The Posterior lobe insufficiency is characterized by an isolated failure of the hormone secretion of the posterior lobe of the pituitary gland or at least a reduced release of the hormones oxytocin and ADH (antidiuretic hormone) formed in the hypothalamus. Oxytocin plays a special role in women giving birth and generally has a positive effect on social relationships. ADH is an antidiuretic peptide hormone that is also synthesized in the hypothalamus and released into the bloodstream from the posterior pituitary gland.
What is posterior pituitary insufficiency?
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The posterior lobe of the pituitary gland (HHL), which is more specifically referred to as the neurohypophysis, is an integral part of the pituitary gland, but represents an evolutionary development of the brain. In contrast to the anterior pituitary lobe (HVL), the HHL does not synthesize the secreted hormones itself, but serves the HHL as a store and activator of the hormones oxytocin and ADH produced in the hypothalamus.
Decreased hormone secretion or a complete loss of hormone secretion by HHL is called Posterior lobe insufficiency (HHL insufficiency). The term insufficiency only expresses that the hormone release of oxytocin and the antidiuretic hormone ADH is disturbed or does not occur at all.
The mere fact that the hormone secretion of HHL is disturbed does not say anything about the causes of the disturbed hormone secretion. For example, no conclusions can be drawn as to whether the causes lie in a malfunction of the HHL or in the hypothalamus or in the transmission path of the "raw hormones" from the hypothalamus to the HHL. The transmission path consists of non-myelinated axons.
causes
The posterior pituitary insufficiency, which occurs in isolation from the anterior pituitary gland (HVL), can have a wide variety of causes. One of the possible causes is an inflammation of the tissue of the HHL itself, so that it cannot respond adequately to control hormones of the hypothalamus to activate and release oxytocin and ADH.
Similar symptoms arise when the pituitary gland is attacked by a tumor or when tumors or bleeding in the surrounding tissue impair the function of the HHL due to space occupation. The reason for a malfunction or for a complete functional failure of the HHL can also lie in the transmission path of the non-activated hormones from the hypothalamus to the HHL.
For example, the non-myelinated axons are very sensitive to possible compressions. They run within the pituitary stalk (infundibulum), which is an integral part of the HHL and connects to the hypothalamus.
In very rare cases, a disorder of the hypothalamus leads to a reduced synthesis of the two hormones, which manifests itself symptomatically as HHL insufficiency. Of course, radiation therapy or a traumatic brain injury (TBI) can also lead to HHL insufficiency.
Symptoms, ailments & signs
The symptoms and complaints of HHL insufficiency usually correspond to the symptoms that typically appear when there is an insufficient supply of the hormones ADH and oxytocin. Oxytocin plays an important role in the process of labor, it induces labor and causes milk to shoot into the nipples.
In addition, oxytocin, which is sometimes referred to as the cuddle hormone, has a positive systemic effect on the psyche in men and women. It promotes the bond between two partners - comparable to the mother-child relationship, which is also controlled by oxytocin. The hormone facilitates and strengthens social ties and counteracts social phobias.
An undersupply of oxytocin makes births more difficult and women cannot breastfeed without the oxytocin. The psychological effects of an oxytocin deficiency are varied and individually different. A deficiency in the antidiuretic hormone ADH, also known as vasopressin, prevents the necessary reabsorption of the primary urine, resulting in severe water loss.
The disease is called diabetes insipidus, which can hardly be compensated for even by increased drinking - in extreme cases up to 20 liters per day. If the HHL insufficiency is caused by tumors or hemorrhages or other space occupancy, primary symptoms such as headaches and, in extreme cases, visual disturbances also occur in addition to the hormone deficiency symptoms.
Diagnosis & course of disease
In those cases in which no primary symptoms and complaints are noticed, a suspicion of the presence of HHL insufficiency can only be triggered by the corresponding hormone deficiency symptoms. Imaging procedures such as x-rays, computed tomography (CT), magnetic resonance imaging (MRI) or somatostatin receptor scintigraphy are used to confirm or reject the suspected diagnosis.
Since imaging procedures do not always allow a clear finding or can lead to incorrect interpretations, an endocrinological examination of the hormone levels in the serum is helpful in many cases to confirm the diagnosis. The course of the disease depends on the primary disease. If left untreated, HHL insufficiency can either persist or it can lead to a serious course, for example due to tumors of the pituitary gland.
Complications
The posterior lobe insufficiency of the pituitary gland usually leads to various complaints that can negatively affect both the psychological and physical condition of the patient. In most cases, the disease has a negative effect on the birth process. In most cases, even after the birth, the mother cannot breastfeed the child.
