Hyperpituitarism: overview, symptoms, causes, diagnosis and management

Hyperpituitarism is a condition in which the pituitary gland of the body is overactive. The pituitary gland is a pea sized small gland located at the base of the brain. It secretes various kind of hormones that control other glands of the human body thus regulating major functions which include development, growth, metabolism, regulation of blood pressure and much more. Therefore, the pituitary gland is also known as master gland of the body. Hyperpituitarism begins when the gland overproduces one or more of the various hormones. So, the symptoms of hyperpituitarism are those which will be caused by that overproduced hormone.

Sign and symptoms

The symptoms of hyperpituitarism can vary significantly between patients depending on the hormone which is overproduced. We will look at the symptoms of overproduction of some hormones

When the hormone relating to growth is overproduced it can lead to gigantism or acromegaly whose symptoms are

• Unusual tall height in children
• Prominent jaws or other facial features in adults
• Enlarged tongue
• Headaches
• Joint pain and limited movements
• Erectile dysfunction

When the hormone controlling the adrenal gland of the body is overproduced it can lead to a syndrome called as Cushing syndrome. Patients may experience the following symptoms

• More abdominal fat compared to fats on hands and legs
• Moon like round face
• Increased facial hair in women
• Easy bruising
• Purple or pink colored stretch marks on abdomen

When the hormone controlling thyroid gland is overproduced it can lead to hyperthyroidism whose symptoms are

• Restless or anxiety
• Increased heart rate and sweating
• Decreased need of sleep
• Heat intolerance

When there is overproduction of prolactin hormone it is called as hyperprolactinemia whose symptoms are

• Tender or painful breasts in women
• Reproductive dysfunction
• Production of milk in even in non-pregnant women and males
• Irregular menstrual cycle

Causes

Tumors of the pituitary gland are the most common cause of hyperpituitarism. Most of the times these tumors are benign that is noncancerous. Prolactinoma is the condition when tumor of the pituitary causes increased production of prolactin hormone. These tumors don’t always cause excessive production of pituitary hormones, sometimes they can be asymptomatic or can cause low production of hormones leading to a condition known as hypopituitarism.

Some of the tumors may be hereditary as a part of multiple endocrine neoplasia syndrome but still the cause of most of the tumors is not known.

Rarely tumors at location other than that of pituitary can produce pituitary hormones leading to hyperpituitarism.

Diagnoses

To establish a diagnosis of hyperpituitarism the doctor will ask you a detailed history of your signs and symptoms. The choice of diagnostic tests will depend upon the symptoms and physical examination. The types of tests that which can be ordered:

Blood tests: blood can be tested to know the levels of different hormones. It will help to know which hormone are in excess quantity. It will also help to rule out whether the overproduction of pituitary hormones is due to the abnormality of pituitary itself or not. Blood can also be used to check for any electrolyte or cell abnormality.

Urine tests: urine can be also tested to measure the levels of hormones.

Image studies: MRI or CT scan can be performed to know the presence of any abnormal growth if tumor is suspected.

Further investigations may be required depending upon the results of the above tests.

Management

The hyperpituitarism will be managed according to the specific symptoms and the cause. Depending upon the hormones which have been increased the management modalities will differ. Your doctor will advise you the best management options that may include one or more of the following:

Medical Management

Medications are used to lower down the level of hormones in the body. Most of these medications work by hampering the synthesis of the hormone. It reduces the symptoms and help to shrink the size of the tumor before the surgery. Medication may be the only management option when the tumor is not removable. So far prolactinoma is the only condition for which long term medical management is fully satisfactory.

Surgical Management

If the underlying cause is a tumor, surgery is recommended to remove it. Surgery is the preferred choice in disease like Cushing, acromegaly and prolactinomas with improving cure rates.

Radiation Therapy

Irradiation is done for the patients who can’t tolerate medicine or to remove the left our portion of the tumor after the surgery. This therapy is not recommended in children due to high risk to low benefit ratio.

Prognosis

Overall prognosis of patient after a successful surgery is good. Long term surgical cure rate approaches to about 82 % for all populations with very low morbidity and no mortality. Hypopituitarism and dependence on lifelong medication are the complications of surgery.

References

• Gounden V, Basit H, Jialal I. Hyperpituitarism [Internet]. StatPearls Publishing; 2019. Available from: https://www.ncbi.nlm.nih.gov/books/NBK482233/
• Sotos JF. Overgrowth. Hormonal Causes. Clin Pediatr (Phila). 1996 Nov. 35(11):579-90.
• Kasum M, Oreskovic S, Zec I, Jezek D, Tomic V, Gall V, et al. Macroprolactinemia: new insights in hyperprolactinemia. Biochem Med (Zagreb). 2012. 22(2):171-9.
• Devoe DJ, Miller WL, Conte FA, et al. Long-term outcome in children and adolescents after transsphenoidal surgery for Cushing’s disease. J Clin Endocrinol Metab. 1997. 82:3196-202.
• Colao A, Lombardi G. Growth-hormone and prolactin excess. Lancet. 1998 Oct 31. 352(9138):1455-61.
• Eugster EA, Pescovitz OH. Gigantism. J Clin Endocrinol Metab. 1999 Dec. 84(12):4379-84. [Medline].
• Gsponer J, De Tribolet N, Deruaz JP, et al. Diagnosis, treatment, and outcome of pituitary tumors and other abnormal intrasellar masses. Retrospective analysis of 353 patients. Medicine (Baltimore). 1999. 78:236-269. [Medline].
• Orth DN. Cushing’s syndrome. N Engl J Med. 1995 Mar 23. 332(12):791-803. [Medline].
• Pandey P, Ojha BK, Mahapatra AK. Pediatric pituitary adenoma: a series of 42 patients. J Clin Neurosci. 2005. 12:124-127.
• Stewart PM, Petersenn S. Rationale for treatment and therapeutic options in Cushing’s disease. Best Pract Res Clin Endocrinol Metab. 2009. 23 Suppl 1:S15-22.