Pituitary Disorders

What is Pituitary Disorders?

Pituitary disorders are conditions that change how much hormone the pituitary gland produces. The gland sits at the base of the brain and releases hormones that control the thyroid, adrenal glands, reproductive organs, growth and water balance.^{[1, 2]} These are medical conditions that need an endocrinologist, and the clinic does not diagnose or manage them.

Common symptoms

Symptoms depend on which hormones are too high or too low. Hormone deficiency often starts slowly, with tiredness and vague complaints that can be missed for a long time.^{[3, 4]}

• Fatigue, weakness, low blood pressure or dizziness when cortisol is low
• Headaches and vision problems when a tumor presses on nearby structures
• Weight change, cold intolerance, low libido, irregular periods or infertility
• Excess thirst and urination when the water-balance hormone vasopressin is lacking
• Enlarged hands, feet and facial features when growth hormone is in excess^[5]

Causes and risk factors

The most common cause of too much hormone is a hormone-secreting pituitary tumor, called an adenoma.^[2] Pituitary adenomas are very common and almost always benign, and most never cause problems during a person's life.^[6]

Too little hormone most often results from a growing mass in or near the gland, or from treatment of such a mass. Less common causes include genetic changes, inflammation of the gland (including with some cancer immunotherapy), infection and traumatic brain injury.^[4]

How it is diagnosed and treated conventionally

Diagnosis rests on blood hormone levels, sometimes with stimulation tests, and MRI of the pituitary.^{[2, 4]} Treatment depends on the cause. Deficient hormones are replaced, for example with hydrocortisone, thyroid hormone, sex hormones, growth hormone or desmopressin.^[7] For hormone excess, treatment can include medicines, surgery or radiotherapy.^[2]

Acromegaly, for instance, is usually managed with a combination of surgery, medicines and sometimes radiation, with the aim of normalizing hormone levels, shrinking the tumor and improving quality of life.^[5] With multimodal treatment, most clinically apparent adenomas can be controlled and quality of life improved.^[6]

Why Pituitary Disorders calls for a whole-person approach

Because the pituitary controls so many other glands, a problem there can affect energy, mood, sleep, weight, fertility and the heart and metabolism at the same time.^[1] Medical treatment aims at the hormone problem itself. Some people may still have tiredness, stress and poor sleep that are not fully explained by hormone numbers alone.

Supportive care can address some of these day-to-day symptoms. It cannot correct a hormone deficiency or shrink a tumor, and the research summarized below is about symptoms, not about the pituitary condition.

Hormone balance and fatigue

Slowly developing fatigue is a common presentation of hypopituitarism.^[3] It needs medical assessment, because it may reflect a hormone that is not adequately replaced.

Metabolic and cardiovascular health

Growth hormone excess is linked with cardiovascular, respiratory, metabolic and musculoskeletal complications, and hypopituitarism with higher cardiovascular and respiratory mortality.^{[1, 5]} General health habits therefore matter alongside hormone treatment.

Stress and sleep

Cortisol, the body's main stress hormone, is controlled by the pituitary. Replacement therapy for low cortisol is a medical task.^[7] Alongside that, ordinary stress and poor sleep add to fatigue and can be targeted with supportive care, as described below.

Acupuncture as supportive care in Pituitary Disorders

What the research shows

No clinical trials of acupuncture for pituitary tumors or pituitary hormone disorders were found in a PubMed search, so there is no evidence that it affects the gland, hormone levels or tumor size. What exists is research on symptoms that people with pituitary disorders may share with others.

For chronic fatigue syndrome, a meta-analysis of 16 trials with 1,346 participants found that in the four trials using sham acupuncture (281 people), the response rate was better with acupuncture. The certainty was low, most studies were of low methodological quality, and the authors could not reach a firm conclusion.^[8] Chronic fatigue syndrome is a different condition from pituitary fatigue, so this result may not apply.

For insomnia, a systematic review of 24 trials found in a pooled analysis of 15 trials that sleep scores improved more with acupuncture than with medication, with benefit seen from about the third week of treatment. Results varied widely between trials.^[9] An overview of 51 systematic reviews in cancer care found acupuncture appeared helpful for fatigue, insomnia and quality of life, although most of those reviews were rated low quality.^[10]

How acupuncture may work

No research has examined how acupuncture might act on the pituitary gland, so we make no claim about it. Any effect on symptoms such as sleep or fatigue is not explained for this condition.

What treatment involves

Treatment uses fine, sterile, single-use needles at points on the body, usually left in place for about 20 to 40 minutes. A course is typically several visits, with reassessment to see whether symptoms such as sleep or fatigue are improving.

In prospective studies, about 9 in 100 patients had a minor reaction such as bleeding, soreness or redness at a needle site, and serious events occurred in about 1 in 10,000 patients.^[11] Tell the practitioner first if you have a bleeding disorder, take blood thinners, are pregnant, or have a pacemaker (relevant to electroacupuncture). Also tell us about any recent pituitary surgery or radiation, and whether you have symptoms of low cortisol, such as dizziness or faintness.

