From the Publisher
The pituitary gland has long been recognized as the master gland of the human body. It influences or regulates most of the vital metastatic functions of the body.
Not until the mid-1960's was it possible for medical scientists to begin to measure (assay) pituitary hormone levels in the blood, and for the study of hormonal function to start in earnest.
Hence the delayed knowledge of pituitary issues and the explanation for the lack of information about pituitary issues within the patient community, the public at large, and too often, the general medical community.
The pituitary plays a primary role in thyroid function, adrenocortical (adrenal) function, gonadal (reproductive/sexual) function, growth, and water and food intake and, when tumors are present, can affect appetite, sleep, mental activity, mood, and muscle function.
The pituitary sits at the base of the brain in a bony structure called the sella turcica or "Turkish Saddle". It is small, about the size of a peanut, with the anterior and posterior portions responsible for different functions.
When things go well and a person is healthy, the pituitary is rarely thought of or appreciated. When it malfunctions, it generally manifests itself in the form of a benign tumor (adenoma), only very rarely as a malignant cancer (carcinoma).
In 1938, in an autopsy series at the Mayo Clinic, it was determined that 22.4% of the population develop pituitary tumors in their lifetime. Age, sex, gender, race or national original have apparently no influence on who will develop the tumors, most of which, fortunately, are clinically silent and cause no symptoms.
Today, with our longer lives, nearly 30% of the world's population may develop pituitary tumors. It is estimated that between 1 and 2% of the world's population develop clinically significant tumors if we take into account infertility, impotence, emotional problems, vision problems, etc.
The number of estimated cases of pituitary tumors climbs every year, not because of an actual increase in their number, but because of greater awareness, better detection and diagnostic methods and a clearer understanding of cause and effect.
By far the greatest number of pituitary patients, however, are still undiagnosed and , therefore, untreated or under treated.
Pituitary disease (and tumors) and their clinical consequences date back to Goliath in the Bible and Akhenaten, the Egyptian Pharaoh, and before. It is also known that genetic links and therefore a tendency for susceptibility to the tumors is often passed from parent to child.
Though certainly not an issue of an epidemic proportion, pituitary disease, disorders and tumors are sufficiently prevalent to warrant intense studies as a major public health issue.
The far-ranging, very destructive and often fatal outcome of pituitary disorders demands nothing less.
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It is estimated that between 1 and 2 percent (60 million to 120 million people) of the world's population harbor clinically significant pituitary tumors. Approximately 22% of all adults have been found to harbor pituitary adenomas (tumors). While most of these tumors are thought to produce no symptoms, it is, in fact, unknown to what extent most of these tumors affect the hosts. Much still remains to be learned about pituitary functions and disease(s).....
...The pituitary is an intriguing yet confusing organ that is essential for life. This tiny bean-shaped tissue, hidden within the cranial cavity and well protected from external insult, is responsible for the production of hormones that determine growth and development, sexual maturation, reproductive function and lactation. It regulates thyroid and adrenal function that in turn are responsible for maintaining all bodily functions from protein, carbohydrate, fat and water metabolism, to blood pressure, sleep cycles and immunity. Its importance is obvious, yet it is the site of common pathology. Despite our advances in medical science, we remain ignorant of the cause of most pituitary diseases.....
....A question that patients frequently ask is "Why have I developed a pituitary tumor?" A second is "Could I pass this pituitary tumor on to my children?" In most cases, the answers to these questions are not straightforward. However, research is beginning to provide answers to some of these questions....
....Patients with pituitary tumors often require medication therapy to suppress hormonal hypersecretion, to replace the missing hormone(s) or to accomplish both tasks. It is absolutely imperative for the patient to participate actively in the choice of therapy and to comply with the treatment protocol. An active discussion of the reasons for a particular treatment, the goals to be accomplished and the potential pitfalls is a necessary prerequisite for a successful cooperation between a knowledgeable endocrinologist and an intelligent patient....
....A prolactinoma is a tumor in the pituitary gland, which secretes a hormone called prolactin. Pituitary tumors are clinically evident in about 14 people in 100,000. However in postmortem studies about 1 in 20 subjects have a small prolactinoma. This tumor is in over 99% of cases benign. It is the most common type of pituitary tumor. Prolactin is the milk hormone and levels of this hormone in the blood rise during pregnancy to stimulate and prepare the breast for lactation. After delivery of the baby the prolactin levels will fall unless breast-feeding takes place. However if the baby is allowed to suckle then the mother's prolactin will rise in response to the suckling to maintain milk production....
....Beyond the "Big Three" sex hormones---testosterone, estrogen, and progesterone---are a cast of other endocrine characters---peptides and neurotransmitters, as well as hormones---that all exert powerful influences on our sexuality in sickness and in health, for better or for worse, till death do us part. Some, such as pheromones, dopamine and serotonin, have begun to creep into the periphery of our awareness as medical science advances and collides with popular culture, while others, such as oxytocin, vasopressin, prolactin (known to many pituitary-tumor patients) and the alphabet-soup hormones DHEA, PEA and LHRH are primarily the turf of medical researchers, animal labs and arcane professional journals.
...Knowledge is power, however, and the more we know about the way our bodies work, the better advocates we can be for our own health and well-being. Information not only helps us make sense of our experience, it also makes us better able to communicate with our doctors so that we are more likely to get what we need---and want....
....Pituitary tumors often cause sexual problems. This can be one of the most troubling aspects of the disease. Pituitary patients and their sexual partners need information and guidance to deal with these problems. Yet discussion of sexual issues is often lacking in literature written for patients, and many doctors are neither well-informed nor comfortable talking about sexual dysfunction.
How could a tumor on the pituitary, a small gland inside the skull, affect sexuality? Most people only know the pituitary (if they have ever heard of it at all) for its role in promoting growth during adolescence. As most pituitary patients know, however, the pituitary secretes eight different hormones which control diverse bodily functions including growth, metabolism, lactation, and reproduction....
....Functioning and non-functioning pituitary tumors affect the reproductive system. The pituitary tumor may compromise the function of the remaining pituitary gland resulting in decrease in other hormones normally secreted by the pituitary. After pituitary surgery or irradiation, normal pituitary cells may be damaged which will lead to the deficiency of other pituitary hormones. The symptoms of hormone deficiency may become apparent only after many months or years....
....It comes as no surprise that the most neglected effect of pituitary disease is the emotional distress that results from the massive disruption that occurs in one's life and the impact the illness has on one's loved ones and significant others. The impact of the emotional effects of pituitary disease was not lost on Harvey Cushing, perhaps one of the most influential surgeons of the 20th century, particularly with respect to the pituitary gland. Although not a trained psychiatrist, he greatly appreciated the impact that hormonal alterations from pituitary disease had on well-being and emotional functioning. In fact, he had stressed the need to study the emotional side effects of endocrine disorders as well as the impact that hormonal alterations had on preexisting coping patterns. Unfortunately, not much research has been conducted in this area. It is only in the last decade, the "Decade of the Brain," that the relationship between brain structures, neurohormones, neuropeptides, and emotions has become clearer....
