Pituitary insufficiency is defined as failure of the gland to make one or more of the following anterior pituitary hormones: growth hormones (GH), prolactin (PRL), adrenocorticotropin (ACTH), thyrotropin (TSH), leuteinizing hormone (LH), or follicle stimulating hormone (FSH).
Hypopituitarism can be caused by factors that disrupt normal pituitary function. These include pituitary, hypothalamic, or parasellar disease, which causes displacement, infiltration, or destruction of the gland. Examples include meningiomas, craniopharyngiomas, optic nerve gliomas, nasopharyngeal tumors, and pineal dysgerminomas.
If damage is located at the pituitary stalk, all the anterior pituitary hormones (TSH, LH, FSH, GH, and ACTH) decrease, while prolactin (PRL) rises. This rise in prolactin results from the loss of the inhibitory effect of hypothalamic dopamine on the lactotrophs.
Associated Hypopituitary Conditions
- Adrenal Insufficiency
- Hypogonadism (men and women)
- Diabetes insipidus
- Growth hormone insufficiency
Signs and Symptoms
Non-specific symptoms, such as fatigue and weight loss (and other symptoms of adrenocortical insufficiency), are often due to ACTH deficiency. Physical characteristics, such as pubic and axially hair loss in women, with serum sodium levels being low, are also indicative of low ACTH release by the pituitary. Morning cortisol values lower than 10 ug/dl or ACTH stimulated values less than 20 ug/dl are considered indicative of secondary adrenal insufficiency.
Hypothyroidism is primary when the thyroid is not working, as in thyroiditis or Hashimoto’s’ disease. However, in secondary hypothyroidism, thyroid hormone deficiency is secondary to loss of hormones secreted by the pituitary of hypothalamus. The signs and symptoms of secondary hypothyroidism are usually milder than primary hypothyroidism. In some cases, massive pituitary tumors may not result in obvious signs of hypothyroidism. TSH ranges may be only mildly lowered, with T3 in the normal range and with normal to low T4 levels.
The single most important hormone deficiency to identify is cortisol because cortisol deficiency can be life threatening.
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Growth Hormone Deficiency
Growth hormone secretion naturally decreases in the second decade of life and gradually decreases until at the ago of 60, 15% of GH levels occur as opposed to the second decade of life.2 Growth hormone deficiency not only has been treated in children but now also is recognized in the treatment of adults. Side effects of GH therapy include carpal tunnel syndrome, cardiac hypertrophy, edema, joint pain, and hyperglycemia.
A study of 237 hypopituitary adults with GH deficiency was studied in Sweden. Patients were surveyed before and after taking three years of GH therapy. Patients started off at mean dose of 13 mg per day and the mean maintenance dose was 37 mg per day. Research end points measured included visits to the doctor, number of days in hospital. In patients who took the GH therapy, all end points improved significantly after 12 months. Overall, quality of life was improved, as did the amount of physical activity and the patients’ satisfaction with their level of physical activity.3 Although quite controversial, healthy aging adults who had no GH deficiency, as defined by conventional pathology measures, were given GH injections. The objective of GH therapy was to optimize health rather than treat an illness. Combining GH injections with lifestyle changes resulted in improvements not only in feeling of well-being but also in objective lab measures. Insulin sensitivity, lipid profiles, and other arteriosclerosis risk factors, as well as immune profiles, were improved. Other end points such as lean muscle mass increase, decrease of fat body composition, increased energy, lower cholesterol, increase bone density and improved short term memory.4
In another study the use of supraphsyiological doses of GH was administered to 30 healthy physically active adults mean age 25.9 years. No significant change in intracellular water was detected, however there was an increase in fat free mass by 5.3%, indicating the anabolic effects of GH.5
However, these injections are prohibitively costly (USD $500 to $1500 dollars per month) to most people because this treatment is its not covered by most private or state health insurance coverage, unless deemed medically necessary. Nevertheless, it has become a popular therapy among the wealthy and performed by ‘anti-aging’ physicians.
Conventional Medical Treatment [Special Head=SH]
This would include the use of growth hormone injection. It has been successfully done for the last 30 years. Currently, growth hormone therapy is available from recombinant DNA therapy rather than human cadavers. The injections are administered subcutaneously with a weekly dose totaling 30 mg/kg per week.
Naturopathic Medical Treatment and Prevention [SH]
In addition to standard growth hormone injections, amino acid therapy is recommended to help stimulate human growth hormone level. The use of arginine intravenously has demonstrated to be effective in increasing growth hormone levels. Orally 5g and 9g of arginine caused a significant GH response. However, at higher doses, such as 13g, digestive side effects occurred with no further increase of GH stimulation. The rise in GH concentration occurs within 30 minutes and peaks at 60 minutes after oral ingestion.6