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Pituitary gland
Hypothalamus-functions
Hypothalamus- integrative
center for endocrine and
autonomic nervous system
Control of some endocrine
glands by neural and
hormonal pathways
Two major groups of
hormones secreted:
inhibiting and releasing
Midsagital view
illustrates parvicellular
neurosecretory cells
secrete releasing factors
into capillaries which are
then transported to the
anterior pituitary gland
to regulate the secretion
of pituitary hormones
Effect on pituitary
Stimulates ACTH
secretion
Stimulates TSH and
Prolactin secretion
Stimulates GH secretion
Inhibits GH (and other
hormone) secretion
Stimulates LH and FSH
secretion
Stimulates PRL secretion
Inhibits PRL secretion
Pituitary Gland
Posterior Pituitary
Pituitary
population
Product
Target
Corticotroph
15-20%
Thyrotroph
Gonadotroph
3-5%
10-15%
ACTH
Adrenal gland
-lipotropin Adipocytes
Melanocytes
TSH
Thyroid gland
LH, FSH
Gonads
Somatotroph
40-50%
GH
Lactotroph
10-15%
PRL
Breasts
gonads
ANTERIOR PITUITARY
(Adenohypophysis)
ACTH
ANTERIOR
PITUITARY(adenohypophysis)
- TSH
Stimulates the thyroid
gland
metabolic rate
- GH (Growth Hormone)
stimulates growth of
bone/tissue
glucose usage
consumption of fats as
an energy source
Anterior pituitary
Prolactin
Posterior Pituitary
Oxytocin
stimulates gravid uterus
causes let down of milk from the breast
ADH (vasopressin)
causes the kidney to retain water.
Pituitary Tumors
PITUITARY TUMORS
10% OF ALL BRAIN TUMORS
Tumors usually cause hyper release of
hormones
Hypopituitarism
Hypersecretion of Pituitary Hormones
Hypopituitarism
Hypopituitarism
GH deficiency
Hypopituitarism
ACTH
Hypersecretion of Pituitary
Hormones
- Hyperprolactinemia
- Acromegaly
- Cushings Disease
Hypersecretion of Pituitary
Hormones
Prolactinoma
Hypersecretion of Pituitary
Hormones
Cushings Disease
Acromegaly
http://www.endotext.com/neuroendo/neuroendo5e/neuroendoframe5e.htm
Cushings Disease
liams Textbook of Endocrinology. 8th Ed. Foster, DW, Wilson, JD (Eds), WB Saunders, Philadelphia, 1996
Cushings Syndrome
Moon facies
Facial plethora
Supraclavicular
fat pads
Buffalo hump
Truncal obesity
Weight gain
Purple striae
Proximal muscle
weakness
Easy bruising
Hirsutism
Hypertension
Osteopenia
Diabetes
mellitus/IGT
Impaired immune
function/poor
wound
healing
liams Textbook of Endocrinology. 8th Ed. Foster, DW, Wilson, JD (Eds), WB Saunders, Philadelphia, 1996
Age 6
Age 7
Age 8
Age 9
liams Textbook of Endocrinology. 8th Ed. Foster, DW, Wilson, JD (Eds), WB Saunders, Philadelphia, 1996
Age 11
Orth, D. UpToDate
Orth, D. UpToDate
Clinical Evaluation
Hormonal Evaluation
Radiologic Evaluation
Clinical Evaluation
Hormonal Evaluation
Basal hormone measurement and
dynamic stimulation testing.
Screening basal hormone
measurements :
Prolactin
TSH, FT4
ACTH, AM cortisol, midnight salivary cortisol
LH, FSH, estradiol or testosterone
Insulin-like growth factor-1 (IGF-1)
Hormonal Evaluation
Dynamic stimulation/suppression testing :
may be useful in select cases to further
evaluate pituitary reserve and/or for
pituitary hyperfunction
Radiologic Evaluation
MRI
Preferred imaging study for the pituitary
Better visualization of soft tissues and vascular
structures than CT
Structures such as fatty marrow and orbital fat
show up as bright images.
high-intensity signals of structures with high
water content, such as cerebrospinal fluid and
cystic lesions
Radiologic Evaluation
CT-scan
Diagnosis
Usually delayed non specific nature of
symptoms
MRI imaging modality of choice
Tests can reveal whether adenoma is
hypo- or hyperfunctional
DIAGNOSIS -- deficiency
GH
DIAGNOSIS - excess
Prolactinoma
TREATMENT
surgical resection