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Factsheet 14 Pituitary disorders require life-long treatment. As with other chronic conditions, many problems may arise which often require the difficult task of disentangling the physiological, social and psychological aspects. In considering the psychological impact of pituitary disease, there are a number of common problems and patients will need sympathetic help in dealing with them. The emotional impact of neurosurgery The need to adapt to altered body image The feeling of ‘cure’ Social interactions and the effects of chronic illness on family
EMOTIONAL IMPACT OF NEUROSURGERY
Surgical treatment for pituitary disease may be perceived as threatening and often produces a slower than hoped for improvement in the condition. Some patients may experience severe symptoms similar to post traumatic stress disorder after treatment. Patients will be concerned that some of the tumour remains in situ and may regrow. A full recovery undoubtedly takes a considerable time and building up unrealistic expectations before treatment impedes rather than helps recovery. THE NEED TO ADAPT TO ALTERED BODY IMAGE
Acromegaly can have a profound effect on physical appearance causing dysmorphophobia. In acromegalics there are facial changes and enlargement of hands and feet, which, although slow to develop, are not always reversible. Some patients regard themselves as ‘freaks’, and learning to cope with this may take years rather than months. Intervention programmes exist to help with these problems, contact Changing Faces (factsheet 16 - Resources). Cushing’s patients usually suffer from truncal obesity. Increased glucocorticoids in Cushing’s affect weight and body fat distribution. They are also associated with muscle weakness, reduced capacity for physical activity and decreased glucose tolerance. GH therapy may help some patients (factsheet 12). Altered body image is particularly stressful for women, and can be a major cause of depression when it affects relationships. FEELING ‘CURED’
Treatment, even if effective in regulating hormonal levels to what is regarded as normal, may not be followed by a ‘feeling of cure’. Some patients who have pituitary insufficiency may still feel that they have diminished overall capacity even when they are receiving what is regarded as adequate hormone replacement therapy. SOCIAL INTERACTIONS AND THE EFFECTS OF CHRONIC ILLNESS ON FAMILY
Hormonal imbalance has many consequences. The effects of depression, tiredness, snoring and reduced or absent sexual function are some of the aspects of pituitary disease which may lead to social or family problems. Restoring hormonal balance will remove or improve many of these symptoms. RESOURCES FOR PATIENTS
available from The Pituitary Foundation HelpLine or our website www.pituitary.org.uk or our Endocrine Nurse HelpLine
Patient Information Booklet: Psychological Issues in Pituitary Disease
Other information and resource links available at www.pituitary.org.uk FOR GPs MORE SPECIALIST RESOURCES Emotional Aspects of Pituitary Disease. (Eds) Weitzner MA, Sonino N & Knutzen R 1998 Psychotherapy and Psychosomatics 67 Management of Pituitary Tumors: The Clinician’s Practical Guide (2003) (Second Edition), Editors and authors Michael P. Powell, Stafford L. Lightman and Edward R. Laws. Humana Press, Totowa, New Jersey (This contains a “patient’s eye view” chapter written by a patient.)
©2011 Version 3 (To be reviewed by 2013)
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