connects the hypothalamus with the anterior pituitary. Its main function is the transport and exchange of hormones to allow a fast communication between both glands. The fenestrated structure of capillaries in the hypophyseal portal system facilitates a rapid exchange between the hypothalamus and the pituitary, with only a small amount of hormones needed to stimulate an accurate effect in the respective target organs in the body.  Clearly any damage here from whatever cause – and it can be the sort of physical damage described above or damage from pathogens or pharmaceuticals – is going to disrupt a very delicately balanced system.

Ultimately, the person in these cases is suffering from hypoxia – not blood loss per se, but lack of oxygen to the cells, causing cell death.

Histological study of 206 hypophyses of patients who had died from various neurosurgical diseases of the brain showed circulatory disorders in the hypophysis to be of the haemorrhagic type in 15.53% and the ischemic type in 9.22% of cases. The pathoanatomical characteristics of hemorrhages and infarcts of the hypophysis is given, the pathogenesis of these disorders is discussed, and the leading role of mechanical factors in the development of disorders of blood circulation is pointed out.  PMID:  3739495

 

 

Toxins

Considerable attention has currently been focused on bisphenol A (BPA), an environmental endocrine disrupting chemical that has oestrogenic activity. …The treatment of ovariectomized (OVX) Wistar rats with BPA … resulted in significant dose-dependent regrowth of uterus [and], the stimulation of anterior pituitary gland growth and induction of hyperprolactinaemia ….Prolactin immunostaining of anterior pituitary glands revealed that BPA at a dose of 250 mg/kg per day increased the number of prolactin-immunopositive cells by 63% compared to OVX rats. …. The long-term consequences of this proliferation are yet unknown but neoplasm formation is an obvious possibility.  PMID:  10839476

Endocrine disruptors disrupt the endocrine system, full stop.

Treatment

FIND THE CAUSE

References and further reading

As the list of references supporting this article is several pages long, we have placed it in the science section.  It can be found by following this LINK.

Observations

In memory of my dear school buddy, a friend for over 50 years, Chris Gaul, who died of complications following an operation for the removal of a non malignant tumour on the pituitary gland which was causing blurred vision. They removed the tumour but she lapsed into a coma and died eventually, aged 66, after several months from the bleeding from the wound.  There is no such thing as a ‘routine operation’.  They never investigated the cause.  May you rest in peace dear friend.

Related observations