Hyperpituitarism (patient information)

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 * Associate Editor(s)-In-Chief: Jinhui Wu, M.D.

Overview
Hyperpituitarism is the disorder of excess secretion of adenohypophyseal trophic hormones, which is commonly caused by a functional pituitary adenoma. Usual symptoms depend on the cell types affected. Common clinical manifestations of hormone excess may include hyperprolactinaemia, Cushing's disease, precocious puberty, gigantism or acromegaly. Usual signs and symptoms include headache, excessive sweating, hoarseness, galactorrhea, sleep apnea, osteoporosis and hypertension. Hormone tests and cranial MRI may help disgnosis. Treatments of hyperpituitarism focus on surgery to remove the tumor and inhibition of synthesis or secretion of such abnormal hormones.

What are the symptoms of hyperpituitarism?
Signs and symptoms of hyperpituitarism are the excessive production of growth hormone and abnormal hormone excretion controlled by the pituitary, such as prolactin and thyroid hormones.
 * Gigantism in children.
 * Abnormal growth of hands and feet in adults
 * Headache
 * Visual field loss or double vision
 * Excessive sweating
 * Hoarseness
 * Galactorrhea
 * Sleep apnea
 * Carpal Tunnel syndrome
 * Joint pain and limitation of motion
 * Muscle weakness
 * Numbness or tingling of skin
 * Osteoporosis, kyphosis
 * Hypertension, arteriosclerosis, even heart failure

Who is at highest risk?

 * Pituitary tumor
 * Carcinoid tumors

Diagnosis

 * Hormone tests: Hyperpituitarism are is the excessive production of growth hormone and abnormal hormone excretion controlled by the pituitary, such as prolactin and thyroid hormones. In patients with hyperpituitarism, it shows elevated growth hormone level, accompanying diabetes, elevated IGF-1 factor (Insulin-like growth factor), elevated prolactin level, decreased free thyroxine level and elevated thyroid stimulating hormone (TSH).
 * Liver function and renal function tests: Patients with hyperpituitarism show elevated liver function, elevated phosphorus and blood urea nitrogen (BUN) levels.
 * Cranial MRI: Since pituitary tumors are the most common cause of this condition, it may show pituitary tumor signs in MRI. The MRI uses magnetic fields but which is a different imaging type from computed tomography (CT) to produce detailed images of the body.

When to seek urgent medical care?
If you develop signs and symptoms associated with hyperpituitarism, see your doctor to determine the cause. If you experience either of the following symptoms, seeking urgent medical care as soon as possible:
 * Palpitation
 * Chest pain
 * Severe hypertension

Treatment options
Treatment opinion depends on the cause and the cell types affected.


 * Treatments of pituitary tumor: Surgical removal of tumor is the first selection for the treatment. If failed, radiation therapy, or gamma knife radiation treatment may be helpful.
 * Inhibiting growth hormone (GH) synthesis or secretion: Doctors often use bromocriptine to inhibit GH synthesis and use octreotide to suppress GH secretion in at least two-thirds of patients with acromegaly.
 * For Cushing disease: The main treatment for patients with Cushing disease is transsphenoidal microsurgery. The adjunctive drugs such as metyrapone, aminoglutethimide and ketoconazole are used to inhibit the enzymes responsible for cortisol synthesis.
 * Treatments complications such as hypertension and arteriosclerosis: Regular monitoring of blood pressure is important. Low-salt and low-fat diets, drugs such as ACE inhibitors and angiotensin receptor blockers (ARBs) may help control blood pressure.

Diseases with similar symptoms

 * Marfan Syndrome
 * Fragile X syndrome
 * Thymoma
 * Tuberous sclerosis
 * Wilms tumor
 * Multiple endocrine neoplasia

Where to find medical care for hyperpituitarism?
Directions to Hospitals Treating hyperpituitarism

Prevention of hyperpituitarism
The prevention of hyperpituitarism is unknown.

What to expect (Outook/Prognosis)?
Prognosis of hyperpituitariam depends on the hormone level affected.
 * Whether the patient has been treated with surgery to remove the tumor.
 * For hyperprolactinemia: The undetectable level (<2 µg/L) of prolactin predicts cure with more than 90% probability. On the contrary, higher values within the reference range indicate incomplete removal of the adenoma.
 * Postoperative serum GH levels: Basal serum GH levels obtained immediately after surgery suggest the outcome of tumor recurrence in children with GH-releasing adenomas. The higher the GH levels are, the worse of the prognosis will be.
 * For hyperpituitariam resulting from corticotropinoma: The concentration of plasma cortisol concentration in the morning and corticotropin concentration over 24 consecutive hours measured 4-7 days after surgery may demonstrate the prognosis. The lower the concentrations are, the better outcomes will be.