Being aware of the causes, symptoms, and risk factors of anterior pituitary disorders is crucial for the timely diagnosis and treatment. Understanding and mastering this topic is crucial for NEET PG candidates, not only for exams but also for fostering excellent clinical skills and delivering high-quality patient care. 

To learn more, keep reading!

What are the Types of Anterior Pituitary Disorders?

Disorders of the anterior pituitary gland typically fall into 2 broad categories: 

1. Hypopituitarism

This develops when the anterior pituitary fails to produce one or more of its hormones in sufficient amounts. The common hypopituitarism conditions include:

• Secondary Adrenal Insufficiency: Caused by low ACTH (adrenocorticotropic hormone) levels, resulting in underactive adrenal glands.
  
• Growth Hormone Deficiency (GHD): Due to insufficient growth hormone production.
  
• Central Hypogonadism: Results from low FSH (follicle-stimulating hormone) and/or LH (Luteinising Hormone), affecting the production of sex hormones by the ovaries or testes.
  
• Central Hypothyroidism: Occurs when too little TSH (thyroid-stimulating hormone) is produced, leading to underactivity of the thyroid gland.

2. Hyperpituitarism 

This results from the overproduction of one or more hormones by the anterior pituitary. The common hyperpituitarism conditions are:

• Acromegaly: It is caused by excess growth hormone in adults, leading to abnormal growth of bones and tissues.
  
• Gigantism: This results from high levels of growth hormone in children or adolescents, causing excessive height.
  
• Cushing’s Disease: This develops due to excessive ACTH production, which overstimulates cortisol production in the adrenal glands.
  
• Hyperprolactinemia: It is caused by excessive prolactin production.
  
• Central Hyperthyroidism: It is a rare condition caused by too much TSH, leading to an overactive thyroid gland.

What are the Causes of Anterior Pituitary Disorders?

Several factors can disrupt the normal function of the anterior pituitary, leading to either hypo- or hyperpituitarism:

1. Pituitary Adenomas

• Nonfunctioning Adenomas: These can compress surrounding pituitary tissue, leading to hypopituitarism.
  
• Functioning (secreting) Adenomas: Secreting adenomas overproduce specific hormones, causing hyperpituitarism.
  
  • Prolactinoma: Produces excess prolactin.
    
  • Somatotroph Adenoma: Produces excess growth hormone.
    
  • Corticotroph Adenoma: Produces excess ACTH.
    
  • Thyrotroph Adenoma: Produces excess TSH.
    
  • Gonadotroph Adenoma: Produces excess LH and FSH.
    

2. Damage to the Pituitary Gland or Surrounding Areas

• Injury or trauma
• Infections
• Blood loss (pituitary apoplexy)
• Radiation or surgery affecting the pituitary or hypothalamus

3. Genetic Conditions

• Multiple Endocrine Neoplasia (MEN): It is a hereditary disorder that affects endocrine glands and may include pituitary tumours.

4 . Sheehan Syndrome

Sheehan syndrome arises after significant blood loss during or after childbirth. The pituitary gland enlarges during pregnancy and becomes more susceptible to ischemia. When the blood supply is compromised, pituitary tissue dies, leading to hormonal deficiencies. It may present immediately or years after delivery.

What are the Symptoms of Anterior Pituitary Disorders?

The symptoms of pituitary disorders depend on the specific hormone involved and the type of disorder. Some common signs to look out for include:

• Alterations in facial structure
• Voice becoming deeper
• Increased perspiration
• Enlargement of hands, feet, lips, nose, and/or tongue
• Frequent or persistent headaches
• Pain or discomfort in the joints
• Numbness in the hands or signs of carpal tunnel syndrome
• Greasy or oily skin
• Disrupted breathing during sleep (sleep apnea)
• Issues affecting the spinal cord

What is the Diagnosis of Anterior Pituitary Disorders?

A thorough diagnostic process is essential to accurately identify anterior pituitary disorders, given their complex presentation and impact on hormone regulation. This includes:

1. Hormone Tests

It is used to assess baseline hormone levels and identify deficiencies or excesses, such as:

• Baseline Hormone Evaluation
  
  • Provides a snapshot of hormone levels before treatment.
  • May involve collecting blood, urine, and saliva samples over a 24-hour period.
    
• Blood Test
  
  • Measures levels of hormones such as ACTH, TSH, GH (growth hormone), LH, FSH, and prolactin.
    
