From Lewis S Blevins, Jr. MD –
Most of us know of the complexity of the hypothalamic-pituitary and target gland systems in health and disease. Further, the target gland hormones are carried in the blood by different proteins, act within cells differently, and exert their influences on a wide variety of bodily functions. All of this can best be described as body “operating systems” type of stuff! Noooo wonder, then, that it can be difficult to diagnose pituitary diseases and patients go a long time without a proper diagnosis and timely treatment. For example…..fatigue, weight gain, headaches, etc……I’m guessing that those symptoms are the most common symptoms in about one-third of all medical diagnoses and a great proportion of people with depression and stress.
The “hook” or lead into a diagnosis is often something more specific, such as breast milk and loss of periods, but, unfortunately, many patients are still diagnosed incidental to some other problem….a bump on the head leads to an MRI that discloses a pituitary tumor, for example. If one were to look at all of the symptoms and signs related to pituitary disorders of all types, and all of the symptoms of target gland excess and deficiency, the collated list would take up pages and pages of medical texts. It would take many hours to go through them with patients. We’d all be waiting a long time in boring stodgy waiting rooms looking at last years issues of magazines!
How do we do it as physicians? It’s easy. Every question is like a test. Some tests are not indicated. For example, if you have acromegaly…I’m probably not asking a lot of the questions to see if you have Cushing’s syndrome…unless you also look Cushingoid! Basically, we look for patterns and focus on those things. Also, we look at things in groups. For example, its easier to split the symptoms into hormone classes…symptoms of hypothyroidism, of adrenal insufficiency, of hypogonadism, GH deficiency, and so on. I’ll ask the hypothyroid symptoms. Then the GH symptoms etc. It helps me to keep them in groups. Further, within each grouping there are the common and classic symptoms that are seen in all affected patients, and symptoms that are seen in mild, moderate and severe deficiencies. So, if a patient has none of the common symptoms of mild hormone dysfunction, then there is no point in asking about all of the rare symptoms seen in patients with severe forms of the disease state. The same goes for all of the symptoms of hormone excess. It is through this information gathering process that a physician can navigate all of the symptoms and signs of pituitary disease so as to guide diagnostic and treatment decisions.
Many of our patients have so many other medical problems, and symptoms unrelated to pituitary dysfunction, while others do indeed have unusual symptoms related to their disorders. That’s where diagnostic tests come into play…to confirm our clinical suspicions….or to refute them whatever the case may be. In many of our patients, a diagnosis is made, and hindsight leads us to raise our brows, strike our foreheads, and say “duh” my doctor is an eejit and should have got this one years ago. While that is often true, the truth of the matter is this….endocrine disorders are rare, pituitary disorders are even more rare, medical school curricula devote VERY LITTLE to the topic, the usual doctor in training has very little if any exposure to pituitary disorders, and if so, remember these are sleep deprived doctors who are learning to manage heart attacks, ICU patients, super bug infections, and the like…. so, they probably did not take the time to read about pituitary disorders amidst the chaos.
Sigh. So….. we are left with extremely rare disorders that have myriad symptoms and signs that are common to a lot of medical problems faced by doctors who have had very little training. All I can say is that its up to us, all of us, doctors and patients alike, to graciously teach those who know little….so the next patient can benefit from the doctor who is presented with what should be recognizable as a pituitary problem. Go forth…and teach….and doing so make the world a better place. But…. make sure you get your bonafide medical needs met, too!
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