Hypopituitarism Symptoms and Siddha Remedies

Deficiency of all anterior pituitary hormones is more common than individual hormone deficiency:

Luteinizing hormone deficiency (LH)

The deficiency of luteinizing hormone (LH) and follicle-stimulating hormone (FSH), together referred to as the gonadotropins, leads to different symptoms in men and women. Women experience oligo- or amenorrhea (infrequent/light or absent menstrual periods respectively) and infertility.

Men lose facial, scrotal, and trunk hair, as well as suffer, decreased muscle mass, and anemia. Both sexes may experience a decrease in libido and loss of sexual function and have an increased risk of osteoporosis (bone fragility). Lack of LH/FSH in children is associated with delayed puberty.

Growth hormone (GH) deficiency

Growth hormone (GH) deficiency leads to a decrease in muscle mass, central obesity (increase in body fat around the waist), and impaired attention and memory. Children experience growth retardation and short stature.

Adrenocorticotropic hormone (ACTH) deficiency

Adrenocorticotropic hormone (ACTH) deficiency leads to adrenal insufficiency and a lack of production of glucocorticoids such as cortisol by the adrenal gland. If the problem is chronic, symptoms consist of fatigue, weight loss, failure to thrive (in children), delayed puberty (in adolescents), hypoglycemia (low blood sugar levels), anemia, and hyponatremia (low sodium levels).

If the onset is abrupt, collapse, shock and vomiting may occur. ACTH deficiency is highly similar to primary Addison’s disease, which is cortisol deficiency as the result of direct damage to the adrenal glands; the latter form, however, often leads to hyperpigmentation of the skin, which does not occur in ACTH deficiency.

Thyroid-stimulating hormone (TSH) deficiency

Thyroid-stimulating hormone (TSH) deficiency leads to hypothyroidism (lack of production of thyroxine (T4) and triiodothyronine (T3) in the thyroid). Typical symptoms are tiredness, intolerance to cold, constipation, weight gain, hair loss and slowed thinking, as well as a slowed heart rate and low blood pressure. In children, hypothyroidism leads to delayed growth and in extreme inborn forms to a syndrome called cretinism.

Prolactin (PRL) plays a role in BREASTFEEDING, and the inability to breastfeed may point at abnormally low prolactin levels.

Posterior pituitary

Antidiuretic hormone (ADH) deficiency leads to the syndrome of diabetes insipidus (unrelated to diabetes mellitus):

• Inability to concentrate the urine,
• Heading to polyuria (production of large amounts of clear urine) that is low in solutes,
• Dehydration,
• And—in compensation—extreme thirst and constant need to drink (polydipsia),
• Hypernatremia (high sodium levels in the blood).

ADH deficiency may be masked if there is ACTH deficiency, with symptoms only appearing when cortisol has been replaced.

Oxytocin (OXT) deficiency generally causes few symptoms, as it is only required at the time of childbirth and BREASTFEEDING.

Hypopituitarism Causes

Type	Causes
Tumors	Most cases of hypopituitarism are due to pituitary adenomas compressing the normal tissue in the gland, and rarely other brain tumors outside the gland—craniopharyngioma, meningioma, chordoma, ependymoma, glioma or metastasis from cancer elsewhere in the body.
Infection, inflammation, and infiltration	The pituitary may also be affected by infections of the brain (brain abscess, meningitis, encephalitis) or of the gland itself, or it may be infiltrated by abnormal cells (neurosarcoidosis, histiocytosis) or excessive iron (hemochromatosis). Empty Sella syndrome is an unexplained disappearance of pituitary tissue, probably due to outside pressure. Autoimmune or lymphocytic hypophysitis occurs when the immune system directly attacks the pituitary.
Vascular	As a pregnancy comes to term, a pregnant woman’s pituitary gland is vulnerable to low blood pressure, such as may result from hemorrhage; pituitary damage due to bleeding after childbirth is called Sheehan’s syndrome. Pituitary apoplexy is hemorrhage or infarction (loss of blood supply) of the pituitary. Other forms of stroke are increasingly recognized as a cause of hypopituitarism.
Radiation	Radiation-induced hypopituitarism mainly affects growth hormones and gonadal hormones. In contrast, adrenocorticotrophic hormone (ACTH) and thyroid-stimulating hormone (TSH) deficiencies are the least common among people with radiation-induced hypopituitarism. Changes in prolactin-secretion are usually mild, and vasopressin deficiency appears to be very rare as a consequence of radiation.
Other physical	External physical causes for hypopituitarism include traumatic brain injury, subarachnoid hemorrhage, neurosurgery, and ionizing radiation (e.g. radiation therapy for a previous brain tumor). Bites from Russell’s vipers have also been known to cause hypopituitarism in approx 29% of cases
Congenital	Congenital hypopituitarism (present at birth) may be the result of complications around delivery or may be the result of insufficient development (hypoplasia) of the gland, sometimes in the context of specific genetic abnormalities. Mutations may cause either insufficient development of the gland or decreased function. Forms of combined pituitary hormone deficiency (“CPHD”) include: Type OMIM Gene CPHD1 613038 POU1F1 CPHD2 262600 PROP1 CPHD3 600577 LHX3 CPHD4 602146 LHX4 CPHD5 (Septo-optic dysplasia) 182230 HESX1 Kallmann syndrome causes deficiency of the gonadotropins only. Bardet-Biedl syndrome and Prader-Willi syndrome have been associated with pituitary hormone deficiencies.

