Hyperpituitarism (Pituitary Excess)
Cushing’s Syndrome and Disease
The normal function of cortisol in healthy subjects is to increase glucose production, inhibit protein synthesis, increase lipolysis, increase protein breakdown, and modulate immunological and inflammatory responses. ACTH is stimulated by corticotropin-releasing hormone (CRH). Cortisol suppresses the release of ACTH and CRH. Because of the wide variability of cortisol secretions in a 24-hour period, frequent saliva hormone testing during the course of a day can be helpful rather than a single blood draw to measure cortisol levels.
Cushing’s syndrome is a non-specific name for excessive serum glucorticoids. The two main causes include exogenous glucorticoid ingestion (e.g., patients taking steroid medications, typically for inflammatory states) and pituitary dysfunction, which causes a condition that is known as Cushing’s disease.
Cushing’s disease is caused by excess ACTH in 80% of cases. Of these ACTH dependent cases of Cushing’s, 85% are caused by a pituitary disorder (typically a benign adenoma) that affects ACTH production. The remaining 15% are caused by ectopic ACTH producing tumors, such as malignant tumors of the lungs.
Conventional Medical Treatment [SH]
Surgery is often recommended if Cushing’s disease is caused by benign adenoma of the pituitary.
Naturopathic Medical Treatment and Prevention [SH]
Specific therapy for benign adenoma is the use of Vitex agnus and adaptogenic herbs. Clinical studies have only been done on horses, although it has been used successfully in human clinical practice as well. The successful treatment of equine Cushing’s syndrome in decreasing pituitary adenoma is one of the best examples of treating a disease using a naturopathic approach.7
Pituitary Tumors
Pituitary tumors usually make two or more hormones at the same time. In some cases, significant hormones are produced than can end up causing characteristics of several endocrine pathologies simultaneously. Symptoms depend on the type and location of the tumor and whether the tumor causes hormone excess, hormone deficiency, or pressure on the brain and central nervous system.
Thus, one type of pituitary tumor may produce symptoms that are very different from those produced by another type of growth. In addition, some tumors may begin by causing the release of excess hormone and then later result in a hormonal deficiency as normal pituitary cells are suppressed, thereby confounding a proper diagnosis.
Gonadotropinoma
Gonadotropinomas secrete the glycoproteins LH and/or FHS, which may lead to an excess of these hormones. Although they do not always cause endocrine disturbances, these tumors usually cause neurological problems because of their size.
Thyrotropinoma
Whenever patients with high levels of T3 and T4 and have a detectable TSH level, a TSH secreting tumor should be suspected. The conventional treatment includes pituitary ablation. Bromocriptine, a drug that is used to suppress TSH secretion, is usually not that effective.
Not all patients with pituitary tumors and elevated TSH have thyrotropinomas. Patients with long-term untreated hypothyroidism can cause a pseudo tumor as a compensation for the pituitary producing high levels of TSH for the low function of the thyroid gland. For this reason, no patients should go under surgical intervention of pituitary masses without first checking the TSH and T4 levels simultaneously.
Signs and symptoms of thyrotropin adenomas include weight loss, increased appetite, heart palpitations or irregular heartbeat (superventricular tachycardia, atrial fibrillation), tachycardia (rapid heart rate), heat intolerance and increased sweating, tremor, frequent bowel movements, fatigue and muscle weakness, exertional intolerance and shortness of breath, oligomenorrhea (decreased menstrual flow), nervousness and irritability, other mental disturbances, sleep disturbances (including insomnia), changes in vision, photophobia, eye irritation, diplopia or exophthalmos, lower extremity edema (swelling), sudden paralysis, and impaired fertility.
Hyperprolactinemia
Hyperprolactinemia is a common disorder characterized by excess PRL production by the anterior pituitary. Causes of elevated levels of serum prolactin are pituitary tumors, such as pituitary adenoma. Other causes include interferences with the hyopthalamic pituitary pathway, such as caused by tumors, trauma, or surgery, as well as pharmacological agents that interfere with dopaminergic input to the pituitary gland cause elevated prolactin. These drugs are Phenothiazines, Tricyclic antidepressants, Apha-Methyldopa, Metoclopramide, Cimetidine, and estrogens. In prolactin-secreting pituitary adenomas, monoclonal cell populations autonomously produce prolactin. Generally, the most important physiological states in which prolactin is found to be elevated I healthy adults are pregnancy and lactation.
Symptoms and Signs
Symptoms include anxiety, depression, irritability, and weight gain. In women, since excess PRL causes an increase in the estrogen/progesterone ratio, menstrual cycle irregularities, amenorrhea, anovulation, infertility, and ovarian cysts (PCOS) are possible. Hyperandrogenism and insulin resistance are also symptoms of elevated progesterone/estrogen ratio. In men, excess PRL is associated with low libido and erectile dysfunction.
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Prolactin Stimulation
Prolactin can be stimulated by the following deficiencies:
- Deficiency of cortisol, T3, T4
- Deficiency progesterone, Somatostatin.
Prolactin can be stimulated by the following excesses:
- Stress (stimulates B-endorphins)
- TRH
- Melatonin
- Secretin
- B endorphins
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Functional hyperprolactinemia can also be assessed by measuring basal body temperature charting. This charting would show an absence of increase body temperature indicating anovulation because, during ovulation, body temperature normally increases. 8
Conventional Medical Treatment [SH]
The dopamine agonist, bromocriptine mesylate, is the initial drug of choice for treating hyperprolactinemia. It lowers the prolactin level in 70% to100% of patients. However, side effects are common and may include drowsiness, digestive disturbances, headache, and insomnia.
Radiation treatment is another option; however, its benefits in routine treatment have not been shown to outweigh the risks. Radiation is, therefore, typically reserved for rapidly growing tumors.
Surgical care is indicated in patient drug intolerance, tumors resistant to medical therapy, patients who have persistent visual-field defects in spite of treatment, and patients with large cystic or hemorrhagic tumors.
Naturopathic Medical Treatment and Prevention [SH]
Bio-identical Hormones and Clinical Nutrition
Naturopathic treatment of hyperprolactinemia includes the use of nutrients (such as vitamin B-6 and magnesium) that promote dopamine synthesis, since dopamine is the main inhibitor of prolactin. If an elevated estrogen/progesterone ratio is detected, this can be treated with nutrients that promote estrogen metabolism, and/or with bio-identical progesterone replacement.
Dopamine is the key modulator of prolactin and acts as an inhibiting factor. Progesterone also is used because it opposes PRL induced excess estrogen.
Botanical Medicine [C]
Botanicals that are known to inhibit PRL, such as chaste berry (Vitex agnus castus) are indicated. Animal studies confirmed that vitex agnus work comparatively as well as dopamine agonists, such as lisuride, by significantly inhibit TRH-stimulated prolactin secretion of rat pituitary cells. Because of its dopaminergic effect vitex can be considered an efficient alternative to drugs in slight hyperprolactinemia.9
Vitex at a dose of 20 mg vs placebo was administered to 52 women with luteal phase defects due to latent hyperprolactinemia. The treatment group had a statistically significant reduction in prolactin, luteal phase was normalized, and progesterone levels normalized. Two women got pregnant during the study while taking vitex. No side effects in the study were noted.10
Lifestyle
Stress management, aerobic exercise in moderation, and avoidance of hypoglycemic episodes are also indicated.
