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  Hypopituitarism / Empty Sella Syndrome  
 
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Signs, symptoms and indicators | Conditions that suggest it | Contributing risk factors | It can lead to... | Recommendations

 

Hypopituitarism is a general term that refers to any under-performance of the pituitary gland. This is a clinical definition used by endocrinologists and is interpreted to mean that one or more functions of the pituitary are deficient. The term may refer to both anterior and posterior pituitary gland failure. Deficient pituitary gland function can result from damage to either the pituitary or the area just above the pituitary, namely the hypothalamus. The hypothalamus contains releasing and inhibitory hormones that control the pituitary. Since these hormones are necessary for normal pituitary function, damage to the hypothalamus can also result in deficient pituitary gland function. Injury to the pituitary can occur from a variety of insults, including damage from an enlarging pituitary tumor, irradiation of the pituitary gland, limited blood supply (as experienced in a stroke), trauma or abnormal iron storage (hemochromatosis). There appears to be a predictable loss of hormonal function with increasing damage. The progression from most vulnerable to least vulnerable is usually as follows:

  • Growth hormone (GH)
  • Gonadotropins (LH and FSH which control sexual/reproductive function)
  • TSH (which control thyroid hormone release)
  • ACTH (which controls adrenal function)
Growth Hormone
Growth hormone is necessary in children for growth, but also appears necessary in adults to maintain normal body composition (muscle and bone mass). It may also be helpful for maintaining an adequate energy level, optimal cardiovascular status and some mental functions. Symptoms of GH deficiency in adults include fatigue, poor exercise performance and symptoms of social isolation. GH is only available in injectable form and is usually given 6-7 times per week. Homeopathic GH or IGF has been proven to provide benefits in blinded trials.

Gonadotropins
Women develop ovarian suppression with irregular periods or absence of periods (amenorrhea), infertility, decreased libido, decreased vaginal secretions, breast atrophy, and osteoporosis. Blood levels of estradiol are low. Estrogen should be replaced along with progesterone. Annual pap smears and mammograms are mandatory.

Men develop testicular suppression with decreased libido, impotence, decreased ejaculate volume, loss of body and facial hair, weakness, fatigue and often anemia. On testing, blood levels of testosterone are low and should be replaced. In the United States, testosterone may be given as a bi-weekly intramuscular injection, in a patch form or as a gel or crème preparation. In some countries, oral preparations of testosterone are available.

Thyroid Stimulation Hormone
Deficiency of thyroid hormone causes a syndrome consisting of decreased energy, increased need to sleep, intolerance of cold (inability to stay warm), dry skin, constipation, muscle aching and decreased mental functions. This variety of symptoms is very uncomfortable and is often the symptom complex that drives patients with pituitary disease to seek medical attention. Replacement therapy consists of a either T4 (thyroxine) and/or T3 (triiodothyronine). The correct dose is determined through experimentation and blood tests.

Adrenal Hormones
Deficiency of ACTH resulting in cortisol deficiency is the most dangerous and life-threatening of the hormonal deficiency syndromes. With gradual onset of deficiency over days or weeks, symptoms are often vague and may include weight loss, fatigue, weakness, depression, apathy, nausea, vomiting, anorexia and hyperpigmentation. As the deficiency becomes more serious or has a more rapid onset (Addison crisis), symptoms of confusion, stupor, psychosis, abnormal electrolytes (low serum sodium, elevated serum potassium), and vascular collapse (low blood pressure and shock) can occur. Treatment consists of cortisol administration or another similar steroid (like prednisone). For patients with acute adrenal insufficiency, rapid intravenous administration of high dose steroids is essential to reverse the crisis.

Posterior Pituitary - Antidiuretic Hormone (ADH)
Replacement of antidiuretic hormone resolves the symptoms of increased thirst and urination seen in diabetes insipidus. Antidiuretic hormone (ADH) is currently replaced by administration of a synthetic type of ADH either by subcutaneous injection, intranasal spray, or by tablet, usually once or twice a day.

