Tuesday, September 19, 2017




Something I am working on.
A group of people living with PHP are sharing their stories to raise awareness of this rare condition which can be life-threatening.
What is Panhypopituitarism?
"Panhypopituitarism is a condition of inadequate or absent production of the anterior pituitary hormones. It is frequently the result of other problems that affect the pituitary gland and either reduce or destroy its function or interfere with hypothalamic secretion of the varying pituitary-releasing hormones."
"The pituitary gland is called the master endocrine gland of the body because it controls the function of other endocrine organs. The anterior pituitary produces the hormones thyrotropin (thyroid-stimulating hormone [TSH]), corticotropin (adrenocorticotropic hormone [ACTH]), luteinizing hormone (LH), follicle-stimulating hormone (FSH), growth hormone (GH), and prolactin (PRL). The anterior pituitary is controlled by specific hypothalamic-releasing hormones. The posterior pituitary produces vasopressin (antidiuretic hormone [ADH]) and oxytocin."

Friday, September 15, 2017

My article for The Mighty on my conditions related to Panhypopituitarism


Hello. My name is Vanessa and ​I'm a 45 year old woman with chronic illness and disability.

I was born with a very rare pituitary disease called Panhypopituitarism (PHP),​ which​ is a clinical syndrome of deficiency in pituitary hormone production.​ ​In my case it was caused in utero due to Growth Hormone (GH) Insufficiency​ and other health issues.

My pituitary gland is only 60% in size compared to normal and I have an absent pituitary stalk, also known as Pituitary Stalk Interruption Syndrome (PSIS). What this means is that I do not produce Cortisol and have low levels of Thyroid function, no male and female hormones which means that I am in the pre-menarche / post menopausal range when my blood is tested. I have been on Hormone Replacement Therapy in the past and I have just started again.

A major factor ​of panhypopituitarism and PSIS is that in 1971 there were no warnings about smoking and drinking affecting the development of the foetus due to reduced growth hormone insufficiency and other hormones such as cortisol.

Below is an excerpt from a medical article which helped to explain what happened:

"During pregnancy, the hormonal systems of the mother and fetus are intricately interconnected
to ensure normal fetal development.​ ​Accordingly, maternal alcohol consumption during pregnancy can interfere with fetal development, not only directly, through adverse effects exerted by alcohol that crosses the placenta and enters the fetal bloodstream, but also indirectly, by disturbing the functions and interactions of maternal and fetal hormones.

In both the mother and the fetus, alcohol​ ​​exposure can impair the functioning of the hypothalamic-pituitary-adrenal axis, which regulates the body’s response to stress; the hypothalamic-pituitary-gonadal axis, which controls reproductive functions; and the hypothalamic-pituitary-thyroid axis, which regulates the metabolism of almost​ ​all tissues.

In addition, alcohol can interfere with the activities of growth hormone and insulin-like
growth factors, which promote body growth and activity. Some of the effects of maternal alcohol
consumption on fetal hormone systems may contribute to the adverse effects observed in children with fetal alcohol syndrome and related disorders. "​ (​Tze, W J, H G Friesen, and P M MacLeod​, 1976)​

This lack of Growth Hormone meant that the bones in my feet didn't develop in utero and I developed severe Congenita​l​ Talipes equinovarus aka Clubfoot​. My mother was told that I wouldn't be able to walk until I was at least 3 years of age. She was determined to prove them wrong, propping me up against a wall and helping me strengthen my legs and calf muscles so that later I would stand by the age of 2. She also fed my mind and taught me to read and write by that age, which helped me with the pain and discomfort of manipulations, allowing me to escape with the joy of books and stories that helped a great deal.

​I have had several operations on my feet including ​the cutting and manipulation of tendons, ​breaking of bones, chiselling ​of ​some, and setting them with a surgical staple​​ in my Calcanae.​  I then had both my legs in plaster from my toes to my hips. I was in a wheelchair for several months. After the casts came off, I had to learn to walk again.  ​My physical limitations meant that my mother had me focus on learning, creating and finding positive outlets which meant that I had a higher quality of life and through reading so many books, ​a curious ​and open ​mind. ​

​The under-developed pituitary gland led to a lack of Growth Hormone and short stature throughout my life. My bone age was 2 1/2 years behind my chronological age when I was tested at age 13. When I was 5 I looked 3. When I was 8 I looked 6. When I was 16 I looked 13 etc. When I was 16 I went onto Growth Hormone (GH) and reached the height of 5ft 1 1/2 inches (152cm). It wasn't until I reached my mid 30s that I was asked to provide ID to show that I was over 18. I have a youthful face and when I was a primary school teacher I was often mistaken as a student aged 12. Seriously.


