Pituitary Innovation and Teaching

Three problems from a pituitary tumour

Speaker: Dr. Jeannette Goguen, endocrinologist

Video transcript

There are three types of problems that can arise if you have a tumour in your pituitary.

The first one is called mass effect and that has to do with problems arising from the size of the tumours; these tumours are typically very tiny but they're large enough to cause problems in the brain because of the area that they're growing in is very small and there's all sorts of critical structures surrounding them, particularly the nerves to the eyes. The patient may complain of headaches and may complain of visual disturbances that's why its particularly important to have follow up with regular MRIs to assess if the tumour is growing, regular appointments with your eye doctor, and visual field testing.

The second problem is if there is overproduction of pituitary hormones. This is not that common. The commonest version of this is when prolactin is overproduced that can cause milk production for a female, throws off their periods, causes infertility. For the males it can cause low libido or low sex drive and cause problems with erections and problems with fertility as well. The second problem, which is quite rare, is overproduction of growth hormone that causes a disease called acromegaly. And what happens is patients notice their hands and feet are growing, their facial features are changing and there's a whole series of other manifestations. The third with over production of ACTH is called Cushing's disease. And this is as well is rare, but very disturbing for patient. They will gain a lot of weight particularly around the middle, their facial features will change. Problems with bruising, weakness, all sorts of issues that are very disruptive for the patient and can cause serious medical conditions associated with it.

The third type of problem is underproduction. I have already told you there are seven hormones made in the pituitary. each of these can be underproduced if the growth that is happening is disturbing normal pituitary function. this can lead to low acth. so the patient feels very tired, weak, weight loss. It can lead to low TSH affecting the thyroid so the patient develops symptoms of under-active or hypothyroidism and can lead to weight gain, feeling cold, feeling tired, constipation, dry skin. If LH and FSH are disturbed patients can have problems similar to the high prolactin levels where the sexual function is disturbed. Problems with growth hormone are particularly a concern for children because they don't achieve their regular adult height, they stop growing. ADH is more of a problem after surgery, we'll talk about that later.

So when you are sent to see me, I will assess for mass affect, for pituitary hormone over production, and pituitary hormone under production. So there's lots of blood tests, lots of physical exam manoeuvres and such to see if any of these are a problem. As well, if you have Cushing's disease or acromegaly, this can affect a lot of other parts of the body and we have to assess for things like diabetes, hypertension, heart disease. So there's a fair bit of work getting sorted out to make sure that we can get you back to normal.

 

Page last updated: June 3, 2016