In terms of pituitary functions, pituitary diseases are divided into two: hyperfunction of the pituitary, where hormones are over-secreted, and hypofunction, where they are under-secreted.
Incomplete secretion of hormones secreted from the pituitary gland due to different reasons is defined as "Pituitary Failure".
Treatment depends on the cause that led to pituitary failure. Before starting treatment, it is necessary to decide whether pituitary insufficiency is temporary or permanent. Hormones that are deficient in permanent hormone deficiency are replaced.
In the hyperfunction of the pituitary, more hormones are secreted than normal. Although it is generally seen that only one hormone is secreted excessively, there are rare cases where two or more hormones are secreted excessively.

Although there are many diseases associated with the pituitary gland, the most common ones are listed as follows:

Pituitary Failure
Pituitary Tumors
Acromegaly
Cushing's Disease
Prolactinoma
Rare Pituitary Tumors

Pituitary Insufficiency

Pituitary gland tumors are one of the most important causes of pituitary insufficiency. In addition, traffic accidents, head traumas caused by falls or blows to the head, and surgical or radiotherapy applications applied to the pituitary or brain region may also cause a decrease in the hormones secreted from the pituitary gland. Genetic abnormalities, some medications used in cancer treatment, drugs such as morphine, excessive bleeding that may occur after childbirth in women under inappropriate conditions and left untreated, and pituitary insufficiency can be detected in many rare diseases.

What are the Symptoms of Pituitary Insufficiency?

Since each of the hormones secreted from the pituitary gland has different functions, the complaints that occur in case of deficiency also vary in this direction.

In the case of ACTH deficiency; the level of cortisol in the blood decreases and the person becomes vulnerable to all kinds of stress. In the absence of cortisol, weakness, and fatigue occur, and blood sugar and blood pressure decrease. In severe cortisol deficiency, the patient presents to the emergency department with severe general condition disorder and shock picture.
In the deficiency of prolactin hormone; breast tissue cannot produce milk and mothers complain of not being able to breastfeed their babies after birth.
In the deficiency of gonadotropin hormones; estrogen production in women and testosterone production in men decreases. If these hormones, which provide sexual development in men and women, decrease, symptoms such as abortion, infertility, and sexual reluctance are observed in women. In men, complaints such as decreased libido and erectile dysfunction are encountered. Osteoporosis (bone loss) is also among the problems that occur in gonadotropin deficiency.
In TSH deficiency; the thyroid gland, which provides the energy balance of our body, works insufficiently and thyroid hormones cannot be produced as much as they should. As a result, symptoms such as weakness, fatigue, chills, constipation, hair loss, excessive sleep, and concentration disorders occur.
The most important findings of Growth Hormone deficiency are changes in body composition (decrease in muscle mass, increase in fat mass), deterioration in quality of life, deterioration in blood lipids, and neuropsychiatric abnormalities. If these patients are not treated, they feel constantly weak, tired, and unwell. Growth hormone therapy in adults has been neglected for many years.

How Is Pituitary Insufficiency Treated?

When permanent hormone deficiency is detected, treatment is based on replacing the missing hormone or hormones. Hormone therapy continues until old age or for life, depending on the hormone that is missing. Cortisol and thyroid hormone therapy are lifelong. Dose adjustment varies from patient to patient. Dose adjustment should be done very carefully, especially since high medication doses can cause serious side effects. Diagnosis is not always easy, and the diagnosis and treatment of pituitary insufficiency must be done by an experienced endocrinologist. In addition, regular physician controls are extremely important in order to evaluate the effectiveness of the treatment and to make the necessary medication adjustments.

Pituitary Tumors

Pituitary tumors account for 10% of all brain tumors. It has not been fully elucidated how tumors, most of which are benign, form. A small portion of them are genetically inherited.

What Are the Symptoms of Pituitary Tumor?

Tumors that arise in the pituitary gland can present with a wide variety of symptoms, from headache to menstrual irregularity, weight gain, hair loss, and visual disturbances to blood pressure changes. At this point, the size of the tumor, its location, the type, and the amount of the hormone secreted more than normal are important.

Headache, which is the most common symptom due to tumors, has no typical features. Pituitary gland tumors should be considered in chronic headaches that do not go away despite treatment.

Another important finding of pituitary tumors is visual impairment. As the tumor grows and affects the optic nerves, symptoms such as narrowing of the visual field, double vision, or droopy eyelids may occur over time. The most common visual impairment is narrowing of the visual field (in this case, the patient sees as if he/she is looking through a pipe and cannot see around). The drooping of the eyelid that cannot be explained by other reasons should suggest a laterally enlarged pituitary gland. Therefore, the possibility of a pituitary tumor should be considered in case of visual impairment.

Bleeding into the pituitary gland may lead to an emergency picture and delay in treatment may be the cause of death.

How Is Pituitary Tumor Treated?

The definitive diagnosis of the disease should be made by an endocrinologist. According to the clinical picture, medication, surgery, and radiation therapy can be applied. If excessive hormone secretion and tumor growth cannot be stopped by medical or surgical treatment, radiation therapy can be applied. Surgical treatment is the first method in an important part of pituitary tumors. It may be possible to completely get rid of the disease with a specialized and experienced surgical team and sufficient technological infrastructure. However, nowadays, medication treatment is becoming more and more common in parallel with the successful results obtained and can sometimes be the first treatment.

Acromegaly

It is a disease that develops due to excessive secretion of growth hormones. Although it can occur at any age, it is most commonly seen in adults between the ages of 30-50. In case of exposure to excessive amounts of growth hormone before the growth plates close, “gigantism” develops.

