Pituitary Disorders

The pituitary is a gland the size of a pea sitting in a hollow of bone at the base of the brain, just behind the bridge of the nose. It directs the thyroid, the adrenal glands and the ovaries or testes, controls growth in childhood, releases prolactin for breastfeeding, and regulates the body's water balance through a hormone stored in its back portion.

Most problems arise from a benign growth within it. Such a growth causes trouble in three ways: by producing too much of a single hormone, by pressing on the normal gland beside it so the other hormones fall away, and by pressing upward on the nerves carrying vision, which cross directly above it.

Injury, bleeding, radiotherapy, inflammation and heavy blood loss around childbirth are the other routes. Because the gland controls several systems, the effects appear in several places at once and often accumulate slowly enough to be attributed to age or stress.

Much of the diagnosis is in the history. Your doctor will ask about cycles that have stopped, milk from the breast outside breastfeeding, loss of libido, difficulty conceiving, tiredness that has built over months, feeling cold, dizziness on standing, thirst and passing large volumes of urine, headache, and whether rings, shoes or dentures have stopped fitting.

The examination includes checking your visual fields at the bedside by bringing a finger in from each side while you cover one eye, which picks up the characteristic loss at the outer edges. They will also check blood pressure lying and standing, and look at your hands, jaw and facial features against older photographs, which is often the clearest evidence of slow change.

Blood tests measure the pituitary hormones alongside the glands they control, drawn in the morning and repeated, since single readings mislead. An MRI of the pituitary and formal testing of your visual fields follow where the picture points that way.

Recovery depends entirely on what is found. A growth producing prolactin is usually treated with tablets, which shrink it over months; cycles typically return within two to three months and vision recovers over weeks where it was affected.

Surgery through the nose means three to five days in hospital and around four to six weeks before you are back to full activity. Blocked-up nasal breathing for two to three weeks is usual, heavy lifting and straining are avoided, and your team will watch your fluid balance closely in the first fortnight, since thirst and urine output can swing either way before settling.

Where hormones are missing they are replaced, and replacement is lifelong with periodic review of the doses. People usually feel substantially better within weeks of starting it. Fertility often returns with treatment and is worth discussing early, since it changes which replacement is used.