Supporting Anterior Pituitary Dysfunction

What are some ways to support anterior pituitary dysfunction? 

Support for anterior pituitary dysfunction would depend on the cause of dysfunction and what hormones are affected.

The anterior pituitary produces many vital hormones, including TSH, growth hormone, ACTH, LH, FSH, and prolactin (Pagana 2019). Therefore, dysfunction of the anterior pituitary will affect many systems and biomarkers in the body (Emelifeonwu 2020, Iwama 2021, Kim 2019, Ling 2019). In turn, a clinical care plan must address the causes and effects of the dysfunction.

Monitoring relevant biomarkers, including those listed above, as well as evaluating cortisol and resilience to stress, may assist in the assessment.

Identifying the cause of anterior dysfunction to support function is especially important. Causes of disruption to anterior pituitary hormones include pituitary abscess, radiation damage, traumatic brain injury, CVA, and even snake bites.

To determine future clinical focus, blood chemistry evaluation should include thyroid profile, basal cortisol, prolactin, and growth hormone.

Patients with hormonal deficiencies present with the following (Gounden 2021):

ACTH deficiency - Adrenal insufficiency

• Fatigue and postural hypotension

TSH deficiency – Hypothyroidism

• Small and soft thyroid gland, dry and coarse skin, thinning of hair and alopecia, delayed tendon reflexes, cold skin with loss of sweating, and non-pitting type edema.

Gonadotropin deficiency – Hypogonadism

• Small and atrophied testes in men; loss of axillary and pubic hair in women

GH deficiency - Difficulty in thriving and short stature in children.

• Adults are usually asymptomatic; however, they may feel fatigued and weak.

ADH deficiency - Diabetes Insipidus presenting with polydipsia and polyuria

• Hypernatremia, polyuria, and diluted urine

Thyroid function and hypopituitarism

Blood chemistry biomarker patterns should be confirmed regarding the disruption of TSH metabolism and thyroid function. With secondary hypothyroidism of pituitary origin (also called central hypothyroidism), TSH will be low or low-normal but free, and total T3 and T4 will also be low. It would also be prudent to assess for hemochromatosis, which can contribute to both hypopituitarism and hypothyroidism (Gounden 2021, Persani 2019).

Even stress can contribute to pituitary dysfunction and related thyroid dysfunction. Elevated inflammatory cytokines associated with stress can suppress thyroid-releasing hormones from the hypothalamus, leading to reduced TSH from the pituitary (Kim 2015).

Central hypothyroidism has symptoms similar to primary hypothyroidism (e.g., fatigue, lethargy, cold intolerance, constipation, depression, dry skin, thinning hair, hoarse voice, bradycardia, and hyporeflexia), though they may be somewhat milder. Goiter is not usually present (Beck 2017, Prencipe 2023).

Persistent hypofunction of the anterior pituitary may lead to lifelong dependence on thyroid hormone replacement. To avoid exacerbating insufficient cortisol, adrenal function, and cortisol adequacy must be addressed before treating central hypothyroidism. Treating secondary hypothyroidism must also include the goal of obtaining optimal levels of T3 and T4 (approximately midrange) instead of depending on TSH levels (Brar 2011).

When providing thyroid replacement therapy, T4 alone may be insufficient if conversion to T3 is suboptimal. Bovine or porcine thyroid extracts containing both T4 and T3 may be more effective than synthetic T4 alone. These desiccated extracts were the treatment of choice before monotherapy with synthetic T4 became available (Wardle 2014).

If suppression of pituitary and thyroid function is transient, natural support may be therapeutic, including thyroid and pituitary glandular supplements (usually porcine), L-arginine, rubidium sulfate, sage leaf extract, gamma oryzanol, zinc, magnesium, and manganese (Kharrazian 2010).

References

Beck-Peccoz, Paolo et al. “Central hypothyroidism - a neglected thyroid disorder.” Nature reviews. Endocrinology vol. 13,10 (2017): 588-598. doi:10.1038/nrendo.2017.47

Brar, K S et al. “Adult hypopituitarism: Are we missing or is it clinical lethargy?.” Indian journal of endocrinology and metabolism vol. 15,3 (2011): 170-4. doi:10.4103/2230-8210.83400

Emelifeonwu, John A et al. “Prevalence of Anterior Pituitary Dysfunction Twelve Months or More following Traumatic Brain Injury in Adults: A Systematic Review and Meta-Analysis.” Journal of neurotrauma vol. 37,2 (2020): 217-226. doi:10.1089/neu.2018.6349

Gounden, Verena, et al. “Hypopituitarism.” StatPearls, StatPearls Publishing, 28 September 2021. This book is distributed under the terms of the Creative Commons Attribution 4.0 International License 

Iwama, Shintaro et al. “Clinical Characteristics, Management, and Potential Biomarkers of Endocrine Dysfunction Induced by Immune Checkpoint Inhibitors.” Endocrinology and metabolism (Seoul, Korea) vol. 36,2 (2021): 312-321. doi:10.3803/EnM.2021.1007

Kharrazian, Datis. Why Do I Still Have Thyroid Symptoms?: When My Lab Tests are Normal. Morgan James Pub., 2010.

Kim, Seong Yeon. “Diagnosis and Treatment of Hypopituitarism.” Endocrinology and metabolism (Seoul, Korea) vol. 30,4 (2015): 443-55. doi:10.3803/EnM.2015.30.4.443

Kim, Yong-Ku et al. “A review on inflammatory cytokine-induced alterations of the brain as potential neural biomarkers in post-traumatic stress disorder.” Progress in neuro-psychopharmacology & biological psychiatry vol. 91 (2019): 103-112. doi:10.1016/j.pnpbp.2018.06.008

Ling, Sheng-Ying et al. “PITUITARY STALK THICKENING IN A LARGE COHORT: TOWARD MORE ACCURATE PREDICTORS OF PITUITARY DYSFUNCTION AND ETIOLOGY.” Endocrine practice: official journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists vol. 25,6 (2019): 534-544. doi:10.4158/EP-2018-0550

Pagana, Kathleen Deska; Pagana, Timothy J.; Pagana, Theresa N. Mosby's Diagnostic and Laboratory Test Reference. Elsevier Health Sciences. 2019.

Persani, Luca et al. “The diagnosis and management of central hypothyroidism in 2018.” Endocrine connections vol. 8,2 (2019): R44-R54. doi:10.1530/EC-18-0515

Prencipe, Nunzia et al. “Isolated anterior pituitary dysfunction in adulthood.” Frontiers in endocrinology vol. 14 1100007. 8 Mar. 2023, doi:10.3389/fendo.2023.1100007

Wardle, Jon, and Jerome Sarris. Clinical Naturopathy: an evidence-based guide to practice. Elsevier Health Sciences, 2014.