​Due to lack of male and female hormones, ​I have never had a natural period and I cannot conceive without a lot of intervention and even then with a lot of serious health concerns if I tried.​ Fortunately, I married a wonderful man 23 years my senior who has two adult children in their 30s and I have a grandson from the eldest son. I love my stepsons and my grandson and feel blessed that I have them in my life, despite the fact they live in Tasmania and myself in Brisbane, QLD Australia. ​I have a habit of adopting other people's children as members of my soul family and love handing them back afterwards  

I am now retired as a primary school teacher due to the fact that the schools were not disability friendly and I was made to stand on uneven ground for extended periods during recess, lunch and sports duties. When I asked to be given a different task, I was told that it was part of the duties of a substitute teacher and just get on with it. This meant that later that evening and the next day I could barely walk without screaming in agony.

When my father-in-law passed away in 2000 we moved states to Tasmania, Australia from Wollongong (Sydney), Australia and I retired and after some training became a website developer and Digital Media publisher, which I continue to do today.  I work for my own business where I work around my health problems, working my own hours and loving what I do.

At age 19 I attended the University of Wollongong and started a double degree in Mathematics and Computing Science. I loved some subjects but the Theory of Mathematics and Electronics I struggled with. I began having migraines from stress and after a year switched to a 4 Year Bachelor of Education degree which i studied part time for eight years. When I wasn't in class or doing assignments I was studying my condition and psychology. I was like a sponge soaking up all the knowledge. I loved the majority of my Primary Education courses and graduated in 2000. Within my degree I specialised in Information Technology and Communication which is where I developed my love of creating multimedia resources and websites.

I have often said that without my health issues and disabilities, I would not have the drive and determination. I would not be the person I am today. Thanks to having to sit in one place as a baby and toddler, and not as active as my peers growing  due to chronic fatigue, I focused on reading and learning, enriching the mind and was tested as an IQ of 154 via the mensa website at age 22.


I am working with a local charity that supports adults with disabilities, The Spirit of the Dragonfly, as their website developer and social media marketing consultant. They do amazing work with people who have a wide range of disabilities. They fundraise to support their dreams towards independence, travel and other experiences. One of their projects is to send members that qualify on a cruise and as a group bond and grow through their experiences. Some of the members live at home or in group homes and this gives them a sense of independence.

 I love my life and am thankful for everything I have experienced.

​Article Source​s​:

Tze, W J, H G Friesen, and P M MacLeod.
“Growth Hormone Response in Fetal Alcohol Syndrome.”
Archives of Disease in Childhood 51.9 (1976): 703–706
https://pubs.niaaa.nih.gov/publications/arh22-3/170.pdf

​Orpha.net. "Pituitary Stalk Interruption Syndrome"
​http://www.orpha.net/consor/cgi-bin/OC_Exp.php?Lng=EN&Expert=95496​P​
--
Regards,
Vanessa Pike-Russell


Thursday, September 14, 2017

Talipes resulting from Panhypoptiuitarism

I was born with Talipes Equinovarus, also known as Club Feet. This is a condition that stemmed from my primary condition of Panhypopituitarism  and Growth Hormone Insufficiency.  

So what is Talipes?

"In clubfoot, the tendons on the inside of the leg are shortened, the bones have an unusual shape, and the Achilles tendon is tightened." (1) 

A good image showing before and after treatment can be seen below:




Recently I was on Instagram and saw the image by @_kursti of a child wearing a 'boots and bar' apparatus similar to the one I had to straighten the toddler's feet into the correct position.  It didn't work so I underwent invasive surgery. 






I remember feeling frustrated that I had to sit in the one position and it made it difficult to move around. My mum helped me by teaching me how to read by the age of 2 and I always had a book handy to take my mind off things. I am now sitting in one position for up to 18 hrs a day with my website and social media marketing company.

When the boots and bar and manipulations obviously were not working, the Orthopaedic Surgeon cut my tendons, lengthened the inside of the foot tendon and shortened the outside of the foot, in both feet. It didn't work very well and I kept tripping over as my toes would turn inwards. 

