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Symptoms of Pituitary Adrenal Disease: What to Look For

Understanding the symptoms of Pituitary Adrenal Disease is crucial for early detection and effective management. This complex condition can manifest in various ways, often leading to confusion and misdiagnosis. We’ll explore the key signs to watch for, empowering you to recognize potential issues and seek timely medical advice.

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What are the key symptoms of Pituitary Adrenal Disease?

The pituitary gland, a pea-sized structure located at the base of the brain, plays an essential role in regulating the body’s hormones by signaling other glands in the body. When the pituitary gland malfunctions, it can result in a variety of health issues. 

What is the Pituitary Gland?

The pituitary gland, often called the “master gland,” governs several hormonal functions. This tiny yet powerful gland sends out hormone signals that regulate important processes like metabolism, growth, reproduction, and stress response. When the pituitary gland does not function properly, it can disrupt these processes, leading to a range of symptoms.

Symptoms of Pituitary Gland Problems

Hormonal Issues

One of the primary indicators of pituitary gland dysfunction is hormonal imbalance. Since the pituitary gland controls various hormones, disruptions can lead to several noticeable symptoms:

• Unexplained weight changes: Individuals may gain or lose weight without clear reasons.
• Menstrual cycle changes: Women may experience irregular menstrual cycles or even a complete cessation of menstruation.
• Changes in libido: Both men and women might notice a decrease in sexual desire.
• Tiredness and lethargy: These non-specific symptoms can often be traced back to imbalances in hormones regulated by the pituitary gland.

Hormonal irregularities stemming from pituitary dysfunction should not be ignored, as they may be the first signs of an underlying pituitary adrenal disease.

Visual Disturbances

The pituitary gland is located near the optic nerve, and its enlargement or dysfunction can affect vision. Symptoms may include:

• Blurred vision
• Double vision
• Gradual loss of peripheral vision

These visual disturbances are often overlooked but could be critical signs that the pituitary gland is under stress or not functioning properly. Early detection of these symptoms can prevent further damage.

Headaches

Persistent or severe headaches, particularly when accompanied by nausea, are another common symptom of pituitary gland issues. While headaches are a general complaint, those caused by pituitary problems are often more persistent and may be linked to other symptoms like vision changes or hormonal irregularities. If headaches become frequent or severe, it’s important to discuss them with a healthcare provider.

Fatigue and Weakness

Another hallmark of pituitary adrenal disease is a constant feeling of fatigue or weakness, even when an individual is well-rested. This can occur because hormonal imbalances affect the body’s energy levels and metabolism. If fatigue becomes chronic and unexplained, it could be worth investigating the health of the pituitary gland.

Changes in Mood

Hormones play a significant role in regulating emotions, and disruptions in the pituitary gland can lead to noticeable mood changes. Individuals may experience:

• Mood swings
• Irritability
• Feelings of depression

These emotional changes might not always be immediately associated with pituitary problems, but recognizing the connection between mood and hormonal balance is important for addressing potential underlying issues.

How Symptoms Vary by Individual

Pituitary adrenal disease encompasses a range of conditions that affect the adrenal glands and their hormone production, leading to an array of symptoms that vary significantly from person to person. These variations occur based on the specific adrenal disorder, the hormones involved, and individual factors such as age, gender, and overall health.

What Are Adrenal Gland Disorders?

Adrenal gland disorders occur when the adrenal glands, located above each kidney, produce either too much or too little of certain hormones. These glands secrete hormones that are essential for regulating metabolism, blood pressure, the immune system, and the body’s response to stress. The primary hormones involved are:

• Cortisol
• Adrenaline
• Aldosterone

Each adrenal disorder impacts hormone production differently, resulting in a wide range of symptoms.

Types of Adrenal Gland Disorders

Addison’s Disease (Adrenal Insufficiency)

People with Addison’s disease don’t produce enough cortisol and/or aldosterone. The deficiency in these hormones can lead to symptoms like fatigue, low blood pressure, and weight loss. Individuals may also experience salt cravings due to low sodium levels. The severity and combination of these symptoms can vary from mild to life-threatening depending on the level of hormone deficiency.

Adrenal Gland Suppression

This condition occurs when the body’s adrenal glands stop producing sufficient cortisol due to long-term use of synthetic corticosteroids, like prednisone. Symptoms include fatigue, weakness, and weight loss. The extent of the symptoms often depends on the duration and dosage of the synthetic hormone used.