Hypopituitarism Diagnosis

Blood tests

The diagnosis of hypopituitarism is made through blood tests. Two types of blood tests are used to confirm the presence of a hormone deficiency: basal levels, where blood samples are taken–usually in the morning–without any form of stimulation, and dynamic tests, where blood tests are taken after the injection of a stimulating substance.

Measurement of ACTH and growth hormone usually requires dynamic testing, whereas the other hormones (LH/FSH, prolactin, TSH) can typically be tested with basal levels. There is no adequate direct test for ADH levels, but ADH deficiency can be confirmed indirectly; oxytocin levels are not routinely measured.

Generally, the finding of a combination of a low pituitary hormone together with a low hormone from the effector gland is indicative of hypopituitarism. Occasionally, the pituitary hormone may be normal but the effector gland hormone may decrease; in this case, the pituitary is not responding appropriately to effector hormone changes, and the combination of findings is still suggestive of hypopituitarism.

Basal tests

Levels of LH/FSH may be suppressed by a raised prolactin level, and are therefore not interpretable unless prolactin is low or normal. In men, the combination of low LH and FSH in combination with low testosterone confirms LH/FSH deficiency; high testosterone would indicate a source elsewhere in the body (such as a testosterone-secreting tumor).

In women, the diagnosis of LH/FSH deficiency depends on whether the woman has been through menopause. Before menopause, abnormal menstrual periods together with low estradiol and LH/FSH levels confirm a pituitary problem; after menopause, inappropriately low LH/FSH alone is sufficient. Stimulation tests with GnRH are possible, but their use is not encouraged.

Stimulation tests

Growth hormone deficiency is almost certain if all other pituitary tests are also abnormal, and insulin-like growth factor 1 (IGF-1) levels are decreased. If this is not the case, IGF-1 levels are poorly predictive of the presence of GH deficiency; stimulation testing with the insulin tolerance test is then required.

This is performed by administering insulin to lower the blood sugar to a level below 2.2 mmol/l. Once this occurs, growth hormone levels are measured. If they are low despite the stimulatory effect of the low blood sugars, growth hormone deficiency is confirmed. The test is not without risks, especially in those prone to seizures or are known to have heart disease, and causes the unpleasant symptoms of hypoglycemia.

Alternative tests

Alternative tests are less useful, although a stimulation test with arginine may be used for diagnosis, especially in situations where an insulin tolerance test is thought to be too dangerous. If GH deficiency is suspected, and all other pituitary hormones are normal, two different stimulation tests are needed for confirmation.

Diabetes insipidus

Symptoms of diabetes insipidus should prompt a formal fluid deprivation test to assess the body’s response to dehydration, which normally causes the concentration of the urine and increases the osmolarity of the blood.

If these parameters are unchanged, desmopressin (an ADH analog) is administered. If the urine then becomes concentrated and the blood osmolarity falls, there is a lack of ADH due to a lack of pituitary function. In contrast, there is no change if the kidneys are unresponsive to ADH due to a different problem.