I am grateful for the lessons of tolerance and patience that it taught me. I had some amazing people in my life that went out of their way to increase my quality of life and extend upon my skills and talents. Today I wear Colorado boots which help to lock my weak ankles and allow me to walk up to 3km on level ground. I still experience pain and discomfort on a daily basis with poor circulation after my first operation where they cut my tendons and tried to make my feet turn outwards.

When I was 9 I had another operation, this time they broke some bones in my feet and chiseled bones then added a surgical staple in my calcanae which is still in operation today. It caused juvenile arthritis and cold weather made it worse. 

I know it was hard for my mother but she persisted with my physical therapy and despite doctors advice that I wouldn't walk until the age of three, she would strengthen my leg muscles and hold me up against the wall and build up my muscle until I not only walked developed calf muscles which was again contrary to doctor's opinion. 

My mum was determined that I would walk and I can never thank her enough for the fierce determination she showed as a mother of a baby with talipes equinovarus. I am grateful for that her every day.

Below is a photo of my feet, taken when I was at the Podiatrist's. 











In the photos you can see that I walk over my heel as it is malformed. I was supposed to have a heel operation in my late teens but since I was studying my degree I didn't want to take time off. I'm now 45 and suffer from weak ankles and jarring when I walk over my heel when not wearing Colorado boots done up tightly to lock the heel. They are very constrictive but I am so thankful for them. Most people don't notice my talipes. Some notice that one hip is higher than the other, though and my gait is a little lopsided. I am able to walk up to 3km on a good health day, which is amazing. I can't jump or run or hop or enjoy a trampolene but compared to what I was like when I was born and a toddler I am so thankful to my Orthopaedic Surgeons for what they did for me.

Friday, September 8, 2017

My Talipes Equinovarus (Club feet) Journey


@_kursti posted a photo of #bootsandbar apparatus similar to the one I used to wear on my #feet which helps to correct #talipes or #clubfeet
As I was a toddler and there was no photos taken of me in them, I can only go on how they were described to me.
"The #orthosis is two open-toed leather boots connected by a metal bar. The Boots and Bar orthosis is also called a #footabductionbrace orthosis or a #DenisBrownesplint The brace holds the child’s feet turned outwards and in the corrected position. "
I remember feeling #frustrated that I had to sit in the one position and it made it difficult to move around. My mum helped me by teaching me how to read by the age of 2 and I always had a #book handy to take my mind off things. I am now sitting in one position for up to 18 hrs a day with my #website and #socialmedia #marketing company.
I am #grateful for the lessons of tolerance and patience that it taught me. I had some amazing people in my life that went out of their way to increase my quality of life and extend upon my skills and talents.
I know it was hard for my mother but she persisted with my #physicaltherapy and despite doctors advice that I wouldn't walk until the age of three, she would strengthen my leg muscles.
She would hold me up against the wall and build up the #muscle strength in my feet and legs until I not only walked developed #calfmuscles which was again contrary to doctor's opinion.
My mum was determined that I would walk and I can never thank her enough for the #fierce #determination she showed as a #mother of a #babywith #talipesequinovarus
I still experience #pain and #discomfort on a daily basis with poor circulation after my first #operation where they cut my #tendons and tried to make my feet turn outwards. It didn't work and means that I get #pinsandneedles on a regular basis.
I feel blessed that the #orthopaedic doctors and #orthapedicsurgeryspecialists met for a convention when I was 9. My mum and I had travelled up from #wollongong to the #sydneychildrenshospital and I was presented to a group of surgeons who specialised in talipes correction. After examining me they said that there was a new operation which I would be a good candidate for.
In this ground breaking surgery they broke some bones in my feet, chiseled bones and then re-set them and added a surgical staple in my #calcanae which is still in operation today.
The breaking and chiseling of bones caused #juvenilearthritis and cold #weather made it worse. I remember that I did a lot of crying through the night with pain that was crippling and my heart goes out to people like my husband who lives with the pain and aches of arthritis on a daily basis.
Today I wear #colorado #boots which help to lock my #weakankles and allow me to walk up to 3km on level ground. I wear them almost every day and they provide support but are heavy and very constrictive and make my feet ache. I prefer aching, constricted feet to the alternate of walking over my malformed heel and twisting my ankle and not being able to walk at all.
Thanks to my mothers determination that I would have a good education I #graduated from university of wollongong with a degree in #Education with a specialisation in #informationtechnology and #communication which I am forever #thankful for.
I was a casual/ substitute teacher in primary school ( Years K-6 ) until I moved to Tasmania with the death of my father in law. It was mandatory that casual teachers must supervise yard duty at recess and lunch time plus sport where I stood on uneven ground which caused great pain and sometimes I couldn't walk without yelping in pain.
In my degree ( B.Ed) I had excelled at Website Design and Development and whilst living in Tasmania 2000-2002 I focused on creating a collaborative group work project called The Crab Street Journal, a web based magazine for Land Hermit Crab owners. There were over 2000 people in the Land Hermit Crab Owners Society and a group of us published the magazine which is still in operation today.
It made me feel productive and fulfilled and I decided that since I could work around my Panhypopituitarism ( PHP) which in simple terms is Pituitary Disease. I could work my own hours and live a creative, fulfilling life.
I love my job as Website Developer and Social Media Specialist. I still use my Education degree when I train my adult clients and whilst I miss teaching children I am glad that I made the decision to chose to retire from teaching in primary schools that were not sensitive to my physical issues due to talipes and health issues with PHP.
I love my life and feel that my adversity had made me the strong, resilient and compassionate person that I am today