Cushing Syndrome

Cushing syndrome is characterized by excess cortisol levels in the body, which can result in upper body obesity, thinning of the arms and legs, and wide stretch marks across the abdomen. Symptoms can vary based on cortisol levels, ranging from mild weight gain to severe complications like high blood pressure, diabetes, and bone thinning.

Congenital Adrenal Hyperplasia (CAH)

CAH is a genetic condition that results in the adrenal glands not producing enough hormones like cortisol, aldosterone, or both. This leads to symptoms such as dehydration, fatigue, and in severe cases, life-threatening salt loss. The symptoms vary significantly, with some people experiencing mild forms that only manifest during stress, while others face more pronounced challenges.

Hyperaldosteronism

In this condition, the adrenal glands produce too much aldosterone, leading to high blood pressure and low potassium levels (hypokalemia). Symptoms include weakness, muscle spasms, and fatigue, with the severity varying depending on how much excess aldosterone is produced.

Virilization

Virilization is the result of an overproduction of male sex hormones, which is especially evident in people assigned female at birth (AFAB) or prepubescent boys assigned male at birth (AMAB). Symptoms such as facial hair, balding, and acne can appear in AFAB individuals, while boys may experience early puberty signs. The degree of virilization varies based on the hormone levels involved.

Adrenal Gland Tumors and Other Growths

Benign tumors, such as adrenal adenomas, can disrupt hormone production and cause symptoms that mimic other adrenal disorders. These tumors often lead to excess hormone production, and symptoms differ depending on the hormone involved. For instance, pheochromocytoma, a tumor that leads to excess adrenaline, can cause episodes of high blood pressure and heart palpitations.

How Symptoms Vary by Individual

Hormone Levels and Imbalance

The symptoms of pituitary adrenal disease largely depend on which hormones are imbalanced. For example, high cortisol levels in Cushing syndrome lead to weight gain and skin changes, while insufficient cortisol in Addison’s disease results in fatigue and weight loss. Individual hormone levels determine both the type and severity of symptoms experienced.

Age and Gender Differences

Some symptoms of adrenal disorders present differently depending on age and gender. For example:

• Virilization impacts AFAB individuals more visibly, with symptoms like facial hair and deeper voice changes, while boys AMAB experience early signs of puberty.
• Cushing syndrome often affects individuals AFAB more frequently, leading to distinct symptoms such as fat accumulation in the upper body, which may not be as pronounced in those assigned male at birth.

Genetic Factors

Certain adrenal disorders, like congenital adrenal hyperplasia (CAH), are linked to genetic mutations that affect how the adrenal glands function. These genetic variations can lead to different manifestations of the same disease, with some people experiencing mild forms of the condition, while others develop more severe symptoms from an early age.

Pre-Existing Health Conditions

People with pre-existing health conditions may also experience adrenal disorders differently. For example, those with diabetes might find that excess cortisol from Cushing syndrome worsens their blood sugar control. Similarly, individuals with hypertension may see their condition exacerbated by excess aldosterone levels in hyperaldosteronism.

The Role of Hormones in Pituitary Adrenal Disease

Pituitary adrenal disease refers to disorders that involve dysfunction of the pituitary gland and adrenal glands, which play critical roles in regulating hormone production and overall bodily functions. These glands work together in a complex system that ensures the balance of several vital hormones.

Hormones Produced by the Pituitary Gland

The pituitary gland produces a variety of essential hormones that affect almost every aspect of the body’s functions. These hormones include:

1. Growth Hormone

Growth hormone regulates growth and development in children and maintains muscle and bone mass in adults. It promotes healthy tissue growth and overall physical development. An imbalance in growth hormone can result in growth disorders such as gigantism or dwarfism.

2. Thyroid Stimulating Hormone (TSH)

TSH instructs the thyroid gland to produce thyroid hormones, which regulate the body’s metabolism. The proper balance of thyroid hormones is crucial for energy levels, weight management, and overall metabolic activity. When the pituitary fails to produce enough TSH, it can lead to hypothyroidism (underactive thyroid), while excess TSH can result in hyperthyroidism (overactive thyroid).

3. Prolactin

Prolactin plays a significant role in breast milk production during and after pregnancy. Abnormal levels of prolactin can lead to reproductive issues, including infertility in both men and women.

