Dr. Friedman explains the role of the pituitary gland in a woman's body and how a head trauma or pregnancy can cause growth hormone deficiency, Sheehan's syndrome, fatigue or other symptoms.
Pituitary is the master gland at the base of the brain and it controls pretty much all the endocrine organs and it makes different hormones and each hormone, if you are deficient in that, can affect your endocrine status and can give you fatigue.
So what I want to talk about briefly is growth hormone. So growth hormone – it can be deficient in adults. When a growth hormone is deficient in children they are short but growth hormone deficiency in adults can lead to fatigue, joint pains, trouble sleeping, muscle pain, some depression.
And these are all very common symptoms that in most patients are probably not due to growth hormone but in the patient that does indeed have a pituitary problem they can be growth hormone deficient.
Growth hormone is the first hormone of the pituitary to be affected if the pituitary is damaged. So for example a person that had head trauma they can have their pituitary damaged in a fairly often mild condition.
So let’s say a person was in a car accident and got a concussion, or let’s say they fell off from a building. I have a patient who fell from a building and he has had a concussion and he had very severe growth hormone deficiency.
What happens is your brain is above your pituitary. It’s connected to your pituitary by a stalk, and you can imagine that if you are getting a head trauma, you are in a car accident for example, your brain might go one way and your pituitary with a stalk sort of stuck here.
And that stalk can get stretched and can no longer supply the hormones at the hypothalamus is supposed to be supplying to the pituitary and you can get pituitary insufficiency and you can get growth hormone insufficiency from that.
Another common condition that’s maybe a little under recognized is something called Sheehan’s syndrome and this happens in women after they give birth.
During pregnancy their pituitary gets much bigger because it’s making more hormones and it gets extra blood supply and then right after you deliver, in occasional patients, the blood supply drops and the person doesn’t get enough blood going to their pituitary and they can have almost like a mini stroke of their pituitary.
The patients will complaint of a severe headache, worst headache of their life, they may have low blood pressure right after that. They may have to stay in hospital a couple of days and then a couple of months later we find they are very fatigued and they are having trouble through periods, for example, that maybe indicate other pituitary problems and we find sure enough they have hypopituitarism and growth hormone deficiency.
The diagnosis of growth hormone deficiency is difficult. We start by measuring a hormone called IGF-1 and I’ll explain why we have to measure IGF-1 and not just growth hormone.
If you are growth hormone deficient we think maybe just measure growth hormone, but growth hormone is made in pulses and you can’t just measure a random growth hormone because you could be at the top of the pulse or at the bottom of the pulse. You don’t know where you are at.
Then the growth hormone then goes to the liver to make a hormone called IGF-1 which is much more stable. So a doctor can measure an IGF-1 as sort of a screen for growth hormone deficiency.
If the IGF-1 is indeed low then the doctor would order some tests called stimulation tests where they give agents that sort of challenge the pituitary to see if it makes growth hormone and if it does makes growth hormone then they are considered normal but if they don’t make enough growth hormone then they are considered deficient.
There’s various tests we could do. What I do is a test called a glucagon stimulation test where I give a hormone called glucagon and that stimulates the pituitary to make growth hormone and if they don’t make enough growth hormone we find they are growth hormone deficient, and we put them on growth hormone and we have to monitor it very carefully.
And many of these patients will get a lot better in their fatigue, that’s due to the growth hormone deficiency or reverse itself.
So I think this is, again, not the most common condition but in patients that have other symptoms of hypopituitarism, especially a woman who is missing their periods at a fairly young age, maybe they had trauma, post-delivery a headache and followed by missing her periods afterwards – I think these should be investigated.
So I would start again by measuring IGF-1. If that’s low I will probably do a pituitary MRI and do the growth hormone stimulation testing.
About Dr. Theodore Friedman, M.D., Ph.D., M.Phil.:
Dr. Theodore Friedman, M.D., Ph.D., M.Phil., specializes in hard-to-diagnose-and- treat cases of adrenal, pituitary, thyroid, and fatigue disorders. He's been with the University of California Los Angeles School of Medicine since 2005 and serves as Chief of the Endocrinology, Metabolism and Molecular Medicine Division at Charles R. Drew University of Medicine and Science. He also served as Director of the Multi-Disciplinary Chronic Fatigue Clinic at Cedars-Sinai Medical Center from 1998-2000.
Dr. Friedman has a private practice near Beverly Hills, California as well as privileges at Cedars-Sinai Medical Center and Martin Luther King Medical Center.