Pituitary Function in Systemic Disorders

Publisher Summary The pituitary gland may be affected by a wide variety of systemic disorders. In some instances, the pituitary is directly involved by the same processes that also afflict other organs, while in other disorders, the primary disease process has indirect, distant effects on pituitary function. Patients with excessive tissue iron deposits, either from idiopathic hemochromatosis, multiple transfusions, or prolonged use of pharmaceutic iron supplements, often develop hypogonadism. Female patients appear to suffer from this complication less frequently than males, perhaps because of the protective effects of monthly menstrual blood loss. Tuberculosis has a predilection for involvement of the basilar meninges and may therefore occasionally involve tissues in the sellar region, sometimes producing anterior or posterior pituitary insufficiency. In polyglandular autoimmune states, clinical involvement of the pituitary is rare. Lymphocytic hypophysitis, an uncommon disorder of pregnant and postpartum women, is associated in some cases with other evidence of endocrine autoimmunity. Antibodies to pituitary tissue have been found in some patients with lymphocytic hypophysitis and in a variety of other endocrine autoimmune disorders, as well as in some patients with the primary empty sella syndrome and Sheehan's syndrome, but, to date, the functional significance of these antibodies remains unclear. Illness, injury and stress, if sufficiently severe, produce a constellation of endocrine changes that are, in general, independent of the specific type of illness.