Empty Sella Syndrome
When the pituitary gland is not visible on CT or MRI scans of the sella turcica, the condition is referred to as the empty sella syndrome. Primary empty sella syndrome occurs when a small anatomical defect above the pituitary gland increases pressure in the sella turcica and causes the gland to flatten out along the walls of the sella. When the sella is empty because the pituitary gland has regressed following an injury (e.g., surgery, head trauma, radiation therapy), the condition is called secondary empty sella syndrome.

Primary empty sella syndrome is most often an incidental finding on radiological imaging of the brain. Pituitary function is usually normal, and patients do not have any symptoms. The hormone prolactin is mildly elevated in 10-15 % of patients, and the elevated prolactin may interfere with normal function of the testes or ovaries. Medications that suppress prolactin production (e.g., bromocriptine) are effective in correcting the problem.

Patients with an empty sella due to destruction of the pituitary gland have signs and symptoms caused by partial or complete loss of pituitary gland functions. The causes and symptoms of pituitary insufficiency are reviewed in the article on hypopituitarism.

Empty sella syndrome is often associated with abnormal pituitary function in children. Isolated deficiency of growth hormone (GH) is most common, but other pituitary hormones may also be deficient. One study observed empty sella in 48% of children with GH deficiency or multiple pituitary hormone deficiencies compared to only 2% of children with normal pituitary function.

It is possible that repeated (?) head injury may contribute to poorer pituitary function. New research shows for the first time that kickboxing can cause brain damage. Head injuries in kickboxing can cause damage to an area of the brain called the pituitary, resulting in decreased production of hormones, which affect the body's metabolism and response to stress. Research published in the March edition of Clinical Endocrinology suggests that amateur kickboxers who have suffered head injuries should be screened to ensure their pituitary is producing enough hormones.

The pituitary is a pea-sized gland, weighing one gram or less, which is found in the brain. It produces many hormones that are involved in the body's regulation of metabolism, coping with daily stress, general wellbeing and sex drive amongst other areas. A team led by Prof. Fahrettin Kelestimur at Erciyes University Medical School in Turkey measured the levels of these hormones in 22 amateur kickboxers and compared these to sex-matched healthy controls. They found that kickboxers (27.3%) suffered more than controls from hypopituitarism, a condition where the pituitary does not produce enough hormones.

 

 
 

Signs, symptoms & indicators of Hypopituitarism / Empty Sella Syndrome:
 
 
Lab Values - Hormones  Normal TSH or low TSH

Counter-indicators:
  (Mildly) elevated TSH

Symptoms - Head - Eyes/Ocular

  Vision disturbances

Symptoms - Head - Nose

  Allergic rhinitis
 
 

Conditions that suggest Hypopituitarism / Empty Sella Syndrome:
 
 
Circulation  Hypertension

Hormones

  Hypogonadism, Male
  Hyperprolactinemia
  Low Adrenal Function / Adrenal Insufficiency
  Low DHEA Level
  Hypothyroidism
  Low Estrogen Levels
  Low Sex Drive

Lab Values

  Elevated Triglycerides

Metabolic

  Problem Caused By Being Overweight
  Headaches

Skin-Hair-Nails

  Male Hair Loss
  Female Hair Loss

Symptoms - Glandular

  (Possible) hypopituitarism or empty sella syndrome

Uro-Genital

  Amenorrhea
  Erectile Dysfunction (ED, Impotence)
 
 

Risk factors for Hypopituitarism / Empty Sella Syndrome:
 
 
Lab Values - Hormones  Hypopituitarism
  Having low-normal/having low TT4 level
 When TSH and Total T4 are both low, a low functioning pituitary gland is suspected.

Symptoms - Glandular

Counter-indicators:
  Absence of hypopituitarism

Symptoms - Skeletal

  Absence of osteoporosis
 Increased bone density has been associated with the Empty Sella Syndrome.
 
