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Pituitary and Adrenal disorders

​​​The pituitary and adrenal glands are part of the body’s endocrine system, responsible for releasing hormones into your body. If a person has a disorder of the pituitary or adrenal gland, he/she is either making too much or not making enough of a certain hormone.​​

 
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Pituitary gland

The pituitary gland is known as the “master hormone gland” of the body. It is a pea-size gland at the base of your brain, roughly sitting behind the bridge of your nose. Despite its small size, the pituitary secretes 8 hormones which in turn control function of your thyroid, adrenals, ovaries/testes, as well as growth, lactation, and thirst mechanisms.​

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Pituitary Hormone Function
Adrenocorticotropic hormone (ACTH)Controls cortisol (stress hormone) production by the adrenals. Cortisol regulates blood pressure, suppresses inflammation, increases blood sugar and control the body's use of carbohydrate, fat and protein.
Growth hormone (GH)Controls growth in children and adolescence. Maintains metabolism (energy production) and body structure in adults
Thyroid stimulating hormone (TSH)Controls the production of thyroid hormones (metabolism) by the thyroid gland
ProlactinLactation hormone involved in breast milk production
Follicle stimulating hormone (FSH)Controls reproduction; involved in sperm production in men as well as maturation and release of eggs in women
Luteinizing hormone (LH)Together with FSH, aids in reproduction
Anti-diuretic hormone (ADH)Helps the kidneys control body water retention
OxytocinInvolved in birth and lactation

  • Tumor growths in or near the pituitary gland
  • Head injury
  • Bleeding in or near the pituitary gland
  • Certain medications or cancer treatments (surgery, radiotherapy, immunotherapy, chemotherapy)


Loss of pituitary hormonal production can occur due to compression and/or loss of normal pituitary tissue. Growths or bleeding arising from the small space that the pituitary sits in, can also compress the nearby eye nerves causing visual changes and headaches.

Pituitary tumors while largely non-cancerous, may sometimes produce excessive hormones. Conditions associated with this include:

  • Acromegaly/Gigantism (excessive growth hormone)
  • Cushing’s disease (excessive cortisol)
  • Prolactinoma (excessive prolactin)
  • Central Hyperthyroidism (excessive TSH)
  • Lack of energy
  • Low sex drive
  • Irregular or abnormal cessation of menstruation
  • Unexpected breast milk production
  • Frequent headaches and visual changes/loss
  • Stunted growth or unusual growth spurt
  • Unexplained weight gain and development of diabetes
  • Difficult-to-control high blood pressure

Pituitary disorders are challenging to diagnose and require the expertise of specialists. Diagnosis requires careful investigation under supervised and controlled conditions. Investigations often occur step-by-step, from screening tests (suspicion), to confirmation tests, and localization (imaging). Do engage with your friendly endocrinologist throughout this journey.

Treatment depends on the diagnosis and severity of disorder. Treatment can be medical, surgical, or both, and may involve a multidisciplinary team of doctors.

Patients with pituitary disorders often require long-term monitoring even after the condition has been successfully treated. This is especially true of persons who have undergone previous pituitary surgery or radiation.​


Adrenal glands

The adrenal glands are a pair of small, triangular-shaped glands sitting above the kidneys. They produce hormones that regulate essential bodily functions such as blood pressure, response to stress, immunity, as well as metabolism.​


Adrenal hormone Function
CortisolA glucocorticoid hormone that regulates blood pressure, suppresses inflammation, increases blood sugar and control the body's use of carbohydrate, fat and protein. It can also decrease bone formation.
AldosteroneA mineralocorticoid hormone that regulates blood pressure, blood sodium and potassium.
Androgenic steroidsPrecursor sex hormones that are converted to testosterone in the testes (male) or estrogens in the ovaries (female).
Adrenaline and noradrenalineProduced in response to stressors and control the flight or fight response by increasing heart rate and blood pressure.

Adrenal nodules/masses:
  • Benign, non-secreting
  • Benign, increased secretion of particular adrenal hormones
  • Malignancy (originating from adrenal or metastasis)


Conditions associated with insufficient adrenal hormone production :
  • Addison’s disease (lack of cortisol and aldosterone)
  • Adrenal insufficiency (lack of cortisol)


Conditions associated with excessive hormone:
  • Primary hyperaldosteronism (excessive aldosterone)
  • Cushing’s syndrome (excessive cortisol)
  • Phaechromocytoma (excessive adrenaline or noradrenaline)
  • Individuals who are vulnerable to autoimmune dysfunction
  • Genetic conditions eg multiple endocrine neoplasia, familial hyperaldosteronism, congenital adrenal hyperplasia.​
  • Lack of energy
  • Loss of weight, poor appetite, nausea, vomiting, abdominal pain, darkening of skin
  • Fat gain around abdomen and face, thin skin, easy bruising, muscle weakness
  • Unexplained weight gain with development of diabetes
  • Difficult-to-control blood pressure
  • Episodic palpitations, sweating, giddiness, headache
  • Abdominal pain
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Adrenal disorders may be incidentally picked up on a scan without symptoms, or present with tell-tale signs and symptoms. They are challenging to diagnose and require careful evaluation under supervised conditions.

Investigations often occur step-by-step, from screening tests (suspicion), to confirmation tests, and localization (imaging). Do engage with your friendly endocrinologist throughout this journey.

Treatment depends on the diagnosis and severity of disorder. Treatment can be medical, surgical, or both, and may involve a multidisciplinary team of doctors. Patients with certain adrenal disorders require long-term medical monitoring.

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Contributed by Endocrinology
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