TITLE: PITUITARY DISORDERS
AUTHORS: AMIR HAMRAHIAN, MD -- Department of Endocrinology
PUBLISHED: JULY 19, 2002
    
Table 1:
Relationship Among Hypothalamic, Pituitary, Target Glands, and Feedback Hormones
Hypothalamic
Regulatory Hormone
Pituitary
Hormone
Target
Gland
Feedback
Hormone
TRH
TSH
Thyroid gland
T4, T3
LH-RH
LH
Gonad
E2, T
LH-RH
FSH
Gonad
Inhibin, E2, T
GH-RH, SMS
GH
Multi-organs
IGF-1
PIF
Prolactin
Breast
?
CRH, ADH
ACTH
Adrenal
Cortisol
ACTH = Adrenocorticotropin hormone; ADH = Antidiuretic hormone; CRH = Corticotropin-releasing hormone; E2 = Estradiol; FSH = Follicle-stimulating hormone; GH = Growth hormone; GH-RH = Growth hormone-releasing hormone; IGF = Insulin-like growth factor; LH = Luteinizing hormone; LH-RH = Luteinizing hormone-releasing hormone; PIF = Prolactin release-inhibitory factor; SMS = Somatostatin; T = Testosterone; T4 = Thyroxine; TRH = Thyrotropin-releasing hormone; TSH = thyroid-stimulating hormone

 

 

Table 2:
Prevalence of Pituitary Adenoma
Adenoma Type
Prevalence (%)
GH cell adenoma
15
PRL cell adenoma
30
GH and PRL cell adenoma
7
ACTH cell adenoma
10
Gonadotroph cell adenoma
10
Nonfunctioning adenoma
25
TSH cell adenoma
1
Unclassified adenoma
2
ACTH=Adrenocorticotropic hormone; GH=Growth hormone; PRL=Prolactin; TSH=Thyroid-stimulating hormone

 

 

 

 

Table 3:
Clinical Manifestations of
Pituitary Tumors Secondary to Mass Effect
  • Headache
  • Chiasmal syndrome
  • Hypothalamic syndrome
  • Disturbances of thirst, appetite, satiety, sleep, and temperature
  • Diabetes insipidus
  • Syndrome of inappropriate ADH secretion (SIADH)
  • Obstructive hydrocephalus
  • Cranial nerves III, IV, V1, V2, and VI dysfunction
  • Frontal and temporal lobe syndromes
  • Cerebrospinal fluid rhinorrhea

 

Table 4:
Clinical Features in Patients with Acromegaly
  • Acral enlargement
  • Arthralgias, neuropathic joints
  • Carpal tunnel syndrome
  • Coarsening of facial features
  • Excessive sweating
  • Goiter
  • Hypertension, congestive heart failure
  • Impaired glucose tolerance, diabetes mellitus
  • Macroglossia
  • Malocclusion and tooth gaps
  • Pituitary mass effect including headache and visual field defects
  • Pituitary insufficiency (partial or complete)
  • Sensory and motor peripheral neuropathy
  • Snoring, sleep apnea
  • Symptoms associated with hyperprolactinemia
  • Thick and course skin, skin tags

 

Table 5:
Diagnostic Tests for Pituitary Hormone Deficiency
Axis
Tests
Growth hormone IGF-1, ITT, GH-RH/arginine, arginine
Adrenocorticotropic hormone Cortisol (morning), LDCT, SDCT, overnight metyrapone test, ITT
Gonadotropins (LH and FSH) Estradiol (free and total testosterone in men), FSH, LH, prolactin
Thyroid-stimulating hormone FT4 index (free T4), TSH
FSH = Follicle-stimulating hormone; FT4 = Thyroxine; GH-RH = Growth hormone-releasing hormone; IGF-1 = Insulin-like growth factor-1; ITT = Insulin tolerance test; LDCT = Low-dose cosyntropin test; LH = Luteinizing hormone; SDCT = Standard-dose cosyntropin test; TSH = Thyroid-stimulating hormone

 

 

 

Table 6:
Diagnosis of Pituitary Excess Hormone Secretion
Axis
Tests
PRL
Prolactin
GH
IGF-1, OGTT
ACTH
24-h UFC, LDDST, LDDST/CRH test, midnight salivary and serum cortisol
Gonadotropins (LH and FSH)
FSH, LH, α- and ß-subunits
TSH
FT4 index (free T4), T3, TSH
ACTH = Adrenocorticotropic hormone; CRH = Corticotropin-releasing hormone; FT4 = Thyroxine; FSH = Follicle-stimulating hormone; GH = Growth hormone; IGF-1 = Insulin-like growth factor-1; LDDST = Low-dose dexamethasone suppression test; LH = Luteinizing hormone; OGTT = Oral glucose tolerance test; PRL = Prolactin; T3 = triiodothyronine; T4 = Thyroxine; TSH = Thyroid-stimulating hormone; UFC = Urinary free cortisol

 

Table 7:
Differential Diagnosis of Hyperprolactinemia
  • Physiologic
    • Pregnancy, postpartum, suckling, stress, hypoglycemia, intercourse, neonate
  • Pituitary disorders
    • Prolactinomas, Mixed pituitary tumors, lymphocytic hypophysitis, empty sella
    • Nonfunctioning pituitary tumors with stalk compression
  • Hypothalamic/Stalk disorders
    • Aneurysm
    • Inflammatory
      • Sarcoidosis, histocytosis, other granulomatous disorders
    • Neoplastic
      • Craniopharyngiomas, meningiomas, gliomas, dysgerminomas, metastasis
    • Trauma, radiotherapy
  • Drugs
    • Neuroleptics, methyldopa, reserpine, metoclopramide, opiates, cocaine, cimetidine, ranitidine, verapamil, tricyclic antidepressants, monoamine oxidase inhibitors, estrogen, antiandrogens, some SSRIs including fluoxetine and fluvoxamine
  • Hypothyroidism, chronic renal failure, cirrhosis,
  • Neurogenic
    • Chest wall disorders
    • Spinal nerve or cord disorder, seizures
  • Ectopic: Hypernephroma, gonadoblastoma, ovarian teratomas
  • Idiopathic

 

 

 

 

Table 8:
Presenting Signs and
Symptoms of Pituitary Apoplexy
Signs and
Symptoms
Percentage of Patients
Headache
90
Visual disturbances
60
Ocular palsies
40
Nausea/Vomiting
40

Altered mental
status
20
Meningismus
20
Hemiparesis
4
Fever
2.5

 

Table 9:
Etiologies of Central Diabetes Insipidus
  • Congenital
  • Trauma/postsurgical
  • Neoplasm: Craniopharyngioma, germinoma, meningioma, leukemia, lymphoma
  • Pituitary macroadenoma with suprasellar extension
  • Metastasis
  • Granulomatous disease: histiocytosis, sarcoidosis, tuberculosis
  • Infectious: meningitis, encephalitis
  • Vascular: Aneurysm, Sheehan's syndrome
  • Autoimmune
  • Familial
  • Idiopathic
  

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