Overactive Pituitary Gland

(Hyperpituitarism)
Having an overactive pituitary gland is called hyperpituitarism. It is most commonly
caused by noncancerous tumors. This causes the gland to secrete too much of certain
kinds of hormones related to growth, reproduction, and metabolism, among other
things.

What is the pituitary gland?

The pituitary gland is a tiny pea-sized endocrine gland located in a bony cavity in the
base of the brain. Endocrine glands secrete hormonal substances into the bodys
bloodstream.

The pituitary gland plays a major role in regulating a wide range of biological functions.
It secretes hormones involved in:

Metabolism
Growth
Blood pressure
Sexual maturation and function

Blood vessels connect the pituitary gland to a part of the brain known as the
hypothalamus. The brain tells the pituitary to increase or decrease the secretion of
certain hormones.

Sometimes the pituitary is called the master gland because it controls the activity of
other endocrine glands. The pituitary gland consists of three parts: the anterior,
intermediate, and posterior lobes.

The anterior lobe, which makes up about 80% of the gland, secretes these hormones:

Adrenocorticotropic hormone (ACTH) causes the adrenal glands to produce

steroid hormones, especially cortisol.
Growth hormone (GH) regulates the bodys growth, metabolism, and
composition.
Thyroid stimulating hormone (TSH) causes the thyroid gland to produce
hormones.
Gonadotropins luteinizing hormone (LH) and follicle stimulating
hormone (FSH) cause the ovaries and testes to secrete sex hormones
involved in reproduction.
Prolactin stimulates milk production in women who have given birth.
The intermediate lobe secretes only one hormone:

Melanocyte-stimulating hormone affects skin pigmentation.

The posterior lobe stores and lets out two hormones that are produced by the
hypothalamus:

Antidiuretic hormone (ADH) regulates water and electrolyte balance.

Oxytocin is involved in uterine contractions during childbirth and the production
and release of breast milk.
 What happens when the pituitary gland
becomes overactive?
Pituitary Hyperfunction
Physiological Pituitary Hyperfunction without pituitary lesion
o failure of the target organ leads to loss of normal feedback inhibition e.g., thryroid
failure TSH hypersecretion
chronic hypersecretion can lead to pituitary hypertrophy (reduced to normal with
replacement therapy)
o pregnancy estrogen surges stimulate hypersecretion of lactotrophs (prolactin from the
pituitary)
o stress infection, starvation, etc will alter hormone secretion (especially ACTH; also GH)
Pathologic Pituitary Hyperfunction involves hypothalamic-pituitary axis
o pituitary adenoma most common pituitary pathology (5-15% at autopsy,
assymptomatic)
almost always benign; can grow to be locally invasive
monoclonal, primarily arise from somatic cells (evidence that they are primary
pituitary tumors)
85% are functional (secrete hormone): PL (40%); GH (20%); gonadotrophs
(15%); ACTH (10%); others rare

Endocrine - Hyperfunction of the Anterior Pituitary

Question Answer

excess secretion of GH giantism if child or acromegaly in adult, atheroscrolosis, HF, DM

excess secretion of prolactin Lactation

excess ACTH secretion Cushings

Treatment surgical removal or radiation of gland, transsphenoidal (through the nose)

Post-op nursing care for Neuro checks to monitor for signs of cerebral edema. Monitor serum sodium and
surgical removal urine output and specific gravity for signs of diabetes insipidus. Watch for signs and
symptoms of target gland deficiency for all hormones

Hyperfunction of the Anterior benign pituitary tumor

Pituitary usually the result of a

Symptoms may include -headache

-visual disturbances (because tumors
put pressure on the optic nerves)
Octreotide does what inhibits the production of growth hormone (GH)

When the pituitary gland is overactive, it secretes excessive amounts of some

hormones, usually due to the presence of a benign (noncancerous) tumor. Overactivity
of the pituitary gland is called hyperpituitarism.

Several disorders related to an overactive pituitary gland can occur. These include:

Cushings syndrome (hypercortisolism): If the pituitary gland secretes too much

ACTH, the adrenal glands may release too much cortisol. Cortisol regulates the
metabolism of proteins, fats, and carbohydrates. It is also involved in the bodys
inflammatory and immune responses. Symptoms of Cushings disease may include:

Accumulation of fat in the upper body

Excessive facial hair in women
Pink or purplish stretch marks on the abdomen
Tendency to bruise easily
Bones may become fragile and tend to break more easily

Acromegaly: This disorder is caused by secretion of excessive amounts of growth

hormone (GH) in adults. Acromegaly can cause:

Hands and feet to grow

Change in facial structure jaw and brow may stick out and the nose, tongue, and lips
may get bigger
Skin becoming thick, coarse, and oily
Irregular periods in women and erectile dysfunction in men
Increased risk for high blood pressure, diabetes, heart attack, and certain types of
cancer

In children and adolescents, excessive levels of growth hormone can result in a

condition called gigantism. Children with this condition may have unusually long arms
and legs and may grow to heights of 7 to 8 feet or more.