 

Hypopituitarism / Empty Sella Syndrome can lead to:
 
 
Hormones  Low HGH (Human Growth Hormone)
  Low DHEA Level
  Low Adrenal Function / Adrenal Insufficiency
  Hypothyroidism
  Low Estrogen Levels
 
 

Recommendations for Hypopituitarism / Empty Sella Syndrome:
 
 
Animal-based  Glandular / Live Cell Therapy

Hormone

  DHEA
 Six months of treatment with DHEA at 30mg/d if over 45 years of age and 20mg/d if under 45 years of age, induced androgen effects on skin and axillary and pubic hair in a study of 38 women with androgen deficiency due to hypopituitarism. Improved alertness, stamina, and initiative was also reported. [J Clin Endocrinol Metab 2002;87(5): pp.2046-2052]

Lab Tests/Rule-Outs

  Test / Monitor Hormone levels
 Individual hormone replacement may be required when the pituitary master gland is failing to control the output of other endocrine glands. These hormones could include thyroid, adrenal (cortisol and DHEA), and HGH.
 
 


KEY
Weak or unproven link
Strong or generally accepted link
Proven definite or direct link
Strongly counter-indicative
Very strongly or absolutely counter-indicative
Likely to help
Highly recommended
 
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GLOSSARY

Acute:  An illness or symptom of sudden onset, which generally has a short duration.

Adrenal Insufficiency:  Also known as Adrenal Exhaustion or Low Adrenal Function, this is a condition where the adrenal gland is compromised in its production of epinephrine, norepinephrine, cortisol, corticosterone or aldosterone. Symptoms include primarily fatigue, weakness, decreased appetite with ensuing weight loss, as well as nausea, vomiting, abdominal pain, diarrhea or constipation, or increased pigmentation of the skin. Cortical insufficiency (low or no corticosteroids) produces a more serious condition called Addison’s Disease, characterized by extreme weakness, low blood pressure, pigmentation of the skin, shock or even death.

Anemia:  A condition resulting from an unusually low number of red blood cells or too little hemoglobin in the red blood cells. The most common type is iron-deficiency anemia in which the red blood cells are reduced in size and number, and hemoglobin levels are low. Clinical symptoms include shortness of breath, lethargy and heart palpitations.

Anorexia Nervosa:  An eating disorder characterized by excess control - a morbid fear of obesity leads the sufferer to try and limit or reduce their weight by excessive dieting, exercising, vomiting, purging and use of diuretics. Sufferers are typically more than 15% below the average weight for their height/sex/age and typically have amenorrhea (if female) or low libido (if male). 1-2% of female teenagers are anorexic.

Anterior:  In the front or forward part of the organ or toward the head of the body.

Cardiovascular:  Pertaining to the heart and blood vessels.

Constipation:  Difficult, incomplete, or infrequent evacuation of dry, hardened feces from the bowels.

Diabetes Insipidus:  Excessive production of urine, usually due to insufficient production of antidiuretic hormone.

Electrolyte:  An element or compound that, when melted or dissolved in water or other solvent, breaks up into ions and is able to carry an electric current.

Estrogen:  One of the female sex hormones produced by the ovaries.

Gram:  (gm): A metric unit of weight, there being approximately 28 grams in one ounce.

Hemochromatosis:  A rare disease in which iron deposits build up throughout the body. Enlarged liver, skin discoloration, diabetes mellitus, and heart failure may occur.

Homeopathy:  A system of medicine based on the belief that the cure of disease can be effected by minute doses of substances that, if given to a healthy person in large doses, would produce the same symptoms as are present in the disease being treated. Homeopathy employs natural substances in small doses to stimulate the body's reactive process to remove toxic waste and bring the body back into balance.

Hormones:  Chemical substances secreted by a variety of body organs that are carried by the bloodstream and usually influence cells some distance from the source of production. Hormones signal certain enzymes to perform their functions and, in this way, regulate such body functions as blood sugar levels, insulin levels, the menstrual cycle, and growth. These can be prescription, over-the-counter, synthetic or natural agents. Examples include adrenal hormones such as corticosteroids and aldosterone; glucagon, growth hormone, insulin, testosterone, estrogens, progestins, progesterone, DHEA, melatonin, and thyroid hormones such as thyroxine and calcitonin.

Hypothalamus:  An important supervisory center in the brain regulating many body functions. Despite its importance in maintaining homeostasis, the hypothalamus in humans accounts for only 1/300 of total brain weight, and is about the size of an almond.