• Urine Test (24-hour Collection)
  
  • Primarily used to assess cortisol levels, aiding in the diagnosis of Cushing syndrome.
    
• Saliva Test
  
  • A late-night sample is commonly used to detect abnormal cortisol levels, useful in evaluating disorders related to adrenal function.

2. Dynamic Hormone Testing

It assesses how the body responds when hormone production is stimulated or suppressed.

• Glucose Suppression Test
  
  • The patient consumes a glucose solution.
  • In a healthy system, growth hormone levels should decrease.
  • If they remain high, this may indicate acromegaly or gigantism.
    
• Growth Hormone Stimulation Test
  
  • Medication is given to stimulate GH release.
  • Inadequate response may suggest growth hormone deficiency.
    
• Dexamethasone Suppression Test
  
  • Dexamethasone is used to suppress cortisol production.
  • If cortisol levels remain elevated, it may indicate Cushing disease or syndrome.
    

3. Imaging (Scans)

It is used to locate pituitary tumours, assess their size and structure, and guide treatment.

• Contrast-Enhanced Magnetic Resonance Imaging (MRI)
  
  • Uses gadolinium, a contrast agent, to highlight abnormal areas.
  • Highly sensitive in detecting microadenomas, particularly in Cushing disease.
    
• Intraoperative MRI (iMRI)
  
  • Provides real-time, high-resolution images during surgery.
  • Especially helpful for removing large or complex tumours with precision.
    
• Open MRI
  
  • Suitable for patients who are uncomfortable with enclosed machines.
  • Delivers high-quality images while enhancing patient comfort.

4. Neuropathology (Tissue Testing)

This is performed when tumour or gland tissue is removed to confirm diagnosis and determine tumour type. The types of tests include:

• Molecular Pathology: Examines cellular structures to identify abnormal growth or function.
  
• Cytogenetics: Analyses DNA (deoxyribonucleic acid) and chromosome changes related to pituitary diseases.
  
• Ultrastructural Analysis: Uses advanced imaging to observe fine cellular details beyond what traditional microscopes can detect.

What are the Treatment Options for Anterior Pituitary Disorders?

Treatment for pituitary disorders is highly individualised and depends on the type of hormone imbalance. Common treatment approaches include:

1. Medication

Medications are often the first line of treatment, especially when surgery is not immediately necessary or to support recovery post-surgery. Some of the approved medications are:

• Mifepristone: Used to manage high blood sugar related to Cushing syndrome.
• Pasireotide: Effective in treating acromegaly and Cushing disease by suppressing hormone overproduction.

2. Radiation Therapy

Used to shrink pituitary tumours or prevent them from growing further, especially when surgery isn’t possible or when residual tumour remains after surgery. The types of radiation therapy include:

• Traditional Radiation Therapy
  
  • Involves regular sessions over several weeks to gradually shrink the tumour.

• Stereotactic Radiosurgery
  
  • Delivers highly focused radiation to the tumour while sparing healthy surrounding tissue.

3. Surgery 

Surgery is often the preferred option when a pituitary tumour is clearly affecting hormone production or causing pressure symptoms. The surgical approaches include:

• Transsphenoidal Surgery (≈95% of Cases)
  • Minimally invasive approach performed through the nose and sphenoid sinus.
  • Allows direct access to the pituitary gland with faster recovery and fewer complications.
    
• Transcranial Surgery (Rare)
  
  • Involves opening the skull to access the tumour.
  • Reserved for large or complex tumours that can’t be reached through the nose.

FAQs About Anterior Pituitary Disorders

1. Can anterior pituitary disorders be cured?
Most of these disorders can’t be fully cured, especially if the pituitary gland is damaged. However, with the right hormone treatments and regular check-ups, people can lead healthy, normal lives.

2. Is Sheehan syndrome common today?
Sheehan syndrome is very rare today, thanks to better medical care during childbirth. It affects about 5 in every 100,000 births and is more likely to happen where emergency care isn’t easily available to treat severe bleeding after delivery.

3. Can anterior pituitary disorders affect children?
Yes, they can. Some children are born with a condition called congenital hypopituitarism. If not treated early, it can lead to slow growth, late puberty, and learning difficulties.

Conclusion

Numerous bodily systems may be seriously impacted by hormonal imbalances brought on by anterior pituitary diseases. Understanding their causes, clinical signs, diagnostic methods, and accessible treatments is essential for early discovery and effective management.

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