Saturday, May 27, 2017

Hypopituitarism caused by Ectopic pituitary stalk


Something I learned last week is that my growth, hormone and corticosteroid deficiencies were caused by the absence of a pituitary stalk and that pituitary fossa is 3mm instead of the 5mm average.

Pituitary Stalk (Infundibulum): This critical but delicate neurovascular structure (comprised of nerves and blood vessels) is the connection between the hypothalamus and the pituitary gland. It carries the hypothalamic releasing hormones for the anterior pituitary gland and also axons from the magnocellular neuro-secretory cells of the hypothalamus to the posterior pituitary where they release their hormones oxytocin and antidiuretic hormone (ADH) into the blood. 


The Pituitary Gland
The pituitary gland is at the anatomical and functional crossroads of the brain, mind and body. Weighing less than one gram and measuring a centimeter in width, the pituitary is often called the "master gland" since it controls the secretion of the body’s hormones. These substances when released by the pituitary into the blood stream have a dramatic and broad range of effects on growth and development, sexuality and reproductive function, metabolism, the response to stress and overall quality of life.

This small, bean-shaped gland is located below the brain in the skull base, in an area called the sella turcica. The gland is regulated by a brain region called the hypothalamus which is connected to the pituitary gland by a thin delicate vascular connection called the pituitary stalk or infundibulum. The pituitary is divided into a larger anterior region (adenohypophysis) and smaller posterior region (neurohypophysis). Directly above the pituitary are the optic nerves and the optic chiasm as they project to the eyes. On each side of the pituitary is the cavernous sinus which is a venous channel through which runs the carotid arteries that carry blood to the brain, and important nerves that control eye movements and facial sensation. Because of the proximity of the pituitary to these major intracranial nerves and blood vessels, and the vital hormonal control the pituitary provides, disorders of the pituitary can cause a wide spectrum of symptoms, both hormonal and neurological.



Listed below are the specific hormones produced by the pituitary:

Growth Hormone (GH): This is the principal hormone that, among many other functions, regulates body and brain development, bone maturation, metabolism and is essential for healthy muscles.

Luteinizing Hormone (LH) and Follicle Stimulating Hormone (FSH): These hormones control the production of sex hormones (estrogen and testosterone) as well as sperm and egg maturation and release.

Prolactin (PRL): This hormone stimulates secretion of breast milk.

Thyroid Stimulating Hormone (TSH):  This hormone stimulates the thyroid gland to release thyroid hormones. Thyroid hormones control basal metabolic rate and play an important role in growth and maturation. Thyroid hormones affect almost every organ in the body.

Adrenocorticotropic Hormone (ACTH): This hormone triggers the adrenal glands (located above the kidneys) to release the hormone cortisol which in turn, regulates carbohydrate, fat, and protein metabolism and is essential in the stress response.

Vasopressin - Also called anti-diuretic hormone (ADH): This hormone promotes water to be reabsorbed by the kidneys and is thus essential in water and electrolyte balance.


