Trauma and the Pituitary

From Linda M. Rio, M.A., MFT  –  One of the main reasons for my interest in pituitary disorders actually came from what was new information to me at the time about the impact of emotional trauma, particularly during early childhood years, and the higher than normal incidence of pituitary tumors many years later. And, although it always made logical sense to me that extreme circumstances, particularly during the formative years, could have an effect on the body, there were few studies, especially of the psychological kind, that showed this at the time I was doing my training to become a Marriage & Family Therapist (a very long time ago).

In subsequent years many studies have rather dramatically shown a link between trauma and the body. So first I think I need to provide some definition and context to “trauma”. The American Psychological Association defines trauma as, “an emotional response to a terrible event like an accident, rape or natural disaster. Immediately after the event, shock and denial are typical. Longer term reactions include unpredictable emotions, flashbacks, strained relationships and even physical symptoms like headaches or nausea.” (APA, 2017). Traumatic events happen to people of all ages and most recover, although many suffer posttraumatic stress disorder (PTSD) months to years following the event/events. According to the National Institute of Mental Health (NIMH, 2017), children and teens can have extreme reactions to trauma, but their symptoms may not be the same as adults. For many people, the emotional and/or physical impact on them often is/was never even acknowledged. This is especially true for children in cases where parents or caregivers may not even be aware that a traumatic event has occurred to a child. In cases of child sexual, physical, and/or emotional abuse children often keep such deep wounds a secret, even from their parents. In fact, it is often the case where keeping the traumatic events(s) secret actually propagates the growth of even more trauma or stress, which then becomes compounded over time. Efforts to maintain the secret can in and of itself become traumatic since a person needs to expend a lot of effort just to hide their emotions, especially big and intense emotions resulting from a traumatic event.

One research study many have never heard about but should know is called The Adverse Childhood Experiences Study (ACE Study). This started as an investigation into obesity but eventually became a 25-year-long study of over 17,000 Kaiser Permanente patients in San Diego, CA. This study eventually involved the Centers for Disease Control and Prevention along with Kaiser. The Adverse Childhood Experiences (ACE) research actually refers to a series of over 60 studies conducted in the past 25 years that eventually involved replication in 32 States (Mead, 2015). The studies explore the relationship between difficult childhood events and chronic behavioral, mental and physical health problems in adult life When initially trying to treat weight gain doctors noted that many of those in the clinic’s program dropped out and this was troublesome since many of the drop-outs had actually lost significant weight. Author Jane Ellen Stevens (2012) wrote about the origins and impact of this study and interviewed the principal researcher, Dr. Vincent Felitti. Ms. Stevens reports that he was perplexed that the participants gained weight, that the gain was abrupt but then stabilized and they didn’t keep gaining. For those who lost weight it was then all gained back in spite of the clinic’s efforts. To try to understand this Dr. Felitti and his team decided to do extensive interviews and gained medical and other background information using a standardized set of questions that included asking those who had dropped out of the program: “How much did you weigh when you were born? How much did you weigh when you started first grade? How much did you weigh when you entered high school? How old were you when you became sexually active? How old were you when you married?” When discussing the origins of the study he later recalled that he somewhat mistakenly then asked one woman, “How old were you when you were first sexually active,” He then asked, “How much did you weigh when you were first sexually active?’ The patient responded, ‘Forty pounds”. He didn’t understand what he was hearing. Then asked his mistakenly worded question once again and Dr. Felitti received the answer, “It was when I was four years old, with my father.” (Stevens, 2012). The team later interviewed 286 of the program’s drop-outs to discover most had been sexually abused as children. Stevens’ article goes on to describe how the study then grew. The study sample was comprised of 75% white, 11% Latino, 7.5% Asian and Pacific Islander, and 5% black participants. In two waves, Dr. Felitti and Robert Anda, MD, a medical epidemiologist, asked 26,000 people who came through the department “if they would be interested in helping us understand how childhood events might affect adult health,” says Felitti. Of those, 17,421 agreed (Stevens, 2012; Felitti, 1998). The study they conducted went from 1995 to 1996 (a second wave was also conducted in 1997) showed that adverse experiences in childhood were common among all socioeconomic levels. Furthermore, it showed a direct link between childhood trauma and adult onset of chronic physical and mental health disease along with the likelihood of serving time in prison, and negative effects on employment. The study also showed a high percentage, 87%, had experienced more than one adverse childhood experience (trauma) and most of those who experienced such had a higher risk of medical, mental and social problems in adulthood. The findings suggest that the impact of these adverse childhood experiences on adult health status is strong and cumulative (Felitti, et al, 1998). The ACE Study shows the profound effects of childhood stress that last well into adulthood and not only affect the mental well-being but also the physical health of those who have suffered such trauma. Multiple links to early childhood illnesses and later illness have been reported including: headaches (Anda, Tietjen, Schulman, Felitti, & Croft, 2010); autoimmune disease (Dube et. Al, 2009). Additionally, a high ACE score increases the chances for heart, lung, liver, suicide, sexually transmitted diseases, and other causes of death (Anda, 2017). Overall, lots has been written about the ACE’s and anyone who takes the questionnaire needs to know that it is not intended as a crystal ball to predict your future. Understanding the impact that trauma can have on the body and mind is important as is the importance for healthcare professionals to know about risk factors.