4. Adrenocorticotrophic Hormone (ACTH)

ACTH signals the adrenal glands to produce cortisol, a hormone essential for managing stress, metabolism, and immune response. When the production of ACTH is disrupted, it can lead to adrenal gland disorders, such as Addison’s disease (low cortisol production) or Cushing syndrome (high cortisol production).

5. Follicle Stimulating Hormone (FSH) and Luteinizing Hormone (LH)

FSH and LH are crucial for regulating reproductive processes in both men and women. In women, these hormones control the menstrual cycle and stimulate the ovaries to produce eggs. In men, they help regulate sperm production. An imbalance in FSH and LH can lead to reproductive difficulties, such as infertility.

Hormones Stored and Released by the Pituitary Gland

In addition to producing several hormones, the pituitary gland also stores and releases two key hormones produced by the hypothalamus:

1. Oxytocin

Oxytocin is involved in childbirth and breastfeeding. It stimulates uterine contractions during labor and plays a role in the bonding process between a mother and her newborn. Oxytocin also aids in the release of breast milk during nursing.

2. Vasopressin

Vasopressin, also known as antidiuretic hormone (ADH), helps the body regulate the amount of water and salt. It controls water balance by reducing urine output and helps maintain normal blood pressure. An imbalance in vasopressin can lead to issues like dehydration or excessive water retention.

The Role of These Hormones in Pituitary Adrenal Disease

1. ACTH and Cortisol Regulation

Adrenocorticotrophic hormone (ACTH) plays a central role in pituitary adrenal disease. When ACTH is either overproduced or underproduced by the pituitary gland, it disrupts cortisol production by the adrenal glands. Too much ACTH can cause Cushing syndrome, where excess cortisol leads to weight gain, high blood pressure, and thinning skin. Too little ACTH can result in Addison’s disease, which is characterized by fatigue, low blood pressure, and weight loss due to insufficient cortisol production.

2. Growth Hormone and Body Development

In pituitary disorders, an imbalance in growth hormone can cause a range of issues. In childhood, insufficient production of growth hormone can stunt growth, while an overproduction can lead to abnormally large stature (gigantism). In adults, growth hormone imbalances can cause changes in muscle mass, bone density, and overall physical development.

3. TSH and Metabolism

When pituitary disorders affect the production of TSH, the thyroid gland’s ability to regulate metabolism is impaired. A deficiency in TSH can cause the thyroid to produce too little thyroid hormone, leading to hypothyroidism, characterized by fatigue, weight gain, and depression. An excess of TSH can lead to hyperthyroidism, which causes symptoms such as weight loss, nervousness, and rapid heartbeat.

4. Reproductive Hormones and Infertility

Pituitary gland disorders can also impact the levels of FSH and LH, hormones crucial for fertility and reproductive health. Women may experience irregular menstrual cycles or difficulty conceiving, while men may face reduced sperm production or low testosterone levels.

5. Prolactin and Reproductive Health

Abnormal levels of prolactin, caused by a malfunctioning pituitary gland, can affect fertility. High levels of prolactin (hyperprolactinemia) can disrupt menstrual cycles and reduce sperm production, leading to infertility in both men and women.

When to Seek Medical Attention

Because the symptoms of pituitary adrenal disease can vary widely, it’s important to consult a healthcare provider. Early diagnosis and treatment can help manage symptoms effectively and prevent further complications.

When to See a Doctor

You should contact your healthcare provider if you experience any symptoms that could indicate an adrenal gland disorder, such as:

• Unexplained weight changes.
• Severe fatigue that affects daily functioning.
• Significant changes in hair growth or skin appearance (e.g., bruising, stretch marks).
• Unexplained high blood pressure or muscle weakness.

If you have already been diagnosed with an adrenal disorder, regular visits to your healthcare provider are crucial to monitor your condition.

When to Seek Emergency Care

In some cases, adrenal disorders can lead to life-threatening complications, such as an adrenal crisis. This occurs when cortisol levels drop dangerously low and requires immediate medical attention. If you experience any of the following symptoms, seek emergency care immediately:

• Severe pain in the abdomen or lower body.
• Episodes of vomiting and diarrhea.
• Extreme weakness or confusion.
• Loss of consciousness.
• Signs of low blood pressure or low blood sugar.

