The pituitary gland is the “commander in chief” of our body. This small gland is responsible for the production of hormones, which in turn regulate the functioning of other glands and the production of dozens of other hormones. If the pituitary gland begins to produce substances in excess or insufficient quantities, this leads to the development of various diseases.
The SANMEDEXPERT clinic successfully diagnoses and treats pituitary dysfunction, which helps to effectively treat patients and prevent dozens of diseases.
Causes of dysfunction
Pituitary adenoma is a benign tumor, the main reason why the gland begins to produce large amounts of the hormone.
A decrease in secretion can be caused by a greater number of factors:
- irradiation;
- cerebral hemorrhages;
- traumatic brain injuries;
- surgical intervention;
- congenital pathologies of the pituitary gland;
- brain tumors compressing the gland;
- any form of cerebrovascular accident;
- inflammatory diseases (encephalitis, meningitis).
Pituitary. Location.
Location of the pituitary gland in the skull
Topographically, it is located approximately in the very center of the head.
The weight of the pituitary gland is only about 1 gram, and its dimensions do not exceed 14-15 mm.
The pituitary gland has an oval shape and is located in an isolated bone bed (sella turcica), which also has an oval shape. The pituitary gland is surrounded by bone formations on three sides - front, back and bottom. On the sides of the pituitary gland are the cavernous sinuses - hollow cavities consisting of sheets of dura mater, inside which pass such important vessels as the carotid arteries and nerves, most of which control the movement of the eyeballs. From above, the cavity of the sella turcica is also limited by a fibrous layer of the dura mater - the diaphragm, which has a hole in the center, through which the pituitary gland, through the pedicle, is connected to one of the parts of the brain - the hypothalamus. Figuratively speaking, the pituitary gland hangs on a stalk (stem) like a cherry on a stem.
As a rule, the pituitary gland occupies the entire volume of the sella turcica, but there are various options when it occupies only half of it or, on the contrary, the pituitary gland increases in size, even slightly extending beyond the upper boundaries of the sella turcica.
Symptoms of pituitary gland disorders
Signs of operational problems should also be divided into two groups.
So, you can suspect a lack of hormones produced by the pituitary gland if you have the following symptoms:
- Hypothyroidism develops as a result of decreased efficiency of the thyroid gland. It manifests itself in the form of constant fatigue, weakness in the limbs, muscle and headaches, brittle nails and dry skin, and a constantly depressed mood.
- Dwarfism is dangerous because the first signs of the disease appear only at 2-3 years of age. The baby's growth and physical development slow down. But if treatment is started immediately, the disease can be overcome and the child’s growth will normalize.
- Disruption of the anterior pituitary gland leads to the development of hypopituitarism. Its symptoms depend on which hormone is missing in the body. As a rule, the disease is the cause of infertility. Women do not have menstruation; men are diagnosed with impotence, testicular atrophy, and a decrease in sperm count.
- With diabetes insipidus, which develops due to a lack of vasopressin, the patient experiences a constant feeling of thirst and a frequent urge to urinate. The disease is also signaled by an increase in the volume of urine excreted (up to 20 liters).
Diseases caused by an excess of hormones manifest themselves as follows:
- Hyperprolactinemia is a common cause of male and female infertility. The main symptom of the disease, both in men and women, is milk secreted by the mammary glands.
- An excess of growth hormone leads to the development of gigantism. The main symptom is a small head with great height (2 meters) and long limbs. Many patients with this diagnosis do not live to old age, since the disease is accompanied by a large number of complications.
- The difference between acromegaly is that growth hormone begins to be produced in excess after the development of the body has completed. In this case, the bones, feet, and facial part of the skull increase.
- A serious disease is Itsenko-Cushing's disease. Obesity, decreased immunity, high blood pressure, sexual dysfunction are the main symptoms.
Let's talk separately about the symptoms of pituitary adenoma. It is necessary to undergo examination in the following cases:
- A sharp decrease in vision.
- Headaches do not stop even after taking special medications.
- The appearance of signs of one of the diseases described above.
Is MRI of the pituitary gland without contrast informative?
MRI of the pituitary gland with and without contrast: A - pituitary gland of normal size (circled), B - symmetrical calcifications (arrows)
The question is what is better to do: “MRI of the pituitary gland with or without contrast?” - the doctor must decide. The latter will recommend the characteristics of the device that are acceptable for obtaining high-quality images: scans made using low-field devices with an open circuit are not very informative. It is optimal to undergo examination on a tomograph with a power of 1.5 Tesla.
