Pituitary Disorders

Comprehensive lab testing can determine the presence of too much or too little hormones. These tests can also pinpoint specific pituitary gland disorders, their severity, and what type of treatment is best for the individual. With cases of inherited conditions, the risk of a pituitary disorder is seen across all ages and demands constant checkups.

It’s recommended to seek scheduled testing to compare hormonal measurements at different ages. This can help diagnose fluctuations in TSH (thyroid-stimulating hormone) along with additional hormones produced by the endocrine system such as Thyroxine (Thyroid Gland Hormone T4).

Tests can assess the following hormones:

Regular test results may include:

  • Constant TSH Levels
  • Varying Cortisol Levels
  • Cyclical LH and FSH Levels (Menstrual Cycle Only)
  • Increased Prolactin Production (During Breastfeeding for Women or Periods of Stress)

These variations in each test necessitate regular testing to pinpoint specific trends in the hormonal levels. This can help determine whether a person has excess or deficient hormones. It can also account for medicine-related suppression or production.

SEE BELOW THE LIST OF TESTS FOR MORE INFORMATION ABOUT Testing for Pituitary Gland Disorders


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Measuring the circulating levels of estradiol is important for assessing the ovarian function and monitoring follicular development for assisted reproduction protocols. Estradiol plays an essential role throughout the human menstrual cycle. Elevated estradiol levels in females may also result from primary or secondary ovarian hyperfunction. Very high estradiol levels are found during the induction of ovulation for assisted reproduction therapy or in pregnancy. Decreased estradiol levels in females may result from either lack of ovarian synthesis (primary ovarian hypofunction and menopause) or a lesion in the hypothalamus-pituitary axis (secondary ovarian hypofunction). Elevated estradiol levels in males may be due to increased aromatization of androgens, resulting in gynecomastia.

IMPORTANT - Note this Estradiol test is not for children that have yet to start their menstrual cycle.  If this test is ordered for a child that has yet to begin their menstrual cycle Quest Diagnostics labs will substitute in Estradiol, Ultrasensitive LC/MS/MS - #30289 at an additional charge of $34


Much of Estradiol is bound to proteins. The unbound portion and Estradiol bound to proteins with low affinity reflect the Free concentration. The Free Estradiol may better correlate with medical conditions than the Total Estradiol concentrations.



Estrogens are a group of steroids that regulate the menstrual cycle and function as the main female sex hormones. The most common forms of estrogens tested are estrone (E1), estradiol (E2), and estriol (E3). Estrogens are responsible for the development of female sex organs and secondary sex characteristics and are tied to the menstrual cycle and pregnancy. They are considered the main sex hormones in women and are present in small quantities in men. E1 and E2 are the two main estrogens in non-pregnant females.Estrone (E1) is derived from metabolites from the adrenal gland and is often made in adipose tissue (fat). Estrone can be converted into estrdiol or estriol when needed. Estrone is present in small amounts in children prior to puberty and then increases slightly at puberty for both males and females. While levels remain constant in adult males, it will increase and fluctuate for females during the menstrual cycle. After menopause, it becomes the major estrogen, with E2 and E3 levels diminishing greatly.Estradiol (E2) is the predominant form and is produced primarily in the ovaries with additional amounts produced by the adrenal glands in women and in the testes and adrenal glands in men. In menstruating women, levels vary throughout the month, rising and falling in concert with FSH (follicle-stimulating hormone), LH (luteinizing hormone), and progesterone as follicles are stimulated in the ovaries, an egg is released, and the uterus prepares for a potential pregnancy. The level is lowest at the beginning of the menstrual cycle and rise to their highest level just before the release of an egg from the ovary (ovulation). Normal levels of estradiol provide for proper ovulation, fertilization of the egg (conception), and pregnancy, in addition to promoting healthy bone structure and regulating cholesterol levels.


This test is useful in the differential diagnosis of pituitary and gonadal insufficiency and in children with precocious puberty.