If you have adrenal insufficiency, it’s essential to carry an injectable glucocorticoid with you at all times. This medication can provide quick relief in emergencies, and you should ensure that both you and those around you know how to administer it.

Diagnostic Tests for Pituitary Adrenal Disease

Diagnosing these conditions accurately requires various tests to assess hormone levels and identify any structural abnormalities. 

How Are Adrenal Gland Disorders Diagnosed?

When diagnosing adrenal gland disorders, healthcare providers focus on evaluating hormone levels and identifying any underlying causes of hormonal imbalances, such as tumors. The diagnostic process typically begins with a detailed medical history and physical examination, followed by specific tests that measure hormone activity in the body.

1. Medical History and Physical Examination

Your healthcare provider will ask about your symptoms, family history, and any medications you are taking. The physical exam may involve checking for signs of hormone imbalances, such as changes in weight, blood pressure, and physical appearance. For example, symptoms such as upper body obesity, thin arms and legs, or abnormal skin changes may prompt further testing for adrenal or pituitary dysfunction.

2. Hormone Level Testing

The primary method of diagnosing pituitary adrenal diseases is by measuring hormone levels in various body fluids. These tests help identify whether the pituitary or adrenal glands are producing too much or too little hormone.

Saliva Tests

Saliva testing is often used to measure cortisol levels, especially in cases where adrenal gland disorders are suspected. Cortisol levels fluctuate throughout the day, so multiple samples may be collected at different times to assess any abnormal variations.

Blood Tests

Blood tests are a common diagnostic tool to evaluate hormone levels. These tests can measure:

• Cortisol: A hormone produced by the adrenal glands, which helps regulate metabolism and the body’s response to stress.
• Adrenocorticotrophic hormone (ACTH): This hormone, produced by the pituitary gland, signals the adrenal glands to release cortisol. Abnormal ACTH levels may indicate a pituitary disorder.
• Aldosterone: This hormone helps regulate blood pressure by controlling sodium and potassium levels in the body. Excessive or insufficient aldosterone production can indicate specific adrenal gland disorders.

Urine Tests

In some cases, healthcare providers will collect urine samples over a 24-hour period to measure hormone levels, particularly cortisol. This test helps assess overall adrenal function and detect conditions such as Cushing syndrome or adrenal insufficiency.

3. Imaging Tests for Tumor Detection

If the initial hormone tests suggest abnormal adrenal or pituitary function, healthcare providers may use imaging tests to check for tumors or structural abnormalities in these glands. Tumors can disrupt hormone production and cause a range of symptoms.

CT Scans (Computed Tomography)

CT scans provide detailed cross-sectional images of the adrenal and pituitary glands, helping healthcare providers identify any tumors or abnormal growths. These scans can also reveal any enlargement of the glands or other physical anomalies contributing to hormone imbalances.

MRI (Magnetic Resonance Imaging)

MRI scans use magnetic fields and radio waves to create detailed images of the glands and surrounding tissues. MRI is particularly useful in detecting small tumors in the pituitary gland that may not be visible on a CT scan. It is a non-invasive method that helps in determining the precise location and size of any abnormal growths.

Nuclear Medicine Imaging

In cases where tumors are suspected, nuclear medicine imaging may be used to assess adrenal function further. This technique involves injecting a small amount of radioactive material into the body, which is absorbed by the adrenal glands. Special imaging equipment then detects the radiation to create detailed images of the glands. This test helps distinguish between benign and malignant tumors and evaluate adrenal function.

4. Referral to an Endocrinologist

If your healthcare provider suspects pituitary adrenal disease, they may refer you to an endocrinologist. Endocrinologists specialize in diagnosing and treating hormone-related disorders, and they can offer advanced diagnostic tests and personalized treatment plans. Pediatric endocrinologists are available for diagnosing and treating adrenal gland disorders in babies and children.

Treatment Options and Management Strategies

Adrenal gland disorders can impact your body’s ability to regulate essential functions such as metabolism, blood pressure, immune system, and stress response. Managing these disorders requires a combination of medical treatments, lifestyle adjustments, and proactive symptom monitoring.

How Are Adrenal Gland Disorders Treated?

Treatment for adrenal gland disorders depends on the specific condition and the individual’s symptoms. The goal of treatment is to restore hormone balance and address any underlying issues, such as tumors, that may be affecting adrenal function.

