Hyperpituitarism

Definition
• A rare condition in adults known as
acromegaly and gigantism in children is a type
of hyperpituitarism. The pituitary gland
produces too much growth hormone and can
cause this chronic condition.
 Causes
• A pituitary tumor that is benign (adenoma) is
most commonly the cause of overproduction of
HGH.
In rare cases, a tumor in the area of the brain
right behind the pituitary gland (hypothalamus)
might over stimulate HGH production.
• These benign tumors can either be termed
a microadenoma if it is smaller than 10mm in diameter
or macroadenoma if larger than 10mm in diameter.
Adenomas are mainly due to genetic alterations but less
commonly it may be caused by overactivity of the
hypothalamus which stimulates the pituitary to an
extent where there is an overgrowth of tissue.
 Symptoms
• For children: extreme height because of sudden
growth acceleration; this should not be confused
with normal growth spurts during adolescence.
• For adults symptoms include, enlarged jaw bones,
hands, forehead, and feet; wider neck and head;
coarsened features of the face; teeth spaced
widely; men experience impotence; termination
of menstrual cycles (amenorrhea); women
experience excess facial hair (hirsutism).
• For adults and children: muscle weakness and
fatigue; sweating profusely; gaining weight;
sinus congestion; oily skin; tongue size
increases; voice sounds hollow; joint pain;
oversleeping; tingling feeling in hands;
unexpected mood changes.
• Vision impairment and headaches might occur
as the growth of the tumor applies pressure
inside the skull.
 Diagnosis
• Physical examination (to include visual-field
exams) and patient history.
• Blood tests will reveal elevated quantities of HGH
which are not completely decreased by glucose
administration.
• In the blood, elevated amounts of somatomedin-
C (IGF-1) are measured.
• CT(computed tomography scans) and MRI
(magnetic resonance imaging), can identify a
pituitary tumor.
• Increased bone mass detection using x-rays.
 Treatment of Hyperpituitarism
• Removing the underlying tumor surgically is the
chosen treatment. In some cases, a few hours after
surgery, HGH levels will return to normal and for
tissue that is soft, and not bony, enlargement will
decrease quickly.
Radiation, by itself or following surgery, might be
done to decrease the size of the tumor, or keep it
from coming back.
Several cases require hormone replacement therapy
throughout the patient’s lifetime with adrenal-
steroid or thyroid hormones if damage is caused to
the pituitary gland during radiation or surgery.
• Medications like octreotide or bromocriptine
might be prescribed for decreasing the size of
the tumor and control secretion of HGH.
However, large dosage amounts must be
given daily and success is limited, therefore
medication is generally a supplement to
surgery or radiation.
 Prevention
• No way is known for preventing
hyperpituitarism.
Disease/Syndrome
Cushing's Disease/ Cushing's Syndrome:
Cushing's is a hormonal disorder caused by
prolonged exposure of the body's tissues to high
levels of the hormone cortisol. Your adrenal glands,
which are right above your kidneys, release cortisol
when they receive a chemical message from your
pituitary gland. The message comes in the form of
adrenocorticotrophic hormone (ACTH), which travels
through the bloodstream.
The pituitary gland is known as the “Master gland of
the body” and is about the size of a pea.
Cushing syndrome is also known as Cushing’s
syndrome or hypercortisolism.
 Cushing's Disease: Is the result of a
pituitary tumor and the inappropriate
production of ACTH.

Cushing's Syndrome: Causes the same

symptoms, but is a disorder marked by
overproduction of adrenal hormones,
Cushing’s syndrome is all other forms of
Cushing’s.
“They say Cushing’s is rare, it’s not true it’s just rarely diagnosed”

Causes of Cushing’s

– a benign tumor of the pituitary gland

– a benign tumor of the adrenal gland
– a benign tumor of the lung or other organ
– extensive use of cortisone medication
This condition is the result of abnormally high levels
of a hormone called cortisol. Cortisol is produced by
the adrenal glands and helps with a number of your
body’s functions, including:
• regulating blood pressure and the cardiovascular
system
• reducing the immune system’s inflammatory
response
• converting carbohydrates, fats, and proteins into
energy
• balancing the effects of insulin
• stress response
• Your body may produce high levels of cortisol for a
variety of reasons, including:
• high stress levels in the final trimester of pregnancy
• athletic training
• malnutrition
• alcoholism
• depression or panic disorders
• The most common cause of Cushing syndrome is the
use of corticosteroid medications (like prednisone) in
high doses for a long period of time. These
medications are generally prescribed to prevent
rejection of a transplanted organ. They are also used to
treat inflammatory diseases (like lupus and arthritis).
High doses of injectable steroids for treatment of back
pain can also cause this syndrome.
• Lower dose steroids in the form of inhalants (like those
used for asthma) or creams (like those prescribed for
eczema) usually are not enough to cause Cushing
syndrome.
• Other causes include:
• pituitary gland tumor, also known as Cushing’s disease
(the pituitary gland releases too much adrenocorticotropic
hormone, or ACTH)
• ectopic ACTH syndrome (tumors usually found in the lung,
pancreas, thyroid, or thymus gland)
• familial Cushing syndrome (Cushing syndrome is generally
not inherited, but there may be an inherited tendency to
develop tumors of the endocrine glands)
• adrenal gland abnormality or tumor
• You are at increased risk of this disorder if you are obese,
or if you have type 2 diabetes with uncontrollable blood
glucose levels and high blood pressure.
Pituitary Hormones and Adrenals
 S&S

SWEDISH
S – Spinal tenderness
W – Weight gain
E – Easily bruise
D – Diabetes
I – Intercapsular fat pad
S – Striae
H – HTN
 Diagnosing Cushing Syndrome
• There is no single definitive test for Cushing
syndrome. The diagnosis involves a thorough
physical examination and a review of your
medical history and symptoms. Laboratory tests
that help with the diagnosis may include:
• 24-hour urinary free cortisol test
• midnight plasma cortisol and late-night salivary
cortisol measurements
• low-dose dexamethasone suppression test
(LDDST) (blood test)
• After the condition is diagnosed, the cause of
your excess cortisol production must still be
determined. Tests to help determine the cause
may include:
• corticotropin-releasing hormone (CRH)
stimulation test
• high-dose dexamethasone suppression test
(HDDST) (blood test)
• imaging tests such as computed tomography (CT)
scan and magnetic resonance imaging (MRI)
• This relatively rare condition is usually diagnosed
in adults between the ages of 20 and 50.
 Treatment for Cushing Syndrome
• Treatment will depend on what is causing the
problem. Your doctor may prescribe a medication
to help control cortisol production and ease
symptoms.
• If you use corticosteroids, a change in medication
or dosage may be required. Do not attempt to
change the dosage yourself. Close medical
supervision is required.
• Tumors can be cancerous (malignant) or
noncancerous (benign). Surgical removal may be
required. Radiation therapy or chemotherapy may
also be recommended.