In disease states, the pituitary may under- or over-produce hormones. Decreased pituitary hormone production is called hypopituitarism or pituitary failure. The symptoms and treatments for pituitary failure are listed below:


Hormone Deficient  Symptoms  Treatment GH Children: Growth delay
Adults: Decreased muscle mass, increased body fat, elevated cholesterol, low bone density (osteoporosis), impaired psychological well-being,
poor quality of life Recombinant Human Growth Hormone- Given once daily as an injection under the skin

LH/FSH Decreased libido, erectile dysfunction, irregular or absent menses, decreased body hair, decreased muscle strength, hot flashes, mood changes Men: Testosterone- Given as either topical gel or patch or injections

Women: Estrogen + Progesterone-Given as either topical patch or pills  

ACTH Poor appetite, nausea, weakness, vomiting, low blood sugar, low blood pressure, dizziness, body aches Hydrocortisone or Prednisone-Given as daily pills  

TSH Fatigue, weakness, cold intolerance, dry skin, constipation, heavy/painful menses, weight gain, memory loss, mood disturbance Levothyroxine – Given as daily pills (some examples include Synthroid or Levoxyl or Levothroid or Armour Thyroid)  

Prolactin Inability to lactate No treatment available  

Vasopressin (ADH) Increased thirst and frequent urination DDAVP- Given either as daily pills or nasal spray


Infundubulum - pituitary stalkInfundubulum - pituitary stalk

Meaning of ectopic

A gland in the wrong place is referred to as ectopic, and an ectopic gland at the base or back of the tongue is a lingual thyroid.


Pituitary glandPituitary gland
Ectopic pituitary is a rare congenital anomaly of the pituitary gland. The patient usually presents with panhypopituitarism and has a small or absent infundibular stalk on advanced imaging. Usually MRI is the examination of choice which should demonstrate the displaced neurohypophysis which can be isointense to brain parenchyma but will demonstrate strong contrast enhancement with contrast administration. Associated findings also include absence of tissue within the pituitary sella. Although other lesions can present with a suprasellar "hot" spot (enhancing lesion), coupled with the absence of tissue in the sella and the clinical history the diagnosis is essentially confirmed. The anterior pituitary - adenohypophysis - is hypoplastic or absent.

Cushings Disease

I present all of the symptoms of Cushings Disease except that I don't have a tumour, my pituitary was just underdeveloped and there is an empty space similar to that of a tumour that has been removed.  I have the hump or padding on the back of my neck and all the health implications that come with Cushings.

Symptoms include rapid weight gain, particularly of the trunk and face with sparing of the limbs (central obesity). A common sign is the growth of fat pads along the collar bone and on the back of the neck (buffalo hump) and a round face often referred to as a "moon face." Other symptoms include hyperhidrosis (excess sweating), telangiectasia (dilation of capillaries), thinning of the skin (which causes easy bruising and dryness, particularly the hands) and other mucous membranes, purple or red striae (the weight gain in Cushing's syndrome stretches the skin, which is thin and weakened, causing it to hemorrhage) on the trunk, buttocks, arms, legs or breasts, proximal muscle weakness (hips, shoulders), and hirsutism (facial male-pattern hair growth), baldness and/or cause hair to become extremely dry and brittle. In rare cases, Cushing's can cause hypercalcemia, which can lead to skin necrosis. The excess cortisol may also affect other endocrine systems and cause, for example, insomnia, inhibited aromatase, reduced libido, impotence, amenorrhoea/oligomenorrhea and infertility due to elevations in androgens. Patients frequently suffer various psychological disturbances, ranging from euphoria to psychosis. Depression and anxiety are also common.[6]

Mnemonic

C - Central obesity, Cervical fat pads, Collagen fibre weakness, Comedones (acne)
U - Urinary free cortisol and glucose increase
S - Striae, Suppressed immunity
H - Hypercortisolism, Hypertension, Hyperglycemia, Hypercholesterolemia, Hirsutism
I - Iatrogenic (Increased administration of corticosteroids)
N - Noniatrogenic (Neoplasms)
G - Glucose intolerance, Growth retardation


MRIMRI
   

production of cortisolproduction of cortisol

Friday, March 17, 2017

My life with Congential Panhypopituitarism

When I was a baby in my Mother’s uterus I did not receive enough Growth Hormone and as such parts of my body were under-developed. Thus included my pituitary gland (60% of a full size pituitary gland at age 20) and some bones in my feet causing Congenital Talipes Equinovarus. Congential (from birth) Talipes (Club feet) Equinovarus refers to the position the foot is in (see picture below).
I had it in both feet, with my left foot having a weaker ankle. I had several operations correcting the talipes, firstly severing my tendons and re-attaching so that my feet would straighten out - it didn’t last and causes poor circulation and other problems. The last operation was to break the bones in my feet, chisel them, set them with a surgical staple and put me in plaster from my toes to my hips.
I then had to learn how to walk again after the plasters came off. I am now able to walk up to 3.5km on uneven ground and although people that look closely can see my foot roll, most people don’t notice my mobility disability as I wear Colorado and Caterpillar boots to lock my heel. They are terrifically restrictive and uncomfortable but bearable.