Ayurvedic medicine as supportive care in Pituitary Disorders

The Ayurvedic view

Classical Ayurveda has no category that matches pituitary disease. A practitioner may instead describe the person's symptoms, such as exhaustion, poor sleep or low drive, using traditional ideas of imbalance in the doshas or weak digestive fire (agni). These are traditional frameworks for choosing supportive measures, not diagnoses of the gland or tumor.

Therapies that may be used

Care is individual and may include:

• Regular meals, sleep and activity routines, and stress-reducing practices such as breathing exercises and gentle yoga
• Warm oil massage for relaxation
• Individually chosen herbs, only after review of your medicines and hormone treatment

Panchakarma, the traditional set of cleansing procedures, is not appropriate in pregnancy, acute illness or frailty. It is also not suitable for anyone with unreplaced hormone deficiency, such as low cortisol, or who is recovering from pituitary surgery. Any such procedure should only be considered with your endocrinology team's knowledge.

What the research shows

There are no clinical trials of Ayurvedic treatment for pituitary disorders. One herb with wider research is ashwagandha (Withania somnifera), and it has been studied for stress, anxiety and sleep, not for pituitary disease. A meta-analysis of 9 trials with 558 people found lower perceived stress, anxiety scores and blood cortisol with ashwagandha than with placebo, with mild to moderate side effects in four trials and a need for more long-term safety data.^[12] A second analysis of 12 trials reached a similar conclusion but rated the certainty as low.^[13] A meta-analysis of 5 trials with 400 people found a small improvement in sleep, again with limited safety data.^[14]

These findings come from generally healthy adults or people with stress and anxiety, not from people with pituitary disease. Whether they apply to someone on hormone replacement is not known.

Herbal medicine as supportive care in Pituitary Disorders

Herbs and formulas that have been studied

No Chinese or Western herbal formula has been tested in people with pituitary tumors or hypopituitarism in the studies we found. The herb that has come closest is chasteberry (Vitex agnus-castus), which has been studied in women with mildly raised prolactin and with premenstrual symptoms.^[15] Ashwagandha, discussed above, has been reviewed for its effects on hormones.^[16]

What the research shows

A systematic review of 12 trials of Vitex in women's health included two trials in latent hyperprolactinemia, a mild, hidden rise in prolactin. One found it better than placebo and the other found it comparable to bromocriptine for lowering prolactin. The review noted small trials and varied designs.^[15] That does not show that Vitex helps a prolactin-secreting tumor, and we would not offer it as an alternative to prescribed treatment.

A review of ashwagandha and the endocrine system reported effects on cortisol and on thyroid and reproductive hormones.^[16] This is a reason for caution, not evidence of benefit, in someone whose hormones are being carefully balanced with medicine.

Safety and herb-drug interactions

Herbs that act on hormones can interfere with endocrine treatment. Ashwagandha has been reported to change cortisol and thyroid hormone levels, so anyone taking hydrocortisone, thyroid hormone or a medicine for hormone excess needs their endocrinologist's agreement before using it.^[16] Herb-drug interactions can have serious consequences, and many reports come from case reports and limited observations.^[17] Herbs should not be added to a regimen without checking your full medicine list.

About one fifth of Ayurvedic medicines bought online contained detectable lead, mercury or arsenic.^[18] Herbal and dietary supplements are also a growing cause of liver injury, and the responsible ingredient is often hard to identify.^[19] Tell us if you are pregnant, breastfeeding, trying to conceive, or have liver or kidney disease. Herbs should come from tested sources and be prescribed individually. Do not start herbal products on your own.

A transdermal medication, meaning an herbal preparation applied to the skin, is also offered at the clinic. There is no research showing it helps in pituitary disorders.

Translating traditional medicine into modern biological language

This is interpretation, not equivalence. Chinese medicine may describe low energy and poor sleep as deficiency of qi or of kidney yin or yang, and Ayurveda may describe depletion or an unsettled Vata. These traditions did not know of the pituitary. The closest modern idea is that the pituitary connects the brain's stress response with the adrenal and other glands, a link the endocrine review of ashwagandha describes as the hypothalamic-pituitary-adrenal axis.^[16]

No study shows that a traditional pattern matches a particular hormone abnormality. The pituitary condition itself should be understood and monitored through medical tests.

How this care fits with your medical care

Pituitary disorders need ongoing care from an endocrinologist, and often a neurosurgeon, ophthalmologist and other specialists. Supportive care at the clinic is for symptoms and well-being only. Do not stop or change hormone replacement, hydrocortisone, thyroid medicine, cabergoline, bromocriptine, octreotide or any other prescribed medicine on the basis of anything we offer.

For a condition like this, we ask that you are under a physician's care for it and that your treating team knows you are receiving complementary care. Please bring your diagnosis, recent hormone test results and MRI reports, a full list of medicines and supplements, and details of any surgery or radiation.

When to seek urgent medical care

Some pituitary problems become emergencies quickly.^{[3, 7]}

• Sudden severe headache, especially with vision loss, double vision, nausea or vomiting (possible pituitary apoplexy)
• Marked weakness, fainting, severe vomiting, confusion or very low blood pressure (possible adrenal crisis, especially with known low cortisol)
• Rapidly worsening vision or loss of part of your visual field
• Extreme thirst with very large amounts of urine, or confusion
• Drowsiness or loss of consciousness

If any of these occur, call 911 or go to the nearest emergency department.