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Pituitary

The pituitary gland is deep in the brain and is considered the master gland of the body. It makes hormones that control other glands throughout the body. 

Excess prolactin

Prolactin is a hormone whose primary purpose is to stimulate milk production in lactating women. Outside of pregnancy and lactation, an excess of prolactin can be due to certain medications, tumors in the pituitary that produce excess prolactin, or tumors in or near the pituitary that interfere with normal suppression of prolactin.

  • Symptoms: nipple discharge (milk production), breast enlargement or tenderness in men, irregular or absent periods, infertility in men and women, low testosterone in men
  • Diagnosis: blood test for prolactin, sometimes MRI of the pituitary
  • Treatment: If due to medication, we will discuss if it is safe to reduce or stop the medication in coordination with other providers. If due to a tumor, this can usually be treated with medication that suppresses prolactin production. Rarely, surgery is needed to remove a tumor. 
Growth Harmone

Growth hormone has many functions in the body including regulating blood sugar, maintaining muscle, bone health and regulating fat distribution. 

  • Growth hormone deficiency
    • Symptoms: weight gain, low muscle mass, mood swings, abnormal cholesterol
    • Diagnosis: the hormone IGF-1, or insulin-like growth factor, is a surrogate marker for growth hormone since the level of growth hormone fluctuates rapidly throughout the day. If this is abnormal specialized stimulation tests can be done in the office or at a referral center to confirm the diagnosis. 
    • Treatment-replacement of growth hormone comes in the form of a daily injection

 

  • Growth hormone excess (acromegaly)
    This is a rare condition and usually due to a tumor in the pituitary that makes too much growth hormone

    • Symptoms: Weight gain, insulin resistance/diabetes, flushing, thickened facial features, increased ring/hand/foot/hat size, sleep apnea, carpal tunnel syndrome, headache, vision problems, arthritis
    • Diagnosis: the hormone IGF-1, or insulin-like growth factor, is a surrogate marker for growth hormone since the level of growth hormone fluctuates rapidly throughout the day. If abnormal, a glucose suppression test can be done to confirm the diagnosis.
    • Treatment: surgery to remove the tumor producing excess growth hormone and/or medication to suppress growth hormone may be prescribed.
Antidiuretic hormone (ADH)

Antidiuretic hormone (ADH or vasopressin) is a hormone that is important in regulating water balance

  • Diabetes insipidus is a condition of not enough ADH, either due to deficiency from the pituitary or a problem sensing ADH at the kidney
    • Symptoms: excessive thirst, excessive urination, an abnormal electrolytes
    • Diagnosis: blood tests of electrolytes, sometimes a water deprivation test, and imaging of the pituitary gland may be done
    • Treatment: replacement with medication like ADH and frequent monitoring of electrolytes
  • Syndrome of inappropriate ADH (SIADH) and other disorders of excess ADH
    • Symptoms are primarily due to abnormal concentrations of electrolytes due to excess water. They can include confusion, delirium, nausea, weakness, and in severe cases seizures.
    • Diagnosis: blood and urine tests of electrolytes
    • Treatment: if mild and chronic, this can be managed with attention to salt intake and careful monitoring with blood tests. If severe and sudden, this condition may require hospitalization.
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