So back to Panhypopituitarism:
What is CPHP?
“Panhypopituitarism is a condition of inadequate or absent production of the anterior pituitary hormones. It is frequently the result of other problems that affect the pituitary gland and either reduce or destroy its function or interfere with hypothalamic secretion of the varying pituitary-releasing hormones. Panhypopituitarism can be the end result of various clinical scenarios. The signs and symptoms are diverse. Manifestations that suggest congenital anterior hypopituitarism include micropenis, midline defects, optic atrophy, hypoglycemia, and poor growth.” (Medscape article on Panhypopituitarism)
“The pituitary gland is called the master endocrine gland of the body because it controls the function of other endocrine organs. The anterior pituitary produces the hormones thyrotropin (thyroid-stimulating hormone [TSH]), corticotropin (adrenocorticotropic hormone [ACTH]), luteinizing hormone (LH), follicle-stimulating hormone (FSH), growth hormone (GH), and prolactin (PRL). The anterior pituitary is controlled by specific hypothalamic-releasing hormones. The posterior pituitary produces vasopressin (antidiuretic hormone [ADH]) and oxytocin.” (Medscape article on Panhypopituitarism)
I was born with a pituitary gland that was only 60% developed and an absent pituitary stalk. My pituitary cannot communicate with the hypothalamus effectively without the pituitary stalk. As a result of this, my body does not produce sufficient cortisone, known as the ‘stress hormone’. My doctor explained it to me in simple terms to a scared 13 year old.
“When people get sick, their cortisone level rises and they get better. When you get sick, your cortisone level plummets and you need to take tablets or have an injection of Cortisone or you will get very ill. Sometimes when you get sick you should take extra or double your dose. If you are ill and unable to keep your tablets down then you will need to go to hospital and have an injection of 100mg of Cortisone (4 times my morning dose). If you get physically, mentally or spiritually stressed, this can affect the level of cortisone in your body. Sometimes it can make it go very high and then crash, leaving you with cortisone withdrawal and since cortisone is a steroid, this can cause ‘roid rage’ mood changes, neck and head pain and other physiological changes. Keep dehydrated or you will most probably have an Addisonian Crisis.” Dr Slobodnuik, Endocrinologist from Wollongong NSW Australia
When I was 18 I started drinking alcohol and waking up with the most severe hangovers and also effects of dehydration on someone with Addisons Disease. It really knocks me around, especially if the alcohol is wine or has Sulphur dioxide in it. I have only vomited three times in my life from alcohol - the first time for mixing the wrong types of alcohol in the one night; the second for having a few drinks of sparkling wine and then a lot of greasy food when celebrating graduating for a Bachelor of Education degree, and the third from overindulging at a party. Each time I felt absolutely horrid and promised myself I would limit myself on alcohol, only having one or two and no more. It has been programmed into me that I should do everything I can to avoid vomiting. I only do it once a year at most - as vomiting and not being able to keep my Cortisone down means hospitalisation. Not fun at all.
My initial diagnosis at age 13 was Addisons Disease (secondary). Basically it means I have Adrenal insufficiency and can go into an Addisonian Crisis if I don’t look after myself.
"Adrenal insufficiency implies that the adrenal glands are incapable of producing sufficient hormones, either in the basal (unstressed) state, representing severe adrenal insufficiency; or under conditions of stress such as infection or trauma, indicative of milder degrees of adrenal insufficiency. So, there are differing degrees of effect. The term does not imply a cause for the adrenal insufficiency, which may be Addison's disease, or derive from a regulatory dysfunction like a pituitary problem, where the adrenal glands are no longer properly regulated by the pituitary ACTH.” (Australian Addisons Disease Association Medical FAQ)
My pituitary was undeveloped, so I have secondary Addison's Disease and not primary Addison's Disease which can be auto-immune related.
Someone in the Australian Addisons Disease Association Membership asked a question about drinking:
Question: For some of the less disciplined among us, we were wondering about alcohol. For some of those that have a problem limiting their consumption. Is there a rough guideline you should stick to, so you don’t crash?
Answer: The first thing is, if you are drinking enough to make yourself sick and want to vomit, it doesn’t matter if you have Addison’s disease or not, you are damaging your brain. I strongly advise anyone whether they have Addison’s disease or not, not to drink so much that they physically get sick, because they are doing themselves permanent brain damage, small amounts each time. If you have reasonable amounts of drinks at night you have disturbed sleep. You don’t get the level of sleep to make your ACTH. So if you don’t have Addison’s disease you wake up with not as much Cortisol in your blood the next morning as you would otherwise have had. So a person with a hangover really has the same effect as having Addison’s. You lot have the advantage because when you do wake up you can take your tablets and your Cortisol level will go up to normal, so you would partially correct some of the side effects of a hangover just by taking your morning dose of cortisone. But there is still a problem in the morning. You crash!
Someone with normal kidneys and normal adrenal glands adjusts blood volume / blood pressure, very quickly and very easily. You can’t. You have to rely on certain medication so you are not changing it (blood volume) as quickly. Sure you have all the other systems but you are lacking some of the control systems. One of the things alcohol does is dehydrate you. It dehydrates you because you end up passing a lot more water because of the alcohol. So one of the problems you would have which would exacerbate, make things worse, is that your blood volume would be way down. So that one of the more important things to do is to drink a lot of fluid. Replace your water and salt as well as the cortisone.
I have not really seen any research or any investigation on alcohol and the problem you mentioned but on first principles, I would argue very strongly, one of the first things to do in Addison’s disease is to keep your blood volume up. You should always be hydrating in anticipation. I think you are probably talking about dehydration the next morning being a major problem.
As you can see, there are good reasons for me to not drink alcohol.
So what exactly is the pituitary gland responsible for?
Image from http://emedicine.medscape.com/article/923789-overview