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FSH and LH are secreted by the anterior pituitary in response to gonadotropin-releasing hormone (GNRH) secreted by the hypothalamus. In both males and females, FSH and LH secretion is regulated by a balance of positive and negative feedback mechanisms involving the hypothalamic-pituitary axis, the reproductive organs, and the pituitary and sex steroid hormones. FSH and LH play a critical role in maintaining the normal function of the male and female reproductive systems. Abnormal FSH levels with corresponding increased or decreased levels of LH, estrogens, progesterone, and testosterone are associated with a number of pathological conditions. Increased FSH levels are associated with menopause and primary ovarian hypofunction in females and primary hypogonadism in males. Decreased levels of FSH are associated with primary ovarian hyper-function in females and primary hypergonadism in males. Normal or decreased levels of FSH are associated with polycystic ovary disease in females. In males, LH is also called interstitial cell-stimulating hormone (ICSH). Abnormal LH levels with corresponding increased or decreased levels of FSH, estrogens, progesterone, and testosterone are associated with a number of pathological conditions. Increased LH levels are associated with menopause, primary ovarian hypofunction, and polycystic ovary disease in females and primary hypo-gonadism in males. Decreased LH levels are associated with primary ovarian hyperfunction in females and primary hyper-gonadism in males.

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This test is useful in the differential diagnosis of pituitary and gonadal insufficiency and in children with precocious puberty.

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During pregnancy and postpartum lactation, serum prolactin can increase 10- to 20-fold. Exercise, stress, and sleep also cause transient increases in prolactin levels. Consistently elevated serum prolactin levels (>30 ng/mL), in the absence of pregnancy and postpartum lactation, are indicative of hyperprolactinemia. Hypersecretion of prolactin can be caused by pituitary adenomas, hypothalamic disease, breast or chest wall stimulation, renal failure or hypothyroidism. A number of drugs, including many antidepressants, are also common causes of abnormally elevated prolactin levels. Hyperprolactinemia often results in galactorrhea, amenorrhea, and infertility in females, and in impotence and hypogonadism in males. Renal failure, hypothyroidism, and prolactin-secreting pituitary adenomas are also common causes of abnormally elevated prolactin levels.

Prolactin is a single-chain polypeptide hormone secreted by the anterior pituitary under the control of prolactin-releasing factors. These inhibiting and releasing factors are secreted by the hypothalamus. Prolactin is also synthesized by the placenta and is present in amniotic fluid. Prolactin initiates and maintains lactation in females. It also plays a role in regulating gonadal function in both males and females. In adults, basal circulating prolactin is present in concentrations up to 30 ng/mL. During pregnancy and postpartum lactation, serum prolactin can increase 10-to 20-fold. Exercise, stress, and sleep also cause transient increases in prolactin levels. Consistently elevated serum prolactin levels greater than 30 ng/mL in the absence of pregnancy and postpartum lactation are indicative of hyperprolactinemia, which is the most common hypothalamic-pituitary dysfunction encountered in clinical endocrinology. Hyperprolactinemia often results in galactorrhea, amenorrhea, and infertility in females, and in impotence and hypogonadism in males. Renal failure, hypothyroidism, and prolactin-secreting pituitary adenomas are also common causes of abnormally elevated prolactin levels.

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Selenium is an element of parental nutrition. Monitoring the selenium concentrations is useful in assessing parental nutrition, especially recent intake. Concentrations are also monitored in children with proprionic acidemia who require special diets with supplements.

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Selenium is a key component of a number of functional selenoproteins required for normal health. The best know of these are the antioxidant glutathione peroxidase enzymes. Selenium plays an important role in the control of thyroid hormone metabolism and is important for proper reproductive performance.


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The free T4 are tests thelps evaluate thyroid function. The free T4 test is used to help diagnose hyperthyroidism and hypothyroidism. Free T4 is the active form of thyroxine and is usually ordered along with or following a TSH test. This helps the doctor to determine whether the thyroid hormone feedback system is functioning as it should, and the results of the tests help to distinguish between different causes of hyperthyroidism and hypothyroidism.


The pituitary gland is responsible for regulating hormonal production in the human body. When the gland begins to secrete too much or too little, it often leads to a set of symptoms associated with pituitary disorders. In some cases, the condition involves the presence of a pituitary tumor, which presses against nearby tissues.

