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Diagnosis / Pituitary Abnormalities

The pituitary gland is a pea-sized gland at the base of your brain. As the “master gland” of the body, it produces many hormones that travel throughout the body, directing certain processes or stimulating other glands to produce other hormones.

Pituitary Gland and Hormone Production

The pituitary gland makes or stores many different hormones. The following hormones are made in the anterior (front part) of the pituitary gland:

  • Prolactin – stimulates breast milk production after childbirth. It also affects sex hormone levels from ovaries in women and from testes in men, as well as fertility.
  • Growth Hormone (GH) – stimulates growth in childhood and is important for maintaining a healthy body composition and well-being in adults. In adults, GH is important for maintaining muscle mass and bone mass.   It also affects fat distribution in the body.
  • Adrenocorticotropin (ACTH) – Stimulates the production of cortisol by the adrenal glands – small glands that sit on top of the kidneys.
  • Cortisol, a “stress hormone”, is vital to our survival. It helps maintain blood pressure and blood glucose levels, and is produced in larger amounts when we are under stress – especially after illness or injury.
  • Luteinizing Hormone (LH) – stimulates testosterone production in men and egg release (ovulation) in women.
  • Follicle-Stimulating Hormone (FSH) – promotes sperm production in men and stimulates the ovaries to produce estrogen and develop eggs in women. LH and FSH work together to enable normal function of the ovaries and testes.

The following hormones are stored in the posterior (back part) of the pituitary gland:

  • Antidiuretic Hormone (ADH) – also called vasopressin, regulates water balance in the body. It conserves body water by reducing the amount of water lost in urine.
  • Oxytocin – causes milk to flow from the breasts in breastfeeding women, and may also help labor to progress

Pituitary Tumors

Patients with pituitary disorders often have too much or too little of one hormone. Injuries can cause pituitary disorders, however the most common cause is a pituitary gland tumor. These tumors are fairly common in adults. They are not brain tumors and are almost always benign (that is, not cancer).

There are two types of tumors – secretory and non-secretory. Secretory tumors produce too much of a hormone normally made by the pituitary, and non-secretory tumors do not. Both types of tumors can cause problems if they are large and interfere with normal function of the pituitary gland and/or nearby structures of the brain.

The problems caused by pituitary tumors fall into three categories:

  • Hypersecretion – too much of any hormone in the body is caused by a secretory pituitary tumor.
  • Hyposecretion – too little of any hormone in the body can be caused by a large pituitary tumor, which interferes with the pituitary gland’s ability to produce hormones. Hyposecretion can also result from surgery or radiation of a tumor.
  • Tumor mass effects – as a pituitary tumor grows and presses against the pituitary gland or other areas of the brain, it may cause headaches, vision problems, or other health effects.

What are the Signs and Symptoms of Pituitary Tumors?

Not all pituitary tumors (called pituitary adenomas) cause symptoms. But when they do, they can cause many different types of symptoms. The first signs of a pituitary adenoma often depend on whether the tumor is functional (making excess hormones) or non-functional (not making excess hormones).

Functional Adenomas (Making Excessive Hormones)

  • Functional adenomas can cause problems because of the hormones they release.
  • Most of the time, a functional adenoma makes too much of a single pituitary hormone. These tumors are often found while they are still fairly small (microadenomas). Symptoms from functional adenomas are based on which hormones they make.

Non-functional Adenomas (Not Making Excessive Hormones)

  • Non-functional adenomas that cause no symptoms are sometimes found because of an MRI or CT scan done for other reasons.
  • Tumors that are not making excess hormones (non-functional adenomas) often become large (macroadenomas) before they are noticed.
  • These tumors do not cause symptoms until they press on nearby nerves, parts of the brain, or other parts of the pituitary.
  • These tumors are now being found more often as more MRI and CT scans of the brain are done. These might be the most common pituitary tumors. As long as they are not causing problems, they are often just watched closely without needing treatment.

IVC’s Diagnostic Procedure for Pituitary Abnormalities

At IVC, we offer inferior petrosal sinus sampling (IPSS). During this procedure, adrenocorticotropic hormone (ACTH) levels are sampled from the veins that drain the pituitary gland; these levels are then compared with the ACTH levels in the peripheral blood to determine whether a pituitary tumor is responsible for ACTH-dependent Cushing syndrome. IPSS can also be used to establish on which side of the pituitary gland the tumor is located.

For more information on inferior petrosal sinus sampling or to schedule and appointment for consultation, please call IVC at 503-612-0498.

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