Pituitary/Neuro-endocrine Disorders

Programs and Disease Treatment

Pituitary/Neuro-endocrine Disorders

The pituitary gland — located at the base of the brain — is considered the “master” gland of the body because it controls the secretion of the body’s hormones. The pituitary gland makes:

Prolactin to stimulate milk production after childbirth.
Growth hormone to stimulate growth in childhood and maintain a healthy body composition in adults.
Adrenocorticotropin (ACTH) to stimulate the production of cortisol (an important stress hormone) by the adrenal glands. Cortisol helps maintain blood pressure and blood glucose levels.
Thyroid-stimulating hormone (TSH) to stimulate the thyroid gland, which regulates the body’s metabolism and energy.
Luteinizing hormone (LH) to regulate testosterone in men and estrogen in women.
Follicle-stimulating hormone (FSH) to promote sperm production in men and stimulate the ovaries for ovulation in women.

Because the pituitary gland is close to the brain, disorders of the pituitary gland may also affect the brain. Disorders of or relating to the nervous and endocrine systems (especially as they function together) are called neuro-endocrine disorders.

The pituitary gland is regulated by a region of the brain called the hypothalamus, located in the lower central part of the brain. The hypothalamus secretes hormones that stimulate or suppress the release of hormones in the pituitary. The hypothalamus also secretes a hormone that causes the pituitary gland to stop the release of growth hormone. The hypothalamus is also important in the regulation of satiety (feeling full after eating), metabolism and body temperature.

Most diseases of the pituitary gland involve tumors in the area of the pituitary or the hypothalamus. Most pituitary tumors are benign (non-cancerous). Tumors can make the pituitary gland produce too much or too little of a hormone, which can cause problems in the body. Tumors may also cause headaches, vision problems or other health problems. Other types of brain tumors, such as craniopharyngiomas, germinomas, meningiomas, gliomas and chordomas can also involve the pituitary gland.

Pituitary disorders may also be caused by:

Radiation treatment of the brain (for other disorders)
Sheehan’s syndrome, a disorder that causes bleeding in the pituitary gland (a rare complication of pregnancy)
Lymphocytic hypophysitis, a rare inflammatory lesion of the pituitary gland, commonly affecting young women during late pregnancy or in the postpartum period.
Sarcoidosis
Rathke’s cleft cyst

Multidisciplinary Care

The Pituitary Disorders Clinic, based at Froedtert & The Medical College of Wisconsin, provides comprehensive and timely evaluation and treatment of people with disorders of the pituitary gland and surrounding areas of the brain. The team is headed by Medical College of Wisconsin endocrinologists and neurosurgeons with expertise in pituitary disease. Their knowledge and experience benefit patients with a wide range of pituitary disorders.

Physicians who specialize in radiation oncology, neuro-ophthalmology, neuro-interventional radiology, otolaryngology (ear, nose and throat) and neuro-oncology are also part of the Pituitary Disorders Clinic team. Because many vision and neurological problems may occur as the result of pituitary tumors, neuro-ophthalmologists — physicians who specialize in neurology and ophthalmology to treat visual problems related to the nervous system — are also an important part of the care team.

Diagnostic Tests

Screening tests and confirmatory tests for pituitary disease are performed in the Endocrine Diagnostic Unit at Froedtert & The Medical College. Testing consists of blood tests to determine hormonal deficiencies. Dynamic testing is also done in this unit.

Additional testing includes magnetic resonance imaging (MRI) to locate pituitary tumors and inferior petrosal sinus sampling (IPPS) to check adrenocorticotropic hormone (ACTH) levels. This is an outpatient test performed by interventional neuroradiologists (physicians who specialize in minimally invasive, image-based technologies/procedures to diagnose and treat diseases of the head, neck and spine.). With local anesthesia, catheters are advanced up to the inferior petrosal sinuses in the head using fluoroscopy guidance. Samples of ACTH are drawn from the sinuses and also from an arm vein. The samples are examined in a lab for the ACTH level, and the pituitary-to-arm ACTH ratios are calculated.

