Anterior pituitary insufficiency

In the Anterior pituitary insufficiency there is a partial or complete loss of pituitary anterior lobe hormones. These hormones include control hormones that act on other endocrine glands and effector hormones that have a direct effect on organs. The lost hormones can be substituted therapeutically.

What is anterior pituitary insufficiency?

Patients with anterior pituitary insufficiency show an axis-dependent failure of various hormones and hormonally controlled processes. The human endocrine system is a tight network. If an endocrine gland fails, this failure affects other hormonal glands, as hormones regulate each other.
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The anterior pituitary lobe forms the largest part of the pituitary gland. In this proportion, important hormones are synthesized and released into the body. In terms of shape, the anterior pituitary gland is a typical edocrine gland that mainly produces effector and control hormones. A complete or partial failure of the endocrine anterior pituitary functions is called Anterior pituitary insufficiency.

Control hormones such as TSH (thyroid-stimulating hormone), ACTH (adrenocorticotropic hormone), FSH (follicle-stimulating hormone) and LH l (luteinizing hormone) have a regulating effect on other endocrine organ activities. Effector hormones such as STH (somatotropic hormone), MSH (melanocyte-stimulating hormone) and prolactin, on the other hand, act directly on a specific effector organ.

The release of control hormones from the anterior pituitary gland in particular is influenced by releasing and release inhibiting hormones from the hypothalamus. If this is partially or completely disturbed, then there is an anterior pituitary insufficiency, and that too Hypopituitarism, Simmonds disease or HVL insufficiency designated.

Either certain hormones fail in the disease, or all hormones are affected by the insufficiency. In this context, a distinction is made between complete and incomplete insufficiency of the anterior pituitary lobe.

causes

The primary causes of HVL insufficiency are extremely variable. The cause of anterior pituitary insufficiency is either destruction or displacement of tissue of the pituitary gland. Even when the pituitary gland is no longer connected to the hypothalamus, HVL insufficiency occurs. Such conditions can occur, for example, in the context of tumor diseases.

Most pituitary tumors are benign tumors, such as pituitary adenoma. Insufficiency can also be present after neurosurgical interventions near the pituitary structures. The same applies when tissue has been damaged by radiation therapy. The failure of the endocrine functions is often preceded by degenerative changes that cause the tissue to die.

This can be the case, for example, in the context of stroke-related necrosis. In addition, autoimmune granulomatous processes such as sarcoid are a possible cause of anterior pituitary insufficiency. In addition, hemochromatosis and all inflammatory processes can trigger the inadequacy.

Sometimes the illness is also preceded by trauma, especially injuries to the brain. Since the hormone production of the anterior pituitary gland is influenced by the releasing and release inhibiting hormones of the hypothalamus, a failure of these hormones can also be the cause of HVL insufficiency.

Symptoms, ailments & signs

Patients with anterior pituitary insufficiency show an axis-dependent failure of various hormones and hormonally controlled processes. The human endocrine system is a tight network. If an endocrine gland fails, this failure affects other hormonal glands, as hormones regulate each other.

If the adrenocorticotropic HVL axis fails, there is secondary adrenal insufficiency, for example, which can manifest itself in the form of weight loss, decreased performance, hypoglycaemia, nausea, waxy skin structure and reduced skin pigmentation. When the tax hormonal axis is affected, secondary hypogonadism develops.

The secondary hair decreases. In men there is a loss of libido], which can be associated with erectile dysfunction. Women suffer from menstrual disorders or infertility. There is no puberty. If the somatrotropic HVL axis fails, short stature can occur.

If the thyroid axis is involved, however, secondary hypothyroidism develops, which shows the symptoms of an underactive thyroid, such as weight gain, cold intolerance, bradycardia, or dry and rough skin. A prolactin deficit plays a role especially for women and prevents breastfeeding. MSH failures cause skin pigmentation to decrease. If all axes mentioned are affected by failures, there is complete HVL insufficiency, which can cause a pituitary coma.

Diagnosis & course of disease

The doctor makes the diagnosis of anterior pituitary insufficiency through a survey of the hormonal status. Imaging is done to find out the cause of the HVL insufficiency. In addition, as part of the diagnosis, it is checked to what extent the regulating hormones of the hypothalamus are related to the insufficiency.

In this way, causal hypothalamic insufficiencies with secondary HVL insufficiencies are differentiated from primary HVL insufficiencies. The prognosis for patients with hypopituitarism depends primarily on how many axes are affected and how long the failure has existed.

Complications

The anterior pituitary insufficiency primarily results in an imbalance in hormones. This imbalance can generally have a negative impact on the patient's health. As a rule, there is a strong reduction in resilience and not infrequently a weight loss. Most of those affected also suffer from nausea and vomiting and show a changed skin structure.