As a rule, the child then has to be fed artificially, although the mother experiences psychological problems. Social bonds are also weakened and no longer properly observed, which can lead to problems with friends or with the partner. It is not uncommon for the posterior lobe insufficiency of the pituitary gland to cause visual disturbances or headaches.
The patient's quality of life deteriorates extremely due to the illness and it is not uncommon for the patient to suffer from various psychological disorders. The treatment of posterior pituitary insufficiency is carried out with the help of hormones, although there are no further complications. If the mother is unable to breastfeed the child, the child can be looked after differently. As a rule, there are no developmental delays in the child.
When should you go to the doctor?
Symptoms such as visual disturbances, headache in the back of the skull or a general feeling of illness indicate a posterior pituitary insufficiency. A doctor's visit is necessary if the symptoms mentioned persist for more than a week or if they rapidly increase in intensity. Those affected should then visit their family doctor immediately and arrange for an examination. The symptoms may have a harmless cause that can be treated directly.
If posterior pituitary insufficiency is actually the cause, the patient must be treated in a specialist clinic. Therefore, medical advice should always be sought if there are clear signs such as the characteristic headache and visual disturbances. Cancer patients are particularly prone to posterior lobe insufficiency. People who have suffered a traumatic brain injury or who have had radiation therapy are also at an increased risk of developing HHL. Anyone who belongs to these risk groups must in any case inform the responsible doctor. In addition to the family doctor, a neurologist or internist can also be called in.
Doctors & therapists in your area
Treatment & Therapy
Treatment for HHL insufficiency can be aimed at curing the primary disease or at treating symptoms, which usually involves the administration of replacement hormones. If primary diseases of the pituitary gland and especially the posterior lobe of the pituitary gland can be treated as the cause, the deficiency with the hormones ADH and oxytocin can resolve itself.
In all other cases in which the secreting effect of HHL can no longer be restored, treatment consists of lifelong hormone replacement or hormone balancing therapy. Hormone therapy always includes direct hormone administration.
This also applies in cases in which the pituitary gland normally regulates the hormone concentration by secreting control hormones, i.e. only causes a certain target organ to increase the release of the actual hormone into the metabolism.
prevention
There are no known direct preventive measures that could prevent the development of HHL insufficiency. The best protection is early detection of oxytocin and ADH deficiency. While a gradually occurring oxytocin deficiency is not immediately recognizable as such, a too low level of ADH in the blood serum becomes noticeable by strong feelings of thirst, which should be clarified.
Aftercare
In most cases of posterior pituitary insufficiency, direct follow-up measures are severely limited. As a rule, patients with this disease are dependent on a quick and early diagnosis so that further complications and worsening of the symptoms can be prevented.
In the case of a posterior lobe insufficiency of the pituitary gland, it cannot heal independently. Therefore, the person affected should consult a doctor at the first symptoms and signs of the disease in order to initiate early treatment. With this disease, those affected are usually dependent on taking various medications that can permanently alleviate the symptoms.
It is always important to ensure that it is taken correctly and that the dosage is correct. In the case of children, parents in particular should monitor and control the correct intake. Since posterior pituitary insufficiency can also have negative effects on other organs of the body, the person affected should undergo regular examinations by a doctor in order to detect possible damage at an early stage. Whether the disease will lead to a reduced life expectancy for the patient cannot be universally predicted.
You can do that yourself
Patients with posterior pituitary insufficiency are often required to take hormones for life. Until these hormones are perfectly adjusted, you should be patient, especially if the hormones were not prescribed in tablet form but in the form of nasal sprays or injections. Thereafter, hormone replacement or hormone balancing therapy should be reliably integrated into the daily routine.
It should go without saying that the hormone levels are checked regularly. In order to ensure the necessary therapy compliance, it is advisable to keep records of the blood tests and the determined hormone status. This is particularly helpful if the patients go on vacation longer or change their place of residence. So new doctors can always get an exact picture of the course of the disease.
Patients with posterior pituitary insufficiency may suffer from the fact that their bodies are no longer producing the levels of oxytocin needed for well-functioning social bonds. This can negatively affect the relationship with friends, family and partner and in the worst case even make it impossible. If the medication alone is not enough, an accompanying psychotherapeutic treatment is recommended.
Mothers with posterior pituitary insufficiency are often unable to breastfeed their child, which can be just as psychologically stressful. Here, too, psychotherapeutic treatment is recommended and in most cases it is paid for without any problems by the statutory health insurance companies.
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