Treatments

Medical College of Wisconsin endocrinologists, surgeons and other team members provide the most advanced treatments available for the treatment of pituitary disorders. Treatment is based on each patient’s unique needs; team members thoroughly discuss all possible treatment options with each patient.

Treatment Options

Surgery, which may be recommended to remove hormone-producing tissue (typically in Acromegaly or Cushing’s disease), to reduce the volume of a tumor, or to reduce or remove non-hormone-producing tissue that may threaten surrounding structures in the future. The objective of surgery is to optimize cure and preserve gland function.

Neurosurgeons and specialized otolaryngologists at Froedtert & The Medical College of Wisconsin are highly experienced in removing pituitary tumors using a minimally invasive approach — the endonasal transsphenoidal endoscope. This advanced surgical technique offers many advantages over the traditional method of removing tumors (through an incision in the mouth). The endoscope is placed in the nose and moved to the tumor site. This method gives the surgeon a better view of the tumor, results in minimal blood loss and reduces possible complications. It also eliminates the need to place gauze or cotton (nasal packing) in the nasal area to control bleeding after surgery. In southeastern Wisconsin, Froedtert & The Medical College are unique in providing endonasal transsphenoidal endoscopic surgery. Our team members have expertise in treating even the rarest types of pituitary tumors.

Gamma knife therapy, a method for delivering focused radiation therapy to small pituitary tumors (as well as other tumors and lesions in the brain).

External radiation therapy, a method of delivering radiation therapy to larger pituitary tumors.

Non-surgical Options

Not all pituitary tumors require surgical removal and/or radiation therapy. These treatments include:

Dopamine agonist therapy, medication given to treat prolactin-secreting pituitary tumors and some growth-hormone-secreting pituitary tumors.

Somatostatin/octreotide therapy, for the treatment of acromegaly (excessive growth due to the production of excessive growth hormone by the pituitary gland). This therapy is directed at reducing growth hormone levels from growth-hormone-secreting pituitary tumors.

Hormonal Balance Restoration

For some patients, hormonal therapy and/or medication is given to restore hormonal balance. These treatments include:

Pituitary hormone replacement, hormones given to replace hormones not being produced by the pituitary gland. These include cortisol, thyroid hormone, vasopressin sex hormones, and growth hormone.

Pituitary/Neuro-endocrine Disorders

Medical College of Wisconsin endocrinologists are highly experienced in treating a wide variety of pituitary/neuro-endocrine disorders:

Pituitary masses/tumors

Pituitary adenomas
Craniopharyngioma
Rathke’s cleft cyst
Hypothalamic tumors
Optic chiasm tumors
Meningiomas
Lymphocytic hypophysitis
Nelson’s syndrome
Sarcoidosis

Disorders of the pituitary – hormone excess

Cushing’s disease/cortisol excess
Acromegaly/growth hormone excess
Hyperprolactinemia/prolactinoma
Secondary hyperthyroidism (TSH-producing adenoma)
Gonadotropin – secreting adenomas

Disorders of the pituitary – hormone deficiency

Pituitary adenomas
Apoplexy/Sheehan’s syndrome
Growth hormone deficiency
Secondary adrenal insufficiency
Secondary hypogonadism
Kallmann’s syndrome
Constitutional delay of puberty
Diabetes insipidus
Hemochromatosis
Traumatic brain injury

Pituitary Research

Medical College of Wisconsin researchers have conducted basic and clinical research for pituitary disorders including:

Researching prolactin regulation at the molecular and physiological level.
Clinical studies involving patients with Cushing’s disease.
Studying cell cultures to determine the effect of extensive radiation to pituitary tumor cells.

The Medical College of Wisconsin maintains a tissue bank of pituitary tumors that have been removed. The tumors are frozen for future use in research studies.

Last Review Date: Aug. 25, 2009