Given the size of the pituitary gland (about the size of a pea), MRI is preferably performed with the introduction of a contrast agent. Soluble gadolinium salts (chelates) are used as a dye, which do not pose a danger to the body and, when accumulated in tissues, provide better visualization. Side effects occur in less than 1% of people. Contrasting is limited by:
- a history of significant allergic reaction (such as Quincke's edema) to gadolinium;
- pregnancy regardless of stage;
- an advanced form of renal failure, which requires replacement cleansing therapy.
MRI of the pituitary gland with contrast in children under 12 years of age is performed within the walls of the hospital. Enhanced magnetic resonance imaging is prescribed as part of a preoperative assessment before removal of a tumor (including adenoma) or cyst of the cerebral appendage, to determine the nature of tissue changes after the intervention (allows one to differentiate a formed scar from a relapse of a neoplasm), etc. As an additional method, CT scan, which better demonstrates changes emanating from bone structures and shows pathologies of the sella turcica, hemorrhages in the pituitary gland. MRI of the pituitary gland without contrast is not very informative.
Diagnosis and treatment
If you suspect a dysfunction of the pituitary gland, you should contact experienced endocrinologists at our clinic.
Diagnostics is carried out in several stages:
- A conversation with the patient, the subject of which is complaints, chronic diseases, and the presence of a genetic predisposition.
- Clinical studies, in particular blood tests to determine hormone levels.
- Ultrasound of the brain and/or tomography is a mandatory part of the examination.
Treatment of pituitary dysfunction is a long process. In most cases it is lifelong. The fight against diseases is carried out by prescribing replacement therapy, which makes up for the lack of hormones, or taking medications to suppress the increased activity of the gland. Surgery and radiation therapy are prescribed if a tumor is present.
Preparing for an MRI of the pituitary gland
To obtain high-quality images during the MRI procedure of the pituitary gland, you should lie still.
You must take with you to the clinic the results of previous studies, hospital extracts regarding the disease, a referral, a passport, and money. MRI of the pituitary gland does not require any preparatory measures and can be performed at the time of application. There are a number of nuances:
- Before the MRI procedure, you should deposit all items containing metal - keys, bank cards, coins, watches, etc. Clothing is preferable to a loose fit, without zippers.
- Before the diagnosis begins, the patient fills out a questionnaire indicating the presence of a functioning pacemaker, an injector for drug delivery, a neurostimulator, the presence of staples and clips installed on blood vessels, shrapnel, shavings in the body and other items that are contraindications to magnetic resonance imaging. A woman should notify her doctor about early pregnancy - MRI of the pituitary gland is considered safe for the fetus starting from the second trimester.
- If you plan to perform contrasting during lactation, it is necessary to make a supply of milk in advance for several subsequent feedings (16-20 hours), the excess is expressed and disposed of.
- Some patients develop reactions from the autonomic nervous system to the administration of a gadolinium-based drug - nausea, metallic or salty taste in the mouth, dizziness. The likelihood of their occurrence is less if you have a light snack 40 minutes before the test, for example, drinking sweet tea with cookies.
- MRI of the pituitary gland in children under 5 years of age who are unable to comply with the requirements of medical staff, patients with mental illness and claustrophobia is performed in a hospital setting under sedation.
- The duration of the diagnostic procedure is about 35-45 minutes; to avoid blurring on the scans, you should lie as still as possible. There are no obstacles to daily activities or driving a car after MRI.
Normal levels of pituitary hormones
| Hormone | Normal indicator |
| Thyroid-stimulating hormone | 0.6 – 3.8 µIU/ml (RIA method) 0.24 – 2.9 µIU/ml (IF method) |
| T3 – thyroxine | 2.6 – 5.7 pmol/l |
| T4 – triiodothyronine | 9 – 220 pmol/l |
| Adrenocorticotropic hormone | 0 – 50 pg/ml |
| Luteinizing hormone | 2.12 – 4 mIU/ml (in men) 18.2 – 52.9 mIU/ml (in women during the ovulation period), 3.3 – 4.66 mIU/ml (in women in the follicular phase), 1, 54 – 2.57 mIU/ml (in women in the luteal phase), 29.7 – 43.9 mIU/ml (in women during menopause) |
| Follicle stimulating hormone | 1.9 – 2.4 mIU/ml (in men), 2.7 – 6.7 mIU/ml (in women during the ovulation period), 2.1 – 4.1 mIU/ml (in women in the luteal phase) , 29.6 – 54.9 mIU/ml (in women during menopause) |
| Prolactin | 100 – 265 mcg/l (in men), 130 – 140 mcg/l (in women of childbearing age), 107 – 290 mcg/l (in women during menopause) |
| Somatropin | 0 – 10 ng/ml |
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Growth hormone (somatotropin)
The endocrine system regulates human body growth, protein synthesis, and cell replication. The main hormone involved in this process is growth hormone, also called somatotropin, a protein hormone produced and secreted by the anterior pituitary gland. Its primary function is anabolic: it directly accelerates the rate of protein synthesis in skeletal muscle and bone. Insulin-like growth factor is activated by growth hormone and indirectly supports the formation of new proteins in muscle cells and bone. After 20 years, every subsequent 10 years a person’s growth hormone level decreases by 15%.
