Pituitary and Adrenal

What do the pituitary and adrenal glands do?

The pituitary is a pea-sized gland at the base of the brain that regulates many hormones. The adrenal glands are two small glands above the kidneys that make a hormone called cortisol. NIDDK writes that cortisol, often called the “stress hormone,” is essential for life.

Pituitary tumors

The Endocrine Society writes that a pituitary tumor is the most common pituitary disorder. Almost all are benign, and cancerous ones are extremely rare. MedlinePlus says many cause no symptoms. Tumors fall into two groups: “active” ones that make too much of a hormone, and “inactive” ones. A prolactinoma is the most common active type.

Symptoms come in three groups:

• Pressure on nearby structures: headache and vision problems, especially loss of side vision. An inactive tumor sometimes causes double vision as well.
• Too much hormone:
  • Prolactin: irregular or absent periods, milk production without pregnancy, infertility, reduced sex drive. In men, erectile dysfunction and breast enlargement.
  • Growth hormone: acromegaly. The NHS writes that the hands, feet, face and tongue become larger, with tiredness, sweating, headache, joint pain and sometimes sleep apnea. It usually appears between ages 30 and 50.
  • ACTH: Cushing’s disease.
• Too little hormone (underactive pituitary): tiredness, dizziness, dry skin, weight changes, nausea, low blood pressure, mood changes and sleep problems.

Cortisol conditions

Underactive adrenal glands (Addison’s). The NHS writes that it is a rare condition, most often appearing between ages 30 and 50, and that its most common cause is the immune system attacking the adrenal glands. Symptoms: severe tiredness, darkening of the skin, loss of appetite, weight loss, abdominal pain, nausea and vomiting, craving salty food, dizziness when standing, and muscle and joint pain. Treatment is a daily steroid medicine, usually for life. The NHS says never to stop it suddenly, to always keep a supply, and to carry a steroid emergency card.

Excess cortisol (Cushing’s). The NHS writes that it is a rare condition and that its most common cause is long-term use of high-dose steroid medicines. A benign pituitary or adrenal tumor is another cause. NIDDK says it is three times more common in women than in men. Symptoms: fat on the neck, back and abdomen with thin arms and legs, a round, red face, easy bruising, stretch marks, muscle weakness, irregular periods and excess hair. Complications if untreated: diabetes, high blood pressure, osteoporosis, kidney stones and stroke (NHS and NIDDK).

Who should be seen?

Make an appointment if:

• You have a headache or vision problem with no explanation.
• Your periods are irregular or have stopped, and you have milk production without pregnancy.
• Your hands, feet or face have become larger. The NHS says a doctor sometimes compares photos of you from the past two years.
• Along with the symptoms above, you have severe tiredness, dizziness when standing, unexplained weight loss or a craving for salty food.
• You have taken cortisone pills or injections for a long time and you have symptoms of Cushing’s.

How is it evaluated?

• Pituitary tumor: The Endocrine Society writes blood tests for hormones, a pituitary MRI, a visual field test and sometimes stimulation tests.
• Underactive adrenal glands: The NHS writes the Synacthen test, which measures a blood sample before and after an injection, plus hormone and thyroid tests. NIDDK says CT and MRI find the cause.
• Cushing’s: The NHS writes cortisol in blood, urine or saliva. NIDDK says two confirming tests are usually needed, and before that the doctor checks for similar conditions and for steroid use.

What does treatment generally look like?

• Pituitary tumor: The Endocrine Society writes that, depending on the type, size and symptoms, medicine alone or monitoring with MRI is sometimes enough. For a prolactinoma, pills from the dopamine agonist group are usually used. Surgery (usually through the nose) is for tumors that threaten vision or are growing. Radiation therapy is needed less often. After surgery, replacement medicine or hormones may be needed.
• Acromegaly: The NHS writes surgery, radiation therapy, or injections and pills to lower growth hormone.
• Addison’s: Replacement steroid medicine, usually for life. NIDDK says the amount may be adjusted during surgery, illness, pregnancy or serious injury. Some patients need a high-salt diet.
• Cushing’s: The NHS writes that if a medicine is the cause, the doctor lowers it gradually. If a tumor is the cause, surgery or radiation therapy. There are also medicines to reduce cortisol production.

Stopping a steroid medicine suddenly is dangerous. The NHS writes that if it has been taken for more than three weeks or at a high dose, it must be lowered gradually. Never stop a cortisone medicine on your own, and do not raise or lower it without a doctor. This applies to all patients with Addison’s too.

When to get urgent help

An adrenal crisis can happen in someone taking replacement cortisol. The NHS calls it an emergency. An infection, injury or surgery can trigger it, and it can progress to severe dehydration, a drop in blood pressure, seizures and loss of consciousness. Symptoms: fast heartbeat, severe dizziness, severe pain in the abdomen or side, muscle weakness or cramps, persistent headache, nausea and vomiting, confusion or drowsiness, seizures or loss of consciousness. If you have an emergency steroid injection and have been taught to use it, give it right away. The NHS says to call emergency services even if you have already given it. Show your steroid emergency card to the care team.

A sudden, severe headache with vision changes, nausea or vomiting in someone with a pituitary tumor is also urgent. MedlinePlus writes that the pressure symptoms of a tumor rarely come on suddenly and severely (pituitary apoplexy).

In Iran, call 115 (Iran’s emergency number, not valid abroad). See the full list in the guide “When should I call right away?”