The endocrine system is composed of multiple functional and well-integrated parts, including the pituitary gland. Several glands within the human body are interlinked via the endocrine system. These glands produce a variety of hormones to help balance and regulate the body’s natural processes.

This gland is located at the bottom of the brain and behind the sinus cavity. It also sits below the hypothalamus, which is responsible for sending important messages to other parts of the nervous system while regulating the body’s processes. This includes sending hormones designed to start and/or stop the pituitary gland. Once initiated, the pituitary gland begins to release its hormones to other glands, which increases the production of other hormones throughout the endocrine system.

In its basic layout, the pituitary is composed of two parts – the front (anterior) and the back (posterior). Both parts are responsible for different hormones.

  • Anterior (Front): With the anterior pituitary, it’s responsible for secreting GH (growth hormone), TSH (thyroid-stimulating hormone), ACTH (Adrenocorticotrophic hormone), FSH (follicle-stimulating hormone), Prolactin, and LH (luteinizing hormone). These hormones offer a long list of organic benefits, including increased muscle mass, stress regulation, blood sugar levels, bone growth, metabolic rate, sexual characteristics, and fertility. This includes targeting specific tissues in the human body, such as the ovaries for women, testicles for men, thyroid glands, and adrenal glands.
  • Posterior (Back): With the posterior pituitary, it’s responsible for storing ADH (antidiuretic hormone) and oxytocin from the hypothalamus. The antidiuretic hormone helps regulate the kidney’s water output to ensure the body’s water levels remain balanced while oxytocin is responsible for regulating the uterus and its contractions during the birthing process for women while also playing a role during breastfeeding (releasing milk).

It’s important to note that pituitary disorders encompass several different hormones leading to a unique set of symptoms for everyone.

Causes of Pituitary Disorders

When a tumor begins to grow in the area, this can bring along with several medical concerns. The average tumor is diagnosed as a pituitary adenoma (benign), but this can still lead to significant hormonal production by the pituitary gland when it’s active. As a result, this hampers other glands in the endocrine system while restricting blood flow to the surrounding tissues. Optic nerves and/or blood vessels near the tumor can become compromised due to their positioning. Once the tumor begins to press against the surrounding tissues, it will lead to symptoms such as vision problems (loss of vision), headaches, weakness, seizures, fatigue, and other relevant symptoms associated with hormone production.

Additional causes can include:

  • Head Trauma
  • Genetic Conditions (From Birth)
  • Genetic Mutations
  • A Malignant Tumor
  • Reduced Blood Supply to the Pituitary Gland
  • Radiation Treatment
  • Excess Iron (i.e., Blood Transfusions/Hemochromatosis)
  • Unknown Health Condition

Examples of Pituitary Disorders

Pituitary Tumors

This type of tumor can cause a variety of symptoms, including too much or too little hormone production. In most cases, the tumor will be benign but can cause symptoms such as headaches, visual problems, and other similar problems as it grows. Due to the added growth, this gland can press against surrounding tissues leading to increased hormone production in some areas and reduced hormone production in others.

Growth Hormone Deficiency

This is seen in children and can lead to issues involving delayed growth. For adults, the symptoms can include general fatigue, muscular weakness, obesity, and/or reduced bone mass.

Hypopituitarism

This can include trauma, tumors, infections, sarcoidosis, autoimmune concerns, decreased pituitary blood supply, radiation, side effects of pituitary surgery, or the removal of a pituitary gland. Due to these reasons, the body doesn’t gain access to enough pituitary hormone production to stay healthy.

Hyperprolactinemia

In this case, the pituitary tumor begins to release prolactin and/or suppresses the secretion of prolactin. This can lead to symptoms involving a lack of breast milk for feeding mothers, too much breast milk (outside pregnancy), low libido, lack of menstrual periods, and erectile dysfunction.

Empty Sella Syndrome

This involves the sella, which is a small part of the skull (hollow) where the pituitary is situated. It includes a specialized membrane called the sellae located on top of the pituitary as protection. If something causes this membrane to burst or open, it can lead to a unique MRI scan where the socket appears empty through imaging. Therefore, the condition is called Empty Sella Syndrome by medical experts and can often be associated with radiation therapy or tumors.

