Pituitary Symptoms

Pituitary symptoms are caused by a wide variety of conditions. Symptoms tend to occur in groups depending on what type of pituitary hormone is being excessively produced or whether a pituitary tumor is pressing on tissue surrounding the pituitary gland.

Any pituitary tumor that secretes excess levels of a hormone or compresses surrounding tissue can cause a variety of common symptoms. General symptoms of a pituitary tumor include:

• Abnormal pupil size and nonreactivity to light

• Changes in appetite or sense of smell

• Changes in menstrual cycle

• Decreased sexual drive

• Early or late puberty

• Excessive sweating

• Excessive thirst with or without increased urination

• Fatigue

• Headache

• Intolerance of heat or cold

• Loss of vision or changes in vision

A pituitary tumor that secretes excess levels of prolactin can cause a specific group of symptoms. Symptoms of excess prolactin that can result from a pituitary tumor include:

• Decreased sexual drive

• Infertility

• Irregular menstrual cycle or lack of menstruation

• Osteoporosis (thinning and weakening of the bones)

• Unexpected lactation

• Vaginal dryness

A pituitary tumor that secretes excess levels of growth hormone can cause a specific group of symptoms. Symptoms of excess growth hormone that can result from a pituitary tumor include:

• Change in ring or shoe size as an adult

• Decreased sexual drive

• Enlargement and coarsening of the jaw, hands, tongue or feet (acromegaly)

• Erectile dysfunction

• Excessive sweating

• Joint and bone aches

A pituitary tumor that secretes excess levels of adrenocorticotropic hormone (ACTH) can cause a specific group of symptoms. Symptoms of excess ACTH that can result from a pituitary tumor include:

• Accumulation of fat on the back of the neck (sometimes called buffalo hump)

• Diabetes (chronic disease that affects your body’s ability to use sugar for energy)

• Easy bleeding or bruising

• Excessive hair growth

• Fat accumulating in the torso, with relatively thin arms and legs

• Fragile muscles or bones

• High blood pressure (hypertension)

• Mood swings

• Roundness around the face from fat accumulation (sometimes called moon face)

• Stretch marks or lines in the skin

• Thinning skin

A pituitary tumor that secretes excess levels of TSH can cause a specific group of symptoms. Symptoms of excess TSH that can result from a pituitary tumor include:

• Fatigue and muscle weakness

• Increased appetite

• Increased sweating

• Infertility

• Insomnia and other sleep disturbances

• Irregular heartbeat or palpitations

• Irritability and mood changes

• Shortness of breath on exertion

• Swelling of the lower extremities

• Tremor

• Unexplained weight loss

In some cases, pituitary symptoms may be associated with a serious condition that should be immediately evaluated in an emergency setting. Seek immediate medical care (call 911) if you, or someone you are with, have any of these serious symptoms including:

• Change in level of consciousness or alertness, such as passing out or unresponsiveness

• Chest pain, chest tightness, chest pressure, or palpitations

• Loss of vision or changes in vision

Pituitary symptoms are caused by multiple possible conditions. First, a tumor of cells that make a specific pituitary hormone can cause excess secretion of that hormone. Second, a tumor of cells near the pituitary gland can press on the gland, causing release of pituitary hormones. Third, a tumor in or near the pituitary gland can press on and impair the nerves responsible for vision or controlling eye movement. Finally, interruption of fresh bloodflow into the pituitary can cause all or part of the pituitary gland to stop functioning.

The exact cause of pituitary tumors is usually not known. Pituitary tumors can be benign, meaning that they tend not to invade surrounding tissue, or malignant, meaning that they tend to spread to other areas in the body. Pituitary symptoms can be associated with pituitary tumors that occur in some hereditary diseases, such as multiple endocrine neoplasia 1 (MEN 1).

Pituitary tumors can occur in anyone, and there are very few risk factors for a pituitary tumor. Risk factors for pituitary symptoms and tumors include:

Family history of pituitary symptoms Genetic disorders that cause tumors of the endocrine glands, including multiple endocrine neoplasia types 1 and 4

Most pituitary tumors are not malignant and usually do not spread. However, tumor growth can compress surrounding tissue and continue to secrete high levels of pituitary hormones. Surgery is often necessary to remove the tumor. In some cases, the pituitary tumor is small and does not cause any symptoms, so treatment is deferred. Some specific types of pituitary symptoms can be treated with medication.

Surgery and radiation therapy may be used alone or in combination to treat pituitary symptoms, especially when severe. These treatments may include:

• Surgery to remove the tumor to keep it from compressing nearby tissues or secreting excessive amounts of pituitary hormones. Surgery to remove a pituitary tumor can often be performed through the nose, mouth and sinuses. Rarely, surgery will need to be performed through the skull to resolve pituitary symptoms.

• Radiation directed at a pituitary tumor to stop or slow its growth. This option is sometimes used in combination with surgery, or by itself in people who cannot have surgery for a variety of reasons.

Some medications can be used to treat specific types of pituitary symptoms. These medicines include:

• Bromocriptine (Parlodel) can be used for tumors that secrete prolactin. Bromocriptine can help decrease the release of prolactin and can result in shrinking of the tumor.

• Cabergoline (Dostinex) can be used for tumors that secrete prolactin. Cabergoline can help decrease the release of prolactin and can result in shrinking of the tumor.

• Hormone replacement therapy may be necessary in patients with pituitary symptoms. Replacements for growth hormone, adrenal hormones, thyroid hormones, and sex hormones like testosterone and estrogen may be required to help eliminate some of the symptoms caused by a pituitary tumor.

• Octreotide (Sandostatin) is occasionally used for growth hormone-secreting tumors or thyroid-stimulating hormone-secreting tumors

• Pegvisomant (Somavert) is occasionally used for growth hormone-secreting tumors

Left untreated, pituitary tumors are associated with a number of complications. Some of these complications can be serious, or even life threatening. You can help minimize your risk of serious complications by following the treatment plan you and your health care professional design specifically for you. Complications of pituitary symptoms include:

• Acute pituitary hemorrhage (pituitary apoplexy)

• Adverse effects of treatment

• Diabetes insipidus

• Loss of vision and blindness (optic neuropathy)

• Permanent hormone imbalance, often due to surgical or radiologic intervention

• Spread of malignant pituitary tumors