What hormones are lost and what does it give?
The pituitary gland produces several hormones, and the deficiency of each has its own pattern. Lack of ACTH leads to secondary adrenal insufficiency with weakness, low blood pressure and risk of crisis. A deficiency of thyroid-stimulating hormone is manifested by chilliness, swelling, drowsiness, and weight gain. Gonadotropin deficiency causes decreased libido, cycle disorders, and infertility. Lack of growth hormone in children inhibits growth, and in adults it causes fatigue and changes in body composition. Separately, there is a lack of antidiuretic hormone - it is manifested by strong thirst and excessive urination.
- ACTH deficiency: weakness, low blood pressure, risk of crisis
- TSH deficiency: chilliness, drowsiness, swelling
- Gonadotropin deficiency: cycle disorders, decreased libido
- Growth hormone deficiency: growth retardation in children
- Antidiuretic hormone deficiency: thirst and excessive urination
- Possible deficiency of one hormone or several at once
Reasons
The most common cause in adults is a tumor of the pituitary gland or surrounding structures, as well as the consequences of its treatment: surgery and radiation therapy. Another group of causes are vascular and traumatic: hemorrhage into a pituitary tumor, severe traumatic brain injury, as well as massive blood loss during childbirth with subsequent necrosis of pituitary tissue, known as Sheehan syndrome. Less common are inflammatory and autoimmune lesions of the pituitary gland, infections, systemic diseases with deposition of substances in tissues, as well as congenital developmental disorders.
- Adenomas and other tumors of the pituitary gland
- Surgeries and radiation therapy on the pituitary gland
- Traumatic brain injury
- Hemorrhage into the pituitary gland
- Massive blood loss during childbirth
- Autoimmune inflammation of the pituitary gland
- Congenital forms
Symptoms to watch out for
Complaints develop gradually and are easily mistaken for overwork or age-related changes. The person notes increasing weakness, poor exercise tolerance, dizziness when standing up, dry and pale skin, hair loss in the armpits and pubic area, and decreased libido. Women experience irregular or disappeared menstruation, men experience decreased beard growth and decreased muscle mass. In children, the main symptom is stunted growth. With a tumor of the pituitary gland, headaches and narrowing of visual fields are added.
- Constant weakness and fatigue
- Low blood pressure and dizziness
- Chilliness, dry pale skin
- Cycle disorders, decreased libido
- Hair loss in the armpits and pubic area
- Stunted growth in children
- Headache and visual disturbances due to tumor
Diagnostics
The examination is based on a paired determination of the pituitary hormone and the hormone of the subordinate gland. For example, low free T4 with normal or low TSH indicates central hypothyroidism, as opposed to normal hypothyroidism, in which TSH is elevated. To assess adrenal function, morning cortisol is determined; at borderline values, stimulation tests are performed. Sex hormones and prolactin must be examined, and if a deficiency of antidiuretic hormone is suspected, urine volume and its concentration must be assessed. Once the deficiency is confirmed, an MRI of the pituitary gland is performed to look for the cause.
- TSH and free T4 together
- Morning cortisol, stimulation test if necessary
- LH, FSH, testosterone or estradiol
- Prolactin
- Assessment of micturition and urine concentration
- MRI of the pituitary gland
- Examination by an ophthalmologist with assessment of visual fields
Treatment and observation
Treatment consists of replenishing those hormones that are missing. The order is important: first they compensate for adrenal insufficiency, and only then begin treatment with thyroid hormones, otherwise a sharp deterioration is possible. Next, according to indications, sex hormones are prescribed, and for children, growth hormone. All medications are selected by an endocrinologist, focusing not on one analysis, but on well-being and a set of indicators. As with adrenal insufficiency, during illness and surgery the dose of glucocorticoid is temporarily increased. At the same time, the cause is treated: tumor, inflammation, consequences of injury.
- Glucocorticoid replacement therapy first
- Levothyroxine after adrenal compensation
- Sex hormones according to indications
- Growth hormone in children
- Increasing dose during illness and surgery
- Treating the underlying cause
- Regular monitoring and control of tests