Dr Peter White
St Bartholomew's Hospital, London

Emotional/psychological aspects of disease

Fear and loss are most notable, where fear is the anticipation of loss. Both are associated with cancer (remember most pituitary tumours are benign), eyesight problems, surgery and Radiotherapy, changes to body image, disability or loss of independence, and losing a job or relationship.

To achieve calmness, and so conquer fear, obtain information to reduce uncertainty (uncertainty is worse than reality), talk to doctors and nurses (prepare questions to get the best information at clinic), avoid stimulants like caffeine and chocolate, try methods of relaxation, become involved in physical, social and displacement activities, and conquer avoidance of what you fear (done in stages this has 80-90% cure rates).

Three stages are normal in coping with any loss, namely non-acceptance (denial), emotions (anger/guilt/sadness), and coming to terms with the loss (resolution). Remember that grief is normal; it is abnormal not to grieve. A confiding, supportive relationship is important (e.g. with a partner, counsellor, GP or nurse). You should 'let go' when you are ready and want to. Remember that you do not have to keep grieving - it's all right to stop. It is also important to see the meaningfulness of life without whatever is lost (sometimes this requires help - it is a gradual process).

Mood disorders

These disorders include major depressive illness, dysthymia (chronic low-grade depression), atypical depressive illness (e.g. seasonal affective disorder; it is 'atypical' because sleeping and appetite increase rather than decrease), anger/irritability, panic and generalised anxiety disorders, and phobias. These disorders are not purely psychological; physical changes can be seen in the working brain.

Depressive illness can be detected by mood reduction and lack of pleasure (lasting more than 2 weeks), negative self-image and outlook, poor concentration or memory, low energy, reduced appetite and sleeping (may increase in atypical depression), reduced libido, disruption of periods, fewer bowel movements, and suicidal or morbid thoughts (90% of people with depressive illness have suicidal thoughts).

These problems are all treatable. To help counter depressive illness, visit your GP if you have suicidal or other biological symptoms, avoid alcohol, have your hormone levels checked, use anti-depressants (they are not addictive and now have fewer side-effects), if you have a stressful life, change it (or you), talk with others (cognitive behavioural therapy can help), sleep, and look at your diet and exercise routine.

Cortisol is linked to mood. More than 50% of Cushing's patients have a major depressive disorder (MDD). This is usually treated by treatment of the Cushing's. Interestingly, almost 50% of all patients with MDD (whatever the cause) have increased cortisol and large Adrenal glands.

Although there has been discussion of whether stress causes Cushing's or other endocrine disease, Dr White did not think that the research indicating that this might be the case was performed very rigorously, and in his opinion there was no convincing evidence for a link.

Depressive illness in Cushing's may be summarised as follows. The endocrine disease is not caused by stress. Between 54 and 78% of Cushing's patients show MDD, and 79% have anxiety. In one study, 26% of patients showed mania (the opposite of depression), which is more than in other pituitary diseases. Cortisol affects the sleep pattern, and brain serotonin and noradrenergic receptors are affected. Cortisol also affects the hippocampus, and thus memory. Cushing's patients have less past and family history of MDD than other patients with MDD. Depression is equal between those with the disease (pituitary-based) and the syndrome. The degree of depression is linked to the level of cortisol, and the symptoms are usually resolved by treatment of Cushing's.

Tiredness and sleep

Possible causes of tiredness include your hormone levels (especially thyroid and growth hormones, and cortisol), other medical factors, mood disorders like depression, your sleep pattern and level of activity and fitness, and whether you feel in control or that things are outside your control. Consider all these if you suffer from tiredness. It is important not to be the passive victim of your illness but to be actively in control.

To improve sleep, try to decrease your caffeine and alcohol intake, undergo treatment for any mood disorder, improve your activity and fitness, reduce worry, and use methods of relaxation, cognitive behavioural therapy and, should these fail, non-addictive hypnotic drugs.

Sexual problems

These are generally reduced libido, orgasms or erections. The following considerations are important. Is the problem associated with your hormone problem, or did it exist before? Is it caused by worries about body image? Is it linked to a mood disorder? Are you adjusting to infertility? Are you having difficulty with your relationship? Is it linked to your medication?

Children

Children with pituitary disease have normal IQs even if they have time out from their education. They also have normal emotions and patience. However, they may suffer emotionally from having Short stature.