CORTISOL - THE STRESS HORMONE

Understanding the natural stress response

“When you encounter a perceived threat — a large dog barks at you during your morning walk, for instance — your hypothalamus, a tiny region at the base of your brain, sets off an alarm system in your body. Through a combination of nerve and hormonal signals, this system prompts your adrenal glands, located atop your kidneys, to release a surge of hormones, including adrenaline and cortisol.
Adrenaline increases your heart rate, elevates your blood pressure and boosts energy supplies. Cortisol, the primary stress hormone, increases sugars (glucose) in the bloodstream, enhances your brain's use of glucose and increases the availability of substances that repair tissues.
Cortisol also curbs functions that would be nonessential or detrimental in a fight-or-flight situation. It alters immune system responses and suppresses the digestive system, the reproductive system and growth processes. This complex natural alarm system also communicates with regions of your brain that control mood, motivation and fear.”
(Mayo Clinic article on Stress and Cortisone)
Due to my disease, panhypopituitarism, I respond to stress more acutely and feel the effects of stress on my body as if it has gone into shock..
“Psychological or emotional stress can precipitate an Addison’s crisis with the same effectiveness as physical stress or illness, and most endocrinologists recommend the same increase in cortisone or steroid dose during psychological stress and emotional upsets as they do during physical stress or physical illness.” (Australian Addisons Disease Association)
Lower Back pain and Osteoperosis
“Lower back pain in a person with Addison's Disease... one must bear in mind that there is an increased prevalence of osteoporosis in Addison's Disease which may require specific treatment. In this case, specific treatment may be needed and the cause of pain may be a fracture.” (Australian Addisons Disease Association)
I have pain in my lumbar if I do housework such as vacuuming or sweeping. I have difficulty bending over and picking things up. When I sit at the computer for too long I get tingling up and down my spine and have to go and have a bath and pain killers for relief.
What are some of the symptoms adults with a pituitary disorder experience?
  • Headaches
  • Vision problems
  • Unexplained weight gain
  • Loss of libido
  • Feeling dizzy and nauseous
  • Pale complexion
  • Muscle wasting
  • Coarsening of facial features
  • Enlarged hands and feet
  • Excessive sweating and oily skin
  • Moon face (with reddened skin on face)
  • Carpal Tunnel Syndrome

Helpful Links on PHP

Medscape article on Panhypopituitarism
http://emedicine.medscape.com/article/923789-overview
Australian Addisons Disease Association information on medical FAQ
http://addisons.org.au/information/medical/