Craniopharyngioma

This is often seen in young children and teenagers but can also show up in adults over the age of 50. In general, the condition is benign but can press against the pituitary leading to headaches, delayed growth, hypopituitarism, and vision issues.

Rare Pituitary Disorders

Acromegaly and Gigantism

This is when the growth hormone production skyrockets because of adenoma (benign tumor). The condition usually occurs in childhood and is linked with gigantism (excessive bone growth), causing children to grow taller than the average adult. This is known as acromegaly as the bone thickens, leading to larger hands, coarsened facial features, headaches, larger feet, sleep apnea, fatigue, sweating, hypertension, colon cancer, and/or diabetes mellitus.

Adrenal Insufficiency

This is a rare disorder triggered by pituitary dysfunction. When the hormone ACTH (adrenocorticotropic hormone) depletes, it can often be a sign of adrenal insufficiency. ACTH is responsible for acting as a pituitary messenger. This includes sending messages to the adrenal cortex for it to release cortisol. When the ACTH level drops, it can often be linked to pituitary damage or a pituitary tumor. This leads to a drop in cortisol production, which reduces the amount of aldosterone and cortisone in the body. These hormones are responsible for regulating the body’s blood pressure and metabolism.

Cushing Disease

This disorder encompasses specific symptoms associated with excess ACTH caused by the pituitary tumor. When there’s excess ACTH, this leads to hyperactive adrenal glands releasing too much cortisol. Due to the additional cortisol, it can lead to a long list of symptoms including a larger face, obesity (torso), thinner arms, thinner legs, muscular weaknesses, high blood sugar, pink streaks (Abdomen), osteoporosis, and high blood pressure.

Diabetes insipidus

This includes a reduction in ADH production via the hypothalamus. The kidneys don’t retain enough water causing the individual to feel thirsty while having to frequent the bathroom often (dilute urination).

Nelson Syndrome

This disorder occurs when the adrenal glands have been removed from the human body as a treatment option. The tumor begins to actively produce ACTH while hampering the pituitary hormones. This can lead to symptoms involving skin darkening as the MSH (melanocyte-stimulating hormone) levels rise.

Multiple Endocrine Neoplasia Type 1 (MEN1)

This genetic mutation can increase the likelihood of developing tumors close to the pituitary and other similar endocrine glands.

Kallman Syndrome

This is a genetic condition due to a deficiency in GnRH (gonadotropin-releasing hormone). This can create a reduction in LH and FSH production while halting a child’s puberty and hampering their ability to smell.

Pituitary Infarction

This is often cited as a leading cause of bleeding near a benign pituitary tumor. It occurs once the surrounding tissues have been damaged (hypopituitarism).

Sheehan Syndrome

This is a rare condition that occurs after childbirth. It takes place due to excessive bleeding during birth, causing the pituitary gland to lose function. This is noted as a pituitary infarction.

Tests

Comprehensive lab testing can determine the presence of too much or too little hormones. These tests can also pinpoint specific pituitary disorders, their severity, and what type of treatment is best for the individual. With cases of inherited conditions, the risk of a pituitary disorder is seen across all ages and demands constant checkups.

It’s recommended to seek scheduled testing to compare hormonal measurements at different ages. This can help diagnose fluctuations in TSH (thyroid-stimulating hormone) along with additional hormones produced by the endocrine system such as Thyroxine (Thyroid Gland Hormone T4).

Tests can assess the following hormones:

LH and FSH

Prolactin Cortisol and ACTH

Free T4 (Thyroxine) and TSH IGF-1 and GH

Regular test results may include:

  • Constant TSH Levels
  • Varying Cortisol Levels
  • Cyclical LH and FSH Levels (Menstrual Cycle Only)
  • Increased Prolactin Production (During Breastfeeding for Women or Periods of Stress)

These variations in each test necessitate regular testing to pinpoint specific trends in the hormonal levels. This can help determine whether a person has excess or deficient hormones. It can also account for medicine-related suppression or production.