So, what does all of this have to do with pituitary disorders? Dr. Louis Sobrihno, an endocrinologist and researcher in Portugal described some of his numerous findings in, The Hormone Factor: Bridging the Mind-body Gap (2014) where he concludes that paternal deprivation (defined as absent father before the age of 10 or exposure to a violent one) predisposes an important number of women to develop higher than average prolactin levels, and a small number of these may proceed to develop a clinically relevant prolactinoma. There are other confirmations of the link between pituitary and/or endocrine disorders and trauma, specifically the absence or violence of the father early in life and the occurrence of prolactinomas (Rojas et al. 1981; Jürgensen and Bardé 1983; Assies et al. 1992; Sobrinho et al. 2012). Dr. Sobrinho makes a profound concluding statement that “the possibility that, in some cases, response to environmental challenges in predisposed persons may lead to a sequence of events that promote the development of a pituitary tumor” (Sobrinho, 2014). Posttraumatic stress only develops in response to intensely distressing events. The body is designed to deal quite effectively with acute, short-term stress as part of a biological system involving hormones which cause an immediate response upon physiological organs necessary to protect the body. In an acute situation neurohormones, such as epinephrine and norepinephrine, serotonin, cortisol and other glucocorticoids, vasopressin, oxytocin and more, along with exogenous opioids get released. In a well-functioning organism this all works well to help us react as quickly as necessary to get us out of danger.

Just the other day one of my granddaughters was learning to drive in my car and had a minor traffic accident (any accident is MAJOR to me). At the moment of impact my body and mind reacted quickly to calmly instruct my granddaughter to pull the car over in a safe location, to not get out on the driver’s side due to the fast-moving freeway traffic, and for us both to “just take a breath”. In spite of what I was telling myself about calming-down, my heart was racing out of my chest and I could feel the blood pumping throughout my body with intense pressure. It was only after necessary information was exchanged with the other driver and we got home (I drove) that the pictures started replaying in my head about how it all happened. The impact of the acute stress was present in spite of my cognitive knowledge and training regarding the effects of trauma. We both kept (and keep) telling the story over and over. Telling “the story”, by the way, is a healing process that allows for the mental and physical energy of the traumatic event to be dissipated over a period of time. It is why it is important for anyone involved in a trauma to “tell” their story, and retell it until they do not need to any longer. However, when there is chronic or persistent stress this inhibits the effectiveness of the stress response and induces desensitization (Axelrod & Reisine, 1984). Shalev (1996) states that neuroendocrine studies show a reduced cortisol level in those diagnosed with posttraumatic stress disorder as opposed to raised cortisol levels seen in those with acute stress. The endocrine system is intimately involved in trauma and its role should not be overlooked. Is it possible that one day a standard primary care visit and/or mental health intake will include assessment ratings for levels of stress, particularly traumatic stress in order to add to the decision tree of diagnoses possible? (Rio, 2014). We can certainly hope that given the importance and role of the pituitary in dealing with stress that more careful attention will one day be made to the possibility of dysfunction of this gland in cases where severe and/or chronic stress has occurred.