Somatotropin has the effect of an immunostimulant: it is able to influence carbohydrate metabolism, increasing blood glucose levels, reduces the risk of fat deposits and increases muscle mass. The glucose-lowering effect occurs when growth hormone stimulates lipolysis, or the breakdown of fat tissue, releasing fatty acids into the blood. As a result, many tissues switch from glucose to fatty acids as their primary source of energy, meaning less glucose is supplied from the blood.
Growth hormone also initiates a diabetogenic effect, in which it stimulates the liver to break down glycogen into glucose, which is then deposited into the blood. The name "diabetogenic" comes from the similarity of elevated blood glucose levels observed between people with untreated diabetes and people suffering from excess growth hormone. Blood glucose levels increase as a result of a combination of glucose-sparing and diabetogenic effects.
The amount of growth hormone in the human body changes throughout the day. The maximum is achieved after 2 hours of sleep at night and every 3-5 hours during the day. The peak level of the hormone is observed in a child during intrauterine development at 4-6 months - 100 times more than in an adult. You can increase the level of somatotropin through exercise, sleep, and the use of certain amino acids. If the blood contains large quantities of fatty acids, somatostatin, glucocorticoids and estradiols, the level of growth hormone decreases.
Dysfunction of the endocrine growth control system can lead to several disorders. For example, gigantism is a disorder in children caused by the secretion of abnormally large amounts of growth hormone, resulting in excessive growth.
A similar complication in adults is acromegaly, a disorder that causes the bones of the face, arms, and legs to grow in response to excessive levels of growth hormone. This is reflected in the general condition by muscle weakness and pinched nerves. Abnormally low levels of the hormone in children can cause poor growth, a disorder called pituitary dwarfism (also known as growth hormone deficiency), sexual development, and mental development (significantly affected by an underdeveloped pituitary gland).
Treatment of anterior pituitary insufficiency
Treatment for hypopituitarism takes two forms:
- causal relationship,
- replacement treatment.
Causal treatment consists of eliminating the cause of pituitary insufficiency (surgical treatment of tumors, treatment of inflammation). Replacement therapy, on the other hand, aims to correct the deficiency of hormones by administering them in the form of medications.
The most important thing is to restore the correct concentration of cortisol , a hormone of the adrenal cortex, the deficiency of which can be life-threatening. To do this, 20-30 mg of hydrocortisone is administered daily, of which 2/3 of the dose is taken by the patient in the morning and 1/3 of the dose in the afternoon. If oral administration is not possible, parenteral administration is used. In stressful situations (surgery, infection), the dose of hydrocortisone should be several times higher.
To reduce the symptoms of secondary hypothyroidism, the synthetic thyroid hormone L-thyroxine . The dose is selected individually depending on the clinical condition and the concentration of thyroid hormones in the blood.
In men, gonadal dysfunction is treated with testosterone in the form of long-acting drugs administered intramuscularly once every 1-2 weeks. In women, estrogen-progestogen therapy is used. Such treatment not only restores health in the sexual and mental spheres, but also inhibits premature aging, the accelerated development of atherosclerosis and osteoporosis, which are a consequence of a deficiency of sex hormones.
Growth hormone replacement therapy is commonly used in children. The administration of GH to adults with hypopituitarism is currently being investigated. Patients with hypopituitarism should follow a sodium-rich diet to prevent a drop in blood pressure due to adrenal insufficiency.
Hypopituitarism is associated with constant use of hormonal drugs and monitoring the effectiveness of therapy. This requires the patient to be involved in the treatment process and collaborate with the physician to minimize symptoms of the disease and, in special situations (eg, surgery in a patient with ACTH deficiency), to prevent the occurrence of a life-threatening condition by appropriate modification of therapy.
Lovtsevich Irina Nikolaevna
dermatologist, cosmetologist
Information about the doctor
Lovtseva Irina Nikolaevna - venereologist, 27 years of experience. Discount on doctor's appointments! All reviews about the doctor. Sign up online or by phone.
Accepts adults and children.
Conducts diagnostics, treatment, prevention of dermatological diseases, deals with minor surgery in dermatology and cosmetology, laser dermatology, laser cosmetology, medical pedicure and manicure, aesthetic cosmetology, injection cosmetology, therapeutic cosmetology using a wide range of peelings, masks, serums, creams, cosmetology in trichology, body cosmetology.