The strength of the pigmentation can also decrease. In most people, anterior pituitary insufficiency also leads to a decrease in hair and persistence to erectile dysfunction, whereby women can be affected by menstrual disorders. In children, anterior pituitary insufficiency can lead to short stature. The skin becomes impure and dry as a result of this disease. In severe cases, people can fall into a coma.

The patient's immune system is also weakened, making various diseases faster and easier. The treatment of anterior pituitary insufficiency is usually done with hormone therapy. The disease progresses positively relatively quickly and the symptoms disappear.

However, the affected person may have to rely on this therapy for their entire life, as a causal treatment of anterior pituitary insufficiency is not possible. However, early diagnosis and treatment will not reduce life expectancy.

When should you go to the doctor?

An anterior pituitary insufficiency is primarily expressed by hormonal symptoms. Individuals who suddenly experience unusual weight loss or feel sick and dull for no apparent reason should consult their family doctor. Medical advice is also required if performance declines without a cause being identified. Nausea and vomiting, hypoglycemia and pain attacks are symptoms that must be clarified by a doctor in any case. Medical advice is required at the latest when there are external changes in addition to the signs mentioned.

A doctor should be consulted immediately if reduced skin pigmentation or a waxy skin structure can be found.Affected children should be brought to the doctor if puberty is an unusually long time coming. Women who suffer from menstrual disorders or infertility should discuss this with a gynecologist. Although these symptoms do not necessarily indicate anterior pituitary insufficiency, they must be clarified and treated if necessary. Cancer patients are particularly prone to HVI and should inform the responsible doctor if typical symptoms occur.

Doctors & therapists in your area

Treatment & Therapy

Anterior pituitary insufficiency is treated depending on the cause. In addition to surgical treatment options, drug therapy options are available that generally correspond to hormonal substitution therapy. Operations mainly take place in the case of causative tumor diseases. Active inflammatory processes are treated with anti-inflammatory drugs.

In the case of autoimmune diseases, on the other hand, the administration of immunosuppressants is indicated, which prevents the patient's immune system from causing even more damage to the glandular tissue. In the case of causative tumors, removal of the tumor can restore the full functional spectrum of the anterior pituitary gland.

On the other hand, if tissue has been damaged by inflammation, trauma, or necrosis, full regeneration is less likely. If necessary, those affected receive a lifelong hormone substitution for the axes that have failed due to the insufficiency. If control hormones in the anterior pituitary have failed, certain hormones are no longer produced in other glands.

In the case of hormone substitution, the patient is not given the HVL control hormones in this case. Instead, hormones that are no longer produced by the failed control of other glands are substituted, for example testosterone, thyroxine, somatotropin or cortisol.

prevention

Anterior pituitary insufficiency can only be prevented to the extent that tumors, trauma, inflammation and other injuries to the pituitary gland and hypothalamus can be prevented.

Aftercare

Complete regeneration is not always possible after treatment of anterior pituitary insufficiency. Patients therefore often have to take hormone substitutes for life. These should prevent deficiency symptoms. Regular check-ups are required in consultation with the doctor.

A precise examination of the hormonal situation takes place, which enables early help. Patients need sufficient patience and discipline for therapy and follow-up care. Continuous improvement is only possible if you adhere to the doctor's recommendations.

On the one hand, the focus is on taking the correct medication, on the other hand, the check-ups must be carried out on time. The so-called therapy compliance is also essential for long-term follow-up care. Otherwise, hormone fluctuations can occur, especially in times of stress, which have a negative effect on the state of health.

As part of the security after the illness, the affected persons should always have their emergency ID with them. There is also an emergency kit that is useful in difficult situations. In the often long recovery phase, patients should also take this set with them on day trips or longer trips in order to be prepared for emergencies. Follow-up care primarily relates to reducing health risks.

You can do that yourself

If the anterior pituitary lobe is insufficient, this means for the patient first and foremost that he has to be patient and adherent to the treatment during treatment. Because in order to avoid the various consequences that an anterior pituitary insufficiency can bring about, the prescribed medication (hormones) must be taken reliably according to the instructions of the doctors. This is especially true if the hormones have been prescribed in the form of sprays, gels or even injections.

Furthermore, the current hormone values ​​must be regularly re-recorded and checked. The adherence to therapy required for this - or "compliance", as doctors call it - requires a lot of time and consistency, but this is the only way to avoid major failure symptoms. It is advisable to keep a detailed record of the blood tests and their results. If the patient experiences unforeseen stress, the hormone levels should be re-measured as soon as possible.

In an emergency, pituitary insufficiency patients should always have an emergency ID card and an emergency kit with them. This should not be forgotten, especially on vacation trips or day trips.

Patients with anterior pituitary insufficiency who have lost their body hair often suffer greatly from this cosmetic impairment. But eyebrows in particular can now be filled with appropriate products or traced with permanent make-up.