Therefore, excessive height growth should be given attention in growing children. In the adult period, there is no increase in height, structural changes are in the foreground, and the disease is called "acromegaly". Although it manifests itself with different symptoms in childhood and adulthood, acromegaly also poses a risk in terms of serious health problems such as diabetes, high blood pressure, heart diseases, and deterioration in lung functions.

What Are the Symptoms of Acromegaly?

Growth is observed in the hands, feet, and many parts of the body. Shoes and rings start to look small. Coarsening of the facial lines, protrusion of the lower jaw and forehead, widening of the tooth gaps, enlargement of the nose, lips, and tongue, fat deposition and thickening in the skin, sweating, visual impairment, and headache are among the symptoms of acromegaly. Symptoms of acromegaly can be quite distressing for patients. In addition to physical symptoms, weakness, fatigue, loss of libido and changes in body image may also negatively affect the psychology of the patient.

One of the most important symptoms of acromegaly is the growth seen in many parts of the body, including the hands and feet. Shoes and rings start to look small. Other symptoms include coarsening of the facial lines, protrusion of the lower jaw and forehead, widening of the tooth gaps, enlargement of the nose, lips, and tongue, fat deposition and thickening in the skin, sweating, visual impairment, and headache.

Because the symptoms usually progress very slowly, the patient may not be aware of them, and the diagnosis is often made late.

Acromegaly Treatment

The vast majority of patients with acromegaly regain their health with the correct diagnosis and appropriate treatment. There are three types of treatment approaches: medication treatment, surgical treatment, and radiation treatment. Surgical treatment is the first approach for the majority of patients. Medication treatment is applied to patients who cannot undergo surgery or who do not get successful results despite surgical treatment. Today, there are highly effective medications used in the treatment of acromegaly. The main purpose of the treatment of acromegaly is to reduce the growth hormone and IGF-I levels to normal levels and to reduce the tumor mass. In cases where these goals cannot be achieved with surgery and drug treatment, radiation treatment is applied. Today, there are very advanced technologies in radiation treatment and they are used successfully in our country.

Cushing's Disease (Syndrome)

It is the clinical picture caused by a tumor originating from cells that secrete ACTH hormone in the pituitary gland. The ACTH hormone, which is secreted more than normal levels, causes the cortisol hormone to be secreted above the normal levels from the adrenal gland. This disease, which is more common in women than in men, occurs especially between the ages of 20-40.

What are the Symptoms of Cushing's Disease (Syndrome)?

The clinical picture is not the same in all Cushing's disease patients, and the signs and symptoms vary according to the severity of the disease. Body structure changes, and obesity, which is manifested by fat deposition in the abdomen, and thinning in the arms and legs are important in the diagnosis.

The most important findings are rounding of the face (moon face) and redness, fat accumulation on the neck, hair loss, thinning of the skin, easy bruising with bumps on the skin, the appearance of purple-colored cracks, especially in the abdomen, depression, hypertension, muscle weakness, bone weakness, and bone fractures in advanced cases.

Increased hair growth and menstrual irregularity are common in women. Not infrequently, the symptoms of the disease can be very mild. Cushing's disease should also be considered in patients with diabetes who cannot be controlled despite appropriate treatment and in cases of treatment-resistant obesity.

How is Cushing's Syndrome (Disease) Diagnosed and Treated?

Since the symptoms of the disease are similar to many diseases, it is very difficult to diagnose in mild cases. In the diagnosis, it is important to detect increased cortisol levels in the blood, urine, and, if necessary, in saliva, and to show increased or unsuppressed ACTH levels. In some patients, quite complex tests may be required for diagnosis. The most effective way of treatment is surgical removal of the tumor. In cases where surgery cannot be performed or surgery is unsuccessful, medication treatment and radiation treatment can be used. In cases where all treatment approaches are inadequate, removal of both adrenal glands is also a treatment option.

Prolactinoma

The most common pituitary tumors are prolactin-secreting tumors. Although it can be seen in both sexes, it is more common in women. Prolactin level increases in cases such as pregnancy, breastfeeding, some medications, thyroid gland failure, and kidney failure. However, prolactin elevation in prolactinomas is higher than in other causes (usually over 200 ng/ml).

What Are the Symptoms of Prolactinoma?

The most important sign of high prolactin is milk coming from the nipple spontaneously or by squeezing. This is called galactorrhea. This finding is rarely seen in men. Increased prolactin level has negative effects especially on the reproductive system in men and women. One of the most important effects is infertility. High prolactin levels affect the reproductive hormonal system at the brain level. As a result, estrogen levels drop and menstrual irregularity, a decrease in the frequency of ovulation, and vaginal dryness occur. In men, sexual dysfunctions, breast enlargement, infertility, and sexual reluctance can be seen due to decreased sperm count.

How is Prolactinoma Diagnosed and Treated?

The diagnosis of prolactinoma is made by methods such as detailed examination, laboratory tests, and magnetic resonance imaging of the pituitary gland. It is easier to diagnose than other pituitary tumors. The main purpose of treatment is to reduce prolactin levels and to reduce the tumor mass and to eliminate the complaints. The first treatment approach in prolactinoma is medication treatment. With medication treatment, prolactin decreases to its normal level in the vast majority of cases and the tumor tissue shrinks or even disappears. In rare cases, surgery and radiation treatment may be required.

Rare Pituitary Tumors

Some pituitary tumors may cause pituitary insufficiency without secreting hormones at a level that will cause any abnormality in the body, or they may press on neighboring tissues and may appear with related findings (such as headache, visual impairment). Rarely, TSH-secreting pituitary tumors may be encountered. In these patients, excessive thyroid hormones are secreted from the thyroid gland, and accordingly, a picture of hyperthyroidism occurs. Gonadotropinomas with excessive secretion of FSH and/or LH hormones are very rare. Tumors in which more than one hormone is secreted may also be encountered.