Doctors Lounge - Endocrinology Answers
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Forum Name: Endocrinology Topics
|Tweeters - Sun Jan 15, 2006 11:34 am|
I posted a previous message months ago but haven't got any replies from anyone with a similar condition or any knowledge of this condition so I am still desperately seeking help. I am a 28 year old female diagnosed with hypopituitarism and desperatly trying to figure out how to combat my extreme short-term memory loss issues. My family doctor believes I have these issues because of my medications but my Endocrinologist does not believe this is the case so they basically are arguing back and forth and I am getting nowhere. I have been for memory testing and it has been determined that my memory is not getting any worse, but I have extreme difficulties remembering things on a daily basis. I have tried hypnotherapy which has worked to a certain extent but still I am not at the level of remembering that I'd like to be, and my memory loss seems to get worse every so often. Does anyone out there have any answers? Please help.
|Dr. Shank - Fri Feb 03, 2006 8:38 pm|
Dear Tweeters (Andrea):
You did not say what kind of hypopituitarism you have or how you acquired it.
Severe short-term memory loss is characteristic of deficiency of somatotropin, the main pituitary hormone in adults (better known as "growth hormone" in children). It is also a common feature of hypothyroidism, which may result from a deficiency of thyroid stimulating hormone (TSH) production by the pituitary.
Head trauma is one of the common causes of hypopituitarism (especially for somatotropin deficiency). It can also cause the"post concussive syndrome," which frequently includes memory loss.
You did not say what medications you are on, but the context suggests an argument over the hormone replacement therapy. I would point out to your non specialist physician that the side effects of correcting deficiencies of hormones is to make you closer to normal, not further from it. If your non specialist physician really cannot understand that, keep your endocrinologist and find a better non specialist.
|Tweeters - Mon Feb 06, 2006 8:47 am|
Hello Doctor, thank you for your reply. I currently take growth hormone injections 0.8 mg/day, as well as premarin, provera, and prednisone. I did not know there are different types of hypopoituitarism - can you give me any more information about that? All I know is that I have had this condition for about 12 years, I was diagnosed towards the end of high school - I
had an MRI and extensive bloodwork done. I have been tested for thyroid problems many times, my thyroid is always within normal range. My memory problems do not seem to be getting any worse, but they do certainly interfere with daily life, and nothing I try seems to make any improvement. My doctors both won't do anything for my memory because they say if the problem is not getting any worse then I should just "learn to deal with it". They obviously don't realize how debilitating this is. Thank you for any further info you can provide!
|Dr. Shank - Tue Feb 07, 2006 4:22 pm|
What is your IGF-1 (old name, somatomedin C) level? For your age, the dose of somatotropin ("growth hormone") sounds about right, except that you are taking oral estragens. Oral estrogens roughly double the requirement for somatotropin, making your dose unusually low for your age. This may be relevant to your memory problems.
From what you are telling me, you have a deficiency of at least four out of six pituitary hormones, and one of the other two m(prolactin) ight be deficient, but is never replaced. If you have four (or five) pituitary hormone deficiencies, there is a very high chance that you have a deficiency of thyroid stimulating hormone (TSH), which controls the thyroid. Unless someone compares the free thyroxine (main thyroid hormone) level with the TSH level, this is unlikely to be recognized. Not only am I an endocrinologist, but I have a Ph.D. in Physiology and Biophysics for my work with the thyroid. Unfortunately, most physicians (and an embarrassingly large number of endocrinologists) only look at the TSH. It is maddening to me to have to listen to the mindless mantra that "TSH is the single best test of thyroid function," when TSH is a lousey single test! In addition to never relying upon the TSH alone, I also have a standardized physical examination and questionnaire that I use. Even then, the thyroid hormone status is not always clear-cut. One thing that is clear, however, is that laboratories are still using out-of-date reference ranges for TSH; even if your pituitary still secretes TSH appropriately (which I doubt), you may still be symptomatically hypothyroid and yet fall within the laboratory's reference ranges.
Most endocrinologists now prefer giving estrogens through the skin and using estradiol, rather than horse estrogens. This would also have less of an effect on your need for somatotropin, far more than making up for the higher cost of estrogen patches or gel. There are a number of concerns about medroxyprogesterone, which I have largely stopped using in favor of actual progesterone. The one advantage of medroxyprogesterone is that it has some "male" (testosterone-like) effects, but I prefer to use appropriate doses of testosterone whenever possible.
I hope that you are getting annual DEXA bone densitometry, since you are taking prednisone. For reasons that are not clear, even true "replacement" doses cause loss of bone density, and the traditional doses are more than replacement equivalents (Technically, there is no replacement dose of prednisone, because the body makes cortisol, instead of prednisone. Unfortunately, cortisol would go in one end and out the other, so we use equivalent doses of synthetics that can be taken by mouth.)