Iron:  An essential mineral. Prevents anemia: as a constituent of hemoglobin, transports oxygen throughout the body. Virtually all of the oxygen used by cells in the life process are brought to the cells by the hemoglobin of red blood cells. Iron is a small but most vital, component of the hemoglobin in 20,000 billion red blood cells, of which 115 million are formed every minute. Heme iron (from meat) is absorbed 10 times more readily than the ferrous or ferric form.

Metabolism:  The chemical processes of living cells in which energy is produced in order to replace and repair tissues and maintain a healthy body. Responsible for the production of energy, biosynthesis of important substances, and degradation of various compounds.

MRI:  Magnetic Resonance Imaging. A technique used in diagnosis that combines radio waves and magnetic forces to produce detailed images of the internal structures of the body.

Nausea:  Symptoms resulting from an inclination to vomit.

Osteoporosis:  A disease in which bone tissue becomes porous and brittle. The disease primarily affects postmenopausal women.

Pituitary:  The pituitary gland is small and bean-shaped, located below the brain in the skull base very near the hypothalamus. Weighing less than one gram, the pituitary gland is often called the "master gland" since it controls the secretion of hormones by other endocrine glands.

Potassium:  A mineral that serves as an electrolyte and is involved in the balance of fluid within the body. Our bodies contain more than twice as much potassium as sodium (typically 9oz versus 4oz). About 98% of total body potassium is inside our cells. Potassium is the principal cation (positive ion) of the fluid within cells and is important in controlling the activity of the heart, muscles, nervous system and just about every cell in the body. Potassium regulates the water balance and acid-base balance in the blood and tissues. Evidence is showing that potassium is also involved in bone calcification. Potassium is a cofactor in many reactions, especially those involving energy production and muscle building.

Prolactin:  An anterior pituitary peptide hormone that initiates and maintains lactation.

Serum:  The cell-free fluid of the bloodstream. It appears in a test tube after the blood clots and is often used in expressions relating to the levels of certain compounds in the blood stream.

Sodium:  An essential mineral that our bodies regulate and conserve. Excess sodium retention increases the fluid volume (edema) and low sodium leads to less fluid and relative dehydration. The adult body averages a total content of over 100 grams of sodium, of which a surprising one-third is in bone. A small amount of sodium does get into cell interiors, but this represents only about ten percent of the body content. The remaining 57 percent or so of the body sodium content is in the fluid immediately surrounding the cells, where it is the major cation (positive ion). The role of sodium in the extracellular fluid is maintaining osmotic equilibrium (the proper difference in ions dissolved in the fluids inside and outside the cell) and extracellular fluid volume. Sodium is also involved in nerve impulse transmission, muscle tone and nutrient transport. All of these functions are interrelated with potassium.

Steroid:  Any of a large number of hormonal substances with a similar basic chemical structure containing a 17-carbon 14-ring system and including the sterols and various hormones and glycosides.

Stroke:  A sudden loss of brain function caused by a blockage or rupture of a blood vessel that supplies the brain, characterized by loss of muscular control, complete or partial loss of sensation or consciousness, dizziness, slurred speech, or other symptoms that vary with the extent and severity of the damage to the brain. The most common manifestation is some degree of paralysis, but small strokes may occur without symptoms. Usually caused by arteriosclerosis, it often results in brain damage.

T4:  Thyroxin, thyroid hormone also prepared synthetically, for treatment of hypothyroidism and myxedema.

Testosterone:  The principal male sex hormone that induces and maintains the changes that take place in males at puberty. In men, the testicles continue to produce testosterone throughout life, though there is some decline with age. A naturally occurring androgenic hormone.

Thyroid:  Thyroid Gland: An organ with many veins. It is at the front of the neck. It is essential to normal body growth in infancy and childhood. It releases thyroid hormones - iodine-containing compounds that increase the rate of metabolism, affect body temperature, regulate protein, fat, and carbohydrate catabolism in all cells. They keep up growth hormone release, skeletal maturation, and heart rate, force, and output. They promote central nervous system growth, stimulate the making of many enzymes, and are necessary for muscle tone and vigor.