Diseases of the pituitary gland (hypophysis)

Cushing's disease is a disorder of the pituitary gland. It is caused by a small tumour that leads to increased production of adrenocorticotropic hormone (ACTH), which is responsible for regulating the function of the adrenal cortex. This in turn leads to increased production of cortisol, which ultimately leads to the clinical picture of Cushing's syndrome.

This syndrome is characterised by changes in physical appearance:

• full moon face
• bull neck
• truncal obesity (slender arms and legs with a big belly)

In addition, there are various metabolic changes leading to high blood pressure, diabetes mellitus and osteoporosis.

Acromegaly is the presence of a growth hormone-producing tumour in the pituitary gland.

In children and adolescents

When this condition occurs in childhood and adolescence, it leads to gigantism.

In adults

In adults, the growth plates of the bones are already closed and no further growth can take place. However, the hands, feet, nose, ears and chin can continue to grow. Patients report that their shoes or rings no longer fit. The dentist may notice that the spaces between the teeth become larger. The problem is that internal organs, such as the heart, can also grow. If left untreated, this can lead to cardiac dysfunction and a significantly reduced overall life expectancy.

A prolactinoma is an overproduction of prolactin.

Women and men affected

This can lead to breast growth with milk flow in both men and women. There is also a disruption in the production of sex hormones with the development of hypogonadism. This leads to testosterone deficiency in men and menstrual cycle disorders in women, including amenorrhoea, the complete absence of menstruation.

A prolactinoma is often diagnosed as part of the investigation of fertility disorders in the case of an unfulfilled desire to have children.

In the case of pituitary insufficiency, one or more hormones are no longer produced by the pituitary gland.

This can be caused by surgery or radiotherapy to the pituitary gland. A very large mass caused by a tumour in the pituitary gland can also disrupt normal hormone production. If this tumour is removed, the hypofunction can be corrected in some cases, but in others it may persist.

There are also rare congenital disorders in the development of the pituitary gland, which usually result in partial loss of function.

Diabetes insipidus has similar causes to pituitary insufficiency. It affects the so-called posterior lobe of the pituitary gland, where the hormone ADH is produced. This hormone plays an important role in regulating water and salt levels.

When this hormone is missing, more water is excreted. This means that the patient has to drink more - up to 10 to 20 litres a day.

Treatment consists of removing the cause or replacing the missing ADH hormone.