Your original question had to do with your non specialist physician insisting that your memory problems were due to your medications. Your list of medications confirms my fears about your non specialist physician. It would be very difficult to say anything more about him without being extremely insulting. Instead, let me say that if you are not required to have a non specialist physician and your endocrinologist is willing to assume principal care, you should just drop the non specialist--otherwise, find another non specialist physician (Your endocrinologist can suggest names of physicians with whom he works well, if you ask him to do so.)
There are many things that can interfere with the memory. Abnormal thyroid function, somatotropin deficiency, head trauma (post concussive syndrome), sleep deprivation, narcolepsy, sleep apnea, depression . . . .This should definitely be pursued. Sometimes, subspecialists do not want to deal with problems outside of their own fields, so your endocrinologist might not want to pursue the non endocrine possibilities, and you may need someone else to give you the appropriate referals.
I deal with similar problems and attitudes on a daily basis. If you ever travel to the midwestern portion of the United States, contact me, and I will do my best to help you. You have good reason to feel frustrated about the way you have been treated!
|Tweeters - Wed Feb 08, 2006 3:56 pm|
Hi there, my IGF-1 Levels are always tested, and always are within the normal range. I will mention to my endocrinologist about increasing the growth-hormone dosage. The "TSH" test is what I always get tested for, and it usually comes back within normal range as well. I finally got my endocrinologist to listen to me, so he is sending me for some more extensive bloodwork tomorrow (hopefully this will include further thyroid tests)... hopefully they will be able to learn something from that! As for bone density, my non-specialist physician has tested me for that and it was fine, but I will keep an eye on it. As far as the memory issues, I have not had any head trauma that I know of, and no specific incident which I relate to affecting my memory. That's why I'm so stymied! Hopefully in meeting again with my endocrinologist, he will be able to figure out something to help me with this issue. Thanks again for your reply, it's really good to hear that my concerns are legitimate.
|Dr. Shank - Thu Feb 09, 2006 5:29 pm|
Glad to hear it.
Keep us posted.
|Tweeters - Sun Mar 05, 2006 12:15 pm|
Hi there, well I went to my endocrinologist and he basically told me to get lost, he was hurrying me out of his office practically before I sat down. He refuses to entertain the notion that my memory problems have anything to do with my pituitary dysfunction. I am at my wits end. My bloodwork all came back normal (or so he says), so not sure what to do now. No one seems to know how to treat this memory problem! Anyway thought I'd give you an update!
|Dr. Shank - Sat Mar 11, 2006 3:53 pm|
I'm sorry that your experience with your endocrinologist was so poor. In a separate email, you told me that he increased your somatotropin ("growth hormone") and prednisone, but told you that your memory problems had nothing to do with your pituitary. I am curious to know what the laboratory levels actually were.
Without doing a detailed history and physical examination and seeing your labs myself, it is impossible for me to know whether or not your hormone replacement doses are appropriate. However, I can assure you that some hormones that are dependent upon the pituitary definitely do have effects upon the memory, and anyone who says otherwise has a real problem. I have previously discussed some of those effects, which include thyroid hormones and the sex steroid hormones..
Prednisone (a synthetic substitute for cortisol, which is normally under the control of ACTH from the pituitary) could have either favorable or unfavorable effects, and this may depend not only upon the dose, but time of day, relationship to the memory formation, and the chronicity of the hormone level (See separate email.). I am very concerned that anyone, much less an endocrinologist, would simply double the dose of prednisone without laboratory or other evidence that the dose was inadequate.
The effects of somatotropin on memory are pronounced, and there is extensive literature to support this. Interestingly, too much glucocorticoid (such as prednisone) interferes with the actions of somatotropin and insulin-like growth factor type 1 (IGF-1), and many of the features seen with glucocorticoid excess may be due to these effects on somatotropin and IGF-1.
Having said these things, I have no way of knowing whether or not your memory problems actually are related to your pituitary dysfunction.
From your descriptions, it sounds as if your memory problems are disabling. If you cannot get anyone to investigate them in your area, I do not know what to tell you. I would be happy to see what I could do to help you, but Calgary, Alberta, Canada is a very long way from Lima, Ohio, USA![/b]
|HashiPatient2 - Mon Sep 15, 2008 2:37 pm|
I see an amazing neuroendocrinologist in NYC for the problems I have been having with memory given my severe Hashimoto's. I don't think my doctor would respond this way at all. Send a PM if you would like a link to his site, otherwise I would highly suggest seeking out a neuroendocrinologist in your area...
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