Further investigations

If one of these tests shows a deficiency of hormones produced by the pituitary, a magnetic resonance imaging (MRI) scan of the pituitary is the first step in identifying an underlying cause. MRI may show various tumors and may assist in delineating other causes. Tumors smaller than 1 cm are referred to as microadenomas, and larger lesions are called macroadenomas. Computed tomography with radiocontrast may be used if MRI is not available. 

Other tests that may assist in the diagnosis of hypopituitarism, especially if no tumor is found on the MRI scan, are ferritin, angiotensin-converting enzyme (ACE) levels, and human chorionic gonadotropin. If a genetic cause is suspected, genetic testing may be performed.

Hypopituitarism Treatment

Treatment of hypopituitarism is threefold: removing the underlying cause, treating the hormone deficiencies, and addressing any other repercussions that arise from the hormone deficiencies.

Underlying cause

Transsphenoidal surgery

Pituitary tumors require treatment when they are causing specific symptoms, such as headaches, visual field defects, or excessive hormone secretion. Transsphenoidal surgery (removal of the tumor by an operation through the nose and the sphenoidal sinuses) may, apart from addressing symptoms related to the tumor, also improve pituitary function, although the gland is sometimes damaged further as a result of the surgery.

When the tumor is removed by craniotomy (opening the skull), recovery is less likely–but sometimes this is the only suitable way to approach the tumor. After surgery, it may take some time for hormone levels to change significantly. Retesting the pituitary hormone levels is therefore performed 2 to 3 months later.

Dopamine agonist treatment

Prolactinomas may respond to dopamine agonist treatment–medication that mimics the action of dopamine on the lactotroph cells, usually bromocriptine or cabergoline. This approach may improve pituitary hormone secretion in more than half the cases, and make supplementary treatment unnecessary.

Other treatments

Other specific underlying causes are treated as normal. For example, hemochromatosis is treated by venesection, the regular removal of a fixed amount of blood. Eventually, this decreases the iron levels in the body and improves the function of the organs in which iron has accumulated.

Hormone replacement

Hormone replacement

Most pituitary hormones can be replaced indirectly by administering the products of the effector glands: hydrocortisone (cortisol) for adrenal insufficiency, levothyroxine for hypothyroidism, testosterone for male hypogonadism, and estradiol for female hypogonadism. The growth hormone is available in synthetic form but needs to be administered parenterally (by injection).

Desmopressin tablets

An antidiuretic hormone can be replaced by desmopressin (DDAVP) tablets or nose spray. Generally, the lowest dose of the replacement medication is used to restore wellbeing and correct the deranged results, as excessive doses would cause side effects or complications.

Those requiring hydrocortisone are usually instructed to increase their dose in physically stressful events such as injury, hospitalization, and dental work as these are times when the normal supplementary dose may be inadequate, putting the patient at risk of adrenal crisis.

Long-term follow-up

Long-term follow-up by specialists in endocrinology is generally needed for people with known hypopituitarism. Apart from ensuring the right treatment is being used and at the right doses, this also provides an opportunity to deal with new symptoms and to address complications of treatment.

Difficult situations arise in deficiencies of the hypothalamus-pituitary-gonadal axis in people who experience infertility; infertility in hypopituitarism may be treated with subcutaneous infusions of FSH, human chorionic gonadotropin–which mimics the action of LH–and occasionally GnRH.

Hypopituitarism Prognosis

Several studies have shown that hypopituitarism is associated with an increased risk of cardiovascular disease and some also an increased risk of death of about 50% to 150% of the normal population. It has been difficult to establish which hormone deficiency is responsible for this risk, as almost all patients studied had growth hormone deficiency.

Hypopituitarism is usually permanent. It requires lifelong treatment with one or more medicines.

Ayurveda remedies for Hypopituitarism

Ayurveda provides effective herbal remedies like Stress Support, Ashwagandha Capsules, Punarnava Mandoor, Female Health Support, Gotu Kola Capsules, and Kanchnar Guggul for ayurvedic treatment of hypopituitarism.

These herbal remedies are prepared using the best quality herbs and strictly follow the principles of Ayurveda. All these herbal remedies are 100 percent pure, natural, and vegetarian. These are free from chemicals, additives, and preservatives. These are safe to use as they are free from side effects.

Siddha remedies for Hypopituitarism

A daily routine