Prolactinoma: A tumor on the pituitary known as a prolactinoma may cause the gland
to secrete too much prolactin. High levels of prolactin can disrupt normal reproductive
functions in men and women by interfering with hormones produced by the testes and
ovaries.

A prolactinoma can cause women who are not pregnant or nursing to experience
tenderness of the breasts and start to produce breast milk (galactorrhea). Their
menstrual periods may become irregular or might stop altogether. Women may become
infertile or lose interest in having sex. Having intercourse may be painful due to vaginal
dryness.
For men, the most common symptom of prolactinoma is erectile dysfunction. Men also
may experience a decrease in or loss of sex drive, lower fertility, or loss of energy. In
rare cases, men may secrete milk from their breasts or, when the prolactinoma is large,
blindness or difficulty seeing can occur.

Hyperthyroidism: If the pituitary adenoma causes overproduction of thyroid stimulating

hormone (TSH), the thyroid gland will become hyperactive. Symptoms may include:

Nervousness
Rapid or irregular heartbeat
Weight loss
Fatigue
Muscular weakness

What causes an overactive pituitary gland?

Benign tumors are the most frequent cause of an overactive pituitary. Generally it is not
known why these tumors occur. Depending on which types of cells are affected, the
pituitary gland will start to secrete excessive amounts of one or two hormones. In some
cases, pituitary tumors may result from an inherited condition known as multiple
endocrine neoplasia type 1(MEN1). This disorder also causes benign tumors of the
pancreas and parathyroid glands. In rare cases, a cancerous tumor or a disorder of the
hypothalamus may be the underlying cause.

How common is an overactive pituitary?

Small benign pituitary tumors (adenomas) are fairly common. They may be either
secreting (releasing excess amounts of hormones) or non-secreting and do not cause
any symptoms. Prolactinomas are the most common type of pituitary tumors, occurring
in about 1 out of 10,000 people. They are more common in women than in men.

Acromegaly is a very rare disorder that occurs in only about 3 out of 1 million people
each year. It generally is diagnosed in adults age 40 to 45.

Cushings syndrome is a relatively rare disorder that occurs mainly in adults from age
20 to 50 years old. When the syndrome is caused by an adenoma, it is about 5 times
more common in women than in men.

How is an overactive pituitary diagnosed?

Your doctor will ask you about your medical history and any symptoms you are having.
He or she may order laboratory tests to measure the levels of hormones in your blood
or urine. Various diagnostic tests will be performed depending on the underlying
disorder that may be present.
 If a prolactinoma is suspected, tests will be performed to measure prolactin levels in the
blood. Hypothyroidism (an underactive thyroid) can also cause elevated prolactin levels,
so tests should be done to rule out this possibility.
In the case of acromegaly, blood levels of growth hormone are usually elevated. GH
levels can change over time because the pituitary gland secretes the hormone in spurts.
Often an oral glucose tolerance test is performed to diagnose acromegaly. Healthy
people experience a drop in blood GH levels after drinking glucose, unlike people with
acromegaly.
In the case of Cushings syndrome, tests may be ordered to rule out other causes, such
as a tumor on the adrenal gland or the use of glucocorticoid drugs. Other tests include
the high-dose dexamethasone suppression test and specialized blood sampling, in
which a blood sample is taken from the veins of the sinuses that drain blood from the
pituitary gland.
If laboratory diagnostic tests suggest that a tumor is present, radiologic imaging tests will
be performed to determine the size and location of the tumor. Usually magnetic
resonance imaging (MRI) is more sensitive in this case than a computerized tomography
(CAT) scan. CAT scans may be used with patients who cannot undergo MRI, such as
those with pacemakers or other implants.

How is an overactive pituitary treated?

The treatment will depend on the underlying cause.

Surgery: A procedure called a transsphenoidal adenomectomy is usually recommended

for patients with acromegaly or Cushings disease. The surgeon makes a small incision
through the nose or upper lip to reach the pituitary and remove the tumor. Although this
procedure is very delicate, it has a success rate higher than 80% when performed by
experienced surgeons. Transsphenoidal surgery is most effective for small tumors
(under 10 mm in diameter). Potential drawbacks include long-term dependence on
pituitary hormone replacement therapy and cerebrospinal fluid leakage.
Medication: Drugs may be used to shrink large tumors before surgery or in cases where
surgery is not an option. Medication to reduce prolactin levels is usually the preferred
treatment for patients with a prolactinoma. Patients with acromegaly may be treated with
drugs used to lower growth hormone levels and shrink tumors.
Radiation: Radiation may be used to treat patients who cannot undergo surgery or who
have some residual tumor tissue after surgery and do not respond to medication.

There are two approaches to radiation, conventional and stereotactic therapies:

o Conventional radiation therapy is administered in small doses over a period of 4 to 6
weeks. One drawback is that radiation treatments can damage normal tissue
surrounding the tumor.
o Stereotactic therapy provides a high-dose beam of radiation targeted at the tumor. It
may be completed in one session, resulting in less damage to surrounding tissue. Most
patients that undergo radiation treatment require hormone replacement therapy due to a
gradual decline in the secretion of other pituitary hormones.