1. Medications

Many adrenal gland disorders result from either a deficiency or an excess of certain hormones, such as cortisol or aldosterone. Medications are often prescribed to correct these imbalances:

• Hormone Replacement Therapy (HRT): For conditions like Addison’s disease (adrenal insufficiency), where the body does not produce enough cortisol or aldosterone, hormone replacement therapy is commonly used to supplement these hormones.
• Steroid Medications: For adrenal gland suppression caused by external steroids like prednisone, the gradual reduction of steroid use can help restore normal adrenal function.
• Aldosterone Blockers: In cases of hyperaldosteronism, where the body produces too much aldosterone, medications such as aldosterone blockers can help control blood pressure and potassium levels.

2. Surgery

For adrenal gland disorders caused by tumors, surgery may be necessary to remove abnormal growths and restore hormone balance:

• Adrenalectomy: This surgery involves the removal of one or both adrenal glands if a tumor is causing excess hormone production.
• Pituitary Surgery: In some cases, tumors in the pituitary gland affect adrenal function, requiring surgery to remove these growths.

3. Radiation Therapy

Radiation therapy may be recommended in cases where tumors cannot be surgically removed or when cancer is present. This treatment helps to target and shrink tumors that are disrupting adrenal or pituitary gland function.

4. Lifestyle Modifications

For individuals with certain adrenal disorders, lifestyle adjustments play a crucial role in managing the condition:

• Balanced Diet: A healthy diet can help regulate hormone levels and manage symptoms such as high blood pressure or low potassium.
• Stress Management: Since adrenal disorders often affect the body’s response to stress, learning stress-reducing techniques such as meditation, yoga, or deep breathing can be beneficial.
• Exercise: Regular physical activity can help manage weight and blood pressure, both of which are often affected by adrenal gland disorders.

Prevention and Risk Reduction

Can Adrenal Gland Disorders Be Prevented?

There is no definitive way to prevent adrenal gland disorders, as many of these conditions are caused by factors beyond our control, such as genetic mutations or tumors. However, being mindful of potential risk factors can reduce the likelihood of developing adrenal-related complications.

How Can I Lower My Risk?

Certain lifestyle choices can reduce your risk of developing adrenal gland disorders:

• Avoid Using Steroids Unnecessarily: If you’re considering using synthetic male hormones (anabolic steroids) to enhance muscle mass, think twice. These can interfere with adrenal function and lead to glandular imbalances.
• Monitor Hormone Therapy: If you’re on long-term corticosteroid therapy, work closely with your healthcare provider to ensure the dosage and duration are appropriate to avoid adrenal suppression.

Outlook and Prognosis

What Can I Expect If I Have an Adrenal Gland Disorder?

The outlook for adrenal gland disorders varies based on the type and severity of the condition. With early diagnosis and proper treatment, many people can manage their symptoms and live relatively normal lives. However, long-term management may be necessary for some, especially in cases where hormone replacement therapy is required.

Living With Adrenal Gland Disorders

It’s essential to maintain regular communication with your healthcare provider and follow their treatment recommendations. Monitoring symptoms and adjusting medications or treatment plans can help you manage the condition effectively. Additionally, routine check-ups and tests to monitor hormone levels are vital for ensuring that your condition is well-managed.

Important Questions to Ask Your Doctor

If you are diagnosed with an adrenal gland disorder, it’s natural to have questions and concerns. Here are some important questions to ask your healthcare provider:

• What specific type of adrenal gland disorder do I have?
• Is my condition curable, or will I need long-term management?
• What treatment options are available, and what are the potential side effects?
• Do I have tumors, and will I need surgery or radiation therapy?
• How often should I schedule follow-up appointments or tests?

Staying Informed About Your Health

Staying informed about your health is essential, particularly when managing complex conditions like pituitary-adrenal disease. These disorders affect the hormonal balance in the body, leading to various health complications. 

Understanding Pituitary-Adrenal Disease

Pituitary-adrenal disease refers to a group of conditions that disrupt the function of the pituitary gland and adrenal glands, leading to hormonal imbalances. These glands play critical roles in regulating stress responses, metabolism, blood pressure, and reproductive health. Conditions affecting these glands can have a significant impact on overall well-being.

Types of Pituitary-Adrenal Disorders

Cushing’s Disease

Cushing’s disease is caused by the overproduction of cortisol due to a pituitary adenoma, a benign tumor in the pituitary gland. This excess cortisol leads to symptoms such as weight gain, high blood pressure, diabetes, and mood changes. Managing Cushing’s disease typically involves medications to reduce cortisol levels or surgery to remove the tumor.

