Located at the base of the brain, the pituitary is commonly referred to as the master gland because of the role it plays in controlling the function of all aspects of the body’s vital endocrine glands.

These glands produce our hormones, complex secretions which define the differences between male and female, regulate growth in childhood, control metabolism, body composition, vitality, emotions, sexual maturity and reproduction, our sex drive and virtually make life worth celebrating.

The hypothalamus and the pituitary gland play a vital role in controlling the body’s endocrine glands.

Changes and abnormalities can spark a range of disorders, many with serious health consequences.

So, if you notice unusual changes in your body, be sure to consult a doctor – and if you’re concerned about your hormone levels, ask for a blood test to check for any changes in your pituitary gland.

Through early diagnosis, appropriate medical care, treatment and education, pituitary-related conditions can be controlled and managed to minimise the impact on your health.

Common pituitary symptoms and preliminary tests

Compiled in association with Santosh K Chaubey, MB BS, MD, Advanced Trainee in Endocrinology, Adjunct Lecturer (Clinical), School of Medicine and Dentistry, James Cook University, Townsville.  Department of Diabetes and Endocrinology, The Townsville Hospital, Townsville, QLD.

The Hypothalamus and Pituitary gland work in close association and symptoms related to conditions involving either of these overlap to a great extent. They secrete various hormones which may act directly or indirectly through other peripheral endocrine glands like thyroid or adrenal glands. Both under activity and over activity of the pituitary gland present with a distinct clinical disorder. Clinical presentation may be related to excess or deficiency of hormones or combination of both.

An Increasing number of pituitary tumours are being recognized because of the wide use of brain imaging in modern clinical practice. The majority of tumours do not secrete any hormone and are termed a ‘nonfunctioning adenoma’.  If small enough and non compressive in nature they do not give rise to any symptoms but once they increase in size of compress nearby nerves or blood vessels they may become symptomatic.  Not all pituitary masses are adenomas.  Less commonly, sarcoidosis, lymphoma, metastasis etc. may present in a similar way.  Furthermore, pituitary hormone abnormalities may also be attributable to developmental abnormalities, hypothalamic tumours, cranial irradiation, post partum hemorrhage, head injury etc.

Below is the list of common symptoms related to excess or deficiency of hypothalamic-pituitary hormones. 

Hormone Excess/Deficiency	Symptoms
Any hypothalamic / Pituitary mass lesion: Non specific symptoms	Weakness, peripheral vision loss, double vision, eyelid drop, headache, decreased libido, fatigue (or generalised weakness)
Growth Hormone : Excess	Increased height, tight rings, increasing shoe size, arthritis, protruded lower jaw, sweating and oily skin
Growth Hormone : Deficiency	Failure to grow, decreased muscle mass, obesity
Prolactin: Excess	Irregular or absent menstruation, milky discharge from the breasts, breast tenderness, decreased libido and infertility
Prolactin: Deficiency	No clinical features in male, failure of lactation in females
Adrenocorticotrophin (ACTH): Excess	Weight gain, thin limbs, central obesity, round flushed face, easy bruisability, purple stretch marks, easy fractures, high BP and diabetes, mood disturbances, menstrual disturbances, hyperpigmentation of gums, palmer creases, umbilicus and breast alveolae etc.
ACTH: Deficiency	Weight loss, fatigue, nausea, hypoglycemia (low sugar levels) , low blood pressure, salt craving
TSH: Excess	Thyroid enlargement, fatigue, tremors, sweating, palpitations, heat intolerance, weight loss, nervousness, irregular or absent menstruation
TSH: Deficiency	Fatigue, weight gain, cold intolerance, coarse skin, menstrual irregularity
Luteinizing hormone (LH) & Follicular Stimulating Hormone (FSH): Excess (Very rare)	Commonly related to primary testicular or ovarian failure not pituitary tumour.
LH & FSH : Deficiency	Delayed puberty, irregular or absent menstruation, decreased libido and fertility
Anti Diuretic Hormone( ADH): Excess	Known as SIADH, not directly caused by pituitary tumours. headache, tiredness , nausea, impaired consciousness in severe cases
ADH: Deficiency	Frequent and nocturnal urination, increased thirst, weakness, may lead to severe dehydration
Oxytocin: Excess and Deficiency	No specific symptoms

Know your body, subtle changes are frequently not picked up by those who see you on a continual basis.  It may also be helpful (for both yourself and your doctor) to keep a daily diary noting all symptoms and concerns over a period of a few weeks. Taking this with you to your appointment will ensure that you do not forget to mention anything that may seem insignificant but be important to your diagnosis. It will also give your doctor a better understanding of what is happening.

Quite commonly a pituitary condition is diagnosed incidentally. That is by a local GP, or by a doctor investigating another related or unrelated condition.

If you think you may have a pituitary condition, explore the meaning of your symptoms with your GP.

He may then refer you to an Endocrinologist, a doctor who specializes in hormones.

Simple tests you can ask your GP to consider if he/she suspects you may have a pituitary condition are:

Suspected Condition	Preliminary Tests
Growth Hormone : Excess	Baseline GH, IGF-1
Growth Hormone : Deficiency	Baseline GH, IGF-1
Prolactin: Excess	Baseline Prolactin level
Prolactin: deficiency	Baseline Prolactin level
Adrenocorticotrophin (ACTH): Excess	ACTH, Cortisol, 24 Hour Urine Free Cortisol.
ACTH: Deficiency	ACTH, Cortisol.
TSH: Excess	Thyroid function test, TRH stimulation, T4 suppression test.
TSH: Deficiency	Thyroid function test.
Luteinizing hormone (LH) & Follicular Stimulating Hormone (FSH): Excess (Very rare)	LH, FSH, Estradiol (in females), 9 am testosterone (in males), SHBG
LH & FSH : Deficiency	LH, FSH, Estradiol (in females), 9 am testosterone (in males), SHBG
Anti Diuretic hormone( ADH): Excess	Paired plasma and urine osmolality
ADH: Deficiency	Paired plasma and urine osmolality
Oxytocin: Excess and Deficiency	None

(Further investigations may be needed if clinically indicated or if preliminary test results are abnormal)

The Pituitary Foundation recommends that you request copies of all of your test results to keep in your personal files. This will enable you to have all relevant information on hand for both your own understanding and also future appointments where you may be asked about previously conducted tests.

Updated: July 2010