Pituitary disorders

Pituitary disorders can be classified as hypopituitarism or hyperpituitarism depending upon the particular hormone levels. Hypopituitarism can present as the deficiency of one hormone produced by the pituitary, multiple hormones or all the hormones produced by the pituitary simultaneously. A deficiency of all the hormones is called panhypopituitarism. Hypopituitarism may present as single hormone deficiency, such as hypothyroidism due to thyroid stimulating hormone TSH deficiency, Addison’s disease due to cortisol deficiency, hypogonadism because of follicular stimulating hormone (FSH) and luteinizing hormone (LH) deficiency, diabetes insipidus (DI) due to anti diuretic hormone (ADH) deficiency, growth hormone (GH) deficiency, pituitary apoplexy or Sheehan syndrome. Hyperpituitarism may present as hyperthyroidism i.e. TSH excess, prolactinoma leading to prolactin excess, acromegaly i.e. GH excess, Cushing’s disease i.e. cortisol excess or SIADH i.e. ADH excess. Symptoms and signs of these spectrum of diseases depend on the specific hormone deficiencies and the sequence of their lack. Diagnosis of these diseases is usually based on net hormone assays, stimulation tests, suppression tests, and imaging. Treatment is usually medical but in some instances surgery is required to remove the source of hormonal excess.