Addison’s Disease

Addison’s disease occurs when the adrenal glands do not produce enough cortisol and sometimes aldosterone. This leads to symptoms like fatigue, weight loss, low blood pressure, and hyperpigmentation. Hormone replacement therapy is crucial in managing this condition.

Secondary Adrenal Insufficiency

Secondary adrenal insufficiency is often caused by prolonged use of corticosteroids, which can suppress the pituitary gland’s ability to produce adrenocorticotropic hormone (ACTH). This hormone stimulates the adrenal glands to produce cortisol. Symptoms include fatigue, weakness, and low blood pressure, requiring careful management and, in some cases, hormone replacement therapy.

Causes and Risk Factors

Pituitary-adrenal disorders can arise from various causes, and understanding these can help individuals manage the risks associated with these conditions:

• Genetic Factors: Some pituitary-adrenal disorders are hereditary, passed down through families.
• Tumors: Pituitary adenomas or adrenal tumors can disrupt normal hormone production, leading to imbalances.
• Autoimmune Conditions: Addison’s disease can be triggered when the body’s immune system mistakenly attacks the adrenal glands

Recognizing the Symptoms

The symptoms of pituitary-adrenal disease vary depending on the hormones involved and whether there is an excess or deficiency of these hormones:

• Excess Cortisol: Common symptoms include weight gain, hypertension (high blood pressure), mood swings, and skin changes
• Insufficient Cortisol: This can lead to fatigue, weakness, low blood pressure, and imbalances in electrolytes, which are crucial for maintaining the body’s fluid and nerve functions

Diagnosis of Pituitary-Adrenal Disorders

Diagnosing pituitary-adrenal disease requires a thorough evaluation, which often involves the following steps:

• Hormonal Testing: Blood and urine tests are used to measure cortisol and ACTH levels, which can indicate abnormalities in adrenal function.
• Imaging: MRI or CT scans may be performed to detect tumors in the pituitary or adrenal glands.
• Stimulation Tests: These tests assess how well the adrenal glands respond to ACTH, providing insights into the functionality of the glands

Treatment Options

Effective treatment for pituitary-adrenal disorders depends on the specific condition and severity. The main treatment strategies include:

Medications

• Cushing’s Disease: Medications such as ketoconazole or mifepristone can help regulate cortisol production.
• Addison’s Disease: Hormone replacement therapy is essential to replace the missing cortisol and aldosterone in the body

Surgery

In cases where tumors are responsible for hormone imbalances, surgery may be required. Surgical removal of pituitary adenomas or adrenal tumors can restore normal hormone production and alleviate symptoms

Lifestyle Modifications

Lifestyle changes play a crucial role in managing symptoms and improving quality of life. Key modifications include:

• Diet: A balanced diet supports overall health and helps manage the symptoms of adrenal disorders.
• Exercise: Regular physical activity can help regulate metabolism and improve energy levels.
• Stress Management: Since stress can exacerbate symptoms, adopting relaxation techniques such as yoga, meditation, and deep breathing can help individuals cope better

Staying Informed and Proactive

Staying informed about your health is a key aspect of managing pituitary-adrenal disease. Here are some ways to stay on top of your condition:

Educate Yourself

Understanding your condition helps you actively participate in your treatment plan. Keep up with the latest research and medical recommendations regarding your specific adrenal disorder to ensure you’re aware of all available options.

Regular Check-ups

Monitoring your hormone levels and symptoms through regular check-ups with your healthcare provider is essential. Early detection of any changes can help prevent complications and ensure timely treatment adjustments.

Support Groups

Joining a support group for people with similar conditions can provide emotional support and shared experiences. These groups can offer practical advice on managing day-to-day symptoms and navigating the healthcare system.

Sources.

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Cleveland Clinic: (n.d.). Adrenal disorders. Retrieved from https://my.clevelandclinic.org/health/diseases/16717-adrenal-disorders

Healthdirect: (n.d.). Pituitary gland. Retrieved from https://www.healthdirect.gov.au/pituitary-gland

BMJ: 2021). Addison’s Disease: A Clinical Review. British Medical Journal, 373, n1916. https://doi.org/10.1136/bmj.n1916