It is key to remember that no one has yet to draw a direct line between early childhood adversity/trauma and the later development of pituitary dysfunction. However, there does appear to be a link, nonetheless. Most would agree that there are many factors involved that include the genetic make-up every person has that may provide them with a predisposition to disease or illness as well as protective factors to prevent some illnesses. It is not just exposure to trauma that damages, but the aftermath which may also determine health or development of illness. Study after study has shown the essential protection that a loving, supportive family and environment have in the healing process. There is also important healing that occurs when a person who has experienced trauma can tell, and re-tell, and re-tell their story, their unique experience to a caring and concerned person who can validate the experience. Maybe this is the main reason why I thought it important to write this particular article; to provide validation for those who most certainly have had trauma in their childhood or adulthood lives. I want those reading this to know that there are people, doctors, therapists, neighbors, family that truly want and are ready to hear, listen, validate. It is not, however, easy to find those special individuals who can truly be trusted to truly honor one’s very, very delicate and intimate experiences. But once found, these people can help to slowly transform trauma into triumph.

 

References

American Psychological Association (2017). Trauma. http://www.apa.org/topics/trauma/. Retrieved June 18,

Anda, R. (2017). Overview of the adverse childhood experiences (ACE) Study. https://multco.us/file/37959/download. Retrieved June 20

 

Anda R, Tietjen G, Schulman E, Felitti V, Croft J. (2010). Adverse childhood experiences and frequent headaches in adults. Headache, Oct;50(9):1473-81. doi: 10.1111/j.1526-4610.2010.01756.x.

 

Assies J, Vingerhoets AJJM, Poppelaars K (1992). Psychosocial aspects of hyperprolactinemia. Psychoneuroendocrinology 17, 6, 673-679.

Axelrod, J., & Reisine, T.D. (1984). Stress hormones, their interaction and regulation. Science, 224, 452-459.

 

Centers for Disease Control. Adverse childhood experiences (ACE’s). Retrieved June 20, 2017, from https://www.cdc.gov/violenceprevention/acestudy/index.html

 

Dube SR, Fairweather D, Pearson WS, Felitti VJ, Anda RF, Croft JB. (2009). Cumulative childhood stress and autoimmune disease. Psychom Med.; 71:243–250.

 

Felitti, V.J. et al (1998). Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults: The adverse childhood experiences (ACE) study. American Journal of Preventative Medicine, 14, (4), 245–258. Retrieved from June 28, 2017. http://dx.doi.org/10.1016/S0749-3797(98)00017-8.

Jürgensen O, Bardé B (1983) Psychodynamic findings in women with elevated serum prolactin. In: The Young Woman. Psychosomatic aspects of Obstetrics and Gynecology. Eds. L. Dennerstein and M. de Senarclens. Excepta Médica, I.C.S. 618, Amsterdam, pp. 120-148.

Mead, V. (2015). Adverse childhood experiences and chronic illness: Understanding ACEs and an example from the movie “Boyhood”. Retrieved June 28, 2017, from https://chronicillnesstraumastudies.com/adverse-childhood-experiences-and-chronic-illness-boyhood/.

National Institute of Mental Health (2017). PTSD. Retrieved June 18, 2017, from https://www.nimh.nih.gov/health/topics/post-traumatic-stress-disorder-ptsd/index.shtml.

Rio, L. (2014). The hormone factor in mental health: Bridging the mind-body gap. London/Philadelphia: Jessica Kingsley.

Rojas LM, Sthory I, Canales ES, Zarate A (1981) Psychogenic factors in the syndrome of amenorrea-galactorrhea. Ginecologia y Obstetricia de Mexico. 49, 295, 2914-295.

Shalev, A.Y. (1996). Stress versus traumatic stress from acute homeostatic reactions to chronic phychopathology. In B.A. van der Kolk, A.C. McFarlane, & L.W.eisaeth, Eds. Traumatic Stress: The effects of overwhelming experience on mind, body, and society. New York/London: The Guilford Press.

Sobrinho LG, Duarte JS, Paiva I, Gomes, L Vicente V, Aguiar P (2012) Paternal deprivation prior to adolescence and vulnerability to pituitary adenomas. Pituitary 15, 2, 251-257.

Stevens, J.E. (2012). The adverse childhood experiences study — the largest, most important public health study you never heard of — began in an obesity clinic. Retrieved June 20, 2017, from https://acestoohigh.com/2012/10/03/the-adverse-childhood-experiences-study-the-largest-most-important-public-health-study-you-never-heard-of-began-in-an-obesity-clinic/

 

 

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1 COMMENT

  1. I greatly appreciated your beautifully detailed article about potential links between trauma and pituitary tumors – and am adding some of these references to my list. Glad my blog post could be of help – thanks for linking.

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