The hypothalamus controls several endocrine functions and if it is damaged, the functioning of the pituitary gland will also be affected. Pituitary disease itself is rare, but like hypothalamic disease, the symptoms vary widely and it’s essential to consult an expert for diagnosis and treatment.

Pituitary disease includes a group of conditions that affect the pituitary gland and the hormones it produces. Disorders can happen when the gland produces too much or too little hormone.

Pituitary tumours are often found incidentally on a general MRI or CT scan. Small tumours are naturally more common than larger ones, but all have to be understood. They are usually benign and cause problems because they produce hormones, squash normal hormone-producing cells, cause headaches, put pressure on the nerves to the eyes or – more rarely – those controlling eye movements or facial sensation. We have a wealth of experience diagnosing and treating pituitary tumours and work with a group of experts who can also help. Tumours and/or inflammation can affect sexual function, fertility, energy, growth and weight, and must be diagnosed quickly and accurately.

Hypothalamic tumours are rarer, but much of our general health relies on this part of the brain functioning well. The effects tend to be more subtle than with pituitary tumours and require very specialist assessment, which usually involves radiology, the laboratory, eye specialists and oncologists – a collaboration which we can help you to navigate.

Prolactinoma is a common clinical problem which occurs when the pituitary gland produces excessive prolactin. It causes menstrual irregularities or inappropriate breast milk production, and infertility in both men and women, and is sometimes associated with polycystic ovarian syndrome (PCOS). Following diagnosis, which usually happens quickly, the usual treatment is a dopamine agonist such as cabergoline.

Benign tumours in the pituitary are often too small to cause any harm, but sometimes it’s useful to make a detailed assessment of the pituitary function and carry out ongoing surveillance to find out whether they are stable or changing over time. Larger tumours can squash the cells that make normal pituitary hormones, and this in turn can affect your energy, temperature, breast health, periods, erections and/or fertility, growth, skin condition and mood. As these benign tumours can grow very slowly the changes are often insidious and the tests difficult to interpret. Often they are picked up by an optician, or by a scan for something else.

The larger tumours can get close to – or even squash – the optic nerve, or other nerves used for vision. This must be diagnosed quickly and the pressure relieved, usually by an operation. More rarely, tumours can affect the nerves associated with eye movement and facial sensation.

Whatever the situation, we have experience in assessing and diagnosing pituitary disease and helping you decide on the right treatment for you, connecting you where necessary with a close network of trusted colleagues experienced in these conditions too.

If a tumour or inflammation in the pituitary and/or hypothalamus affects the central control of your adrenals, it can be difficult to diagnose. Secondary adrenal failure, when hormones are not produced correctly, can affect your energy, wellbeing, blood pressure and weight. Our depth of understanding of how the hypothalamic-pituitary-adrenal (HPA) axis works means that we can quickly work out what the best tests are if you become unwell suddenly, how to replace hormones if they are deficient, and how to avoid becoming unwell.  

Thyroid health is more difficult to maintain when pituitary disease is present. The clinic picture becomes more complex and the normal rules for interpreting thyroid blood tests often don’t apply. Decisions about therapy must be made by a thyroid specialist used to dealing with pituitary disease with or without multiple hormone deficiencies. 

If the signals received by your hypothalamus indicate that you might be underweight, it will change the signals it sends out to regulate your libido, periods, erections, energy and sleep, affecting your function in these areas, but also other parts of the body including your skeleton, breasts and womb. While the condition can be difficult to recognise in some patients, we can help you understand what is happening and what can be done about it. Often this is about ensuring your body has the right hormonal environment while we consider your weight and energy balance. It may also involve looking at whether we can improve some co-existing disease that is affecting you – for example, your mental health, cancer or immune problems, coeliac or inflammatory bowel disease.

The hypothalamus, located close to the pituitary in the base of the brain, controls nearly all our endocrine function. It is very sensitive to the body’s energy balance, and if this balance is upset the symptoms can be seen elsewhere.

Rarely, tumours or inflammation of the pituitary gland and/or hypothalamus can interfere with the important centres in the brain which control the adrenals, thyroid, testes and ovaries. Sometimes a tumour makes it clear that we should focus on these areas, but making the right diagnosis can often be more difficult. We are used to interpreting tests of these hormonal axes in pituitary disease and treating dysfunction across them. The effects might be felt in your mood, energy, weight, muscle and fat distribution, libido, periods, erections, fertility, temperature and general wellbeing.