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Pituitary Disorders

The Endocrine System

Consists of several glands


located in various parts of the
body

Pituitary gland

The Master Gland


Primary function is to
control other glands.
Produces many hormones.
Secretion is controlled by
the hypothalamus

Hypothalamus and Pituitary


The hypothalamus-pituitary unit :
the most dominant portion of the entire
endocrine system
regulates the function of the thyroid,
adrenal and reproductive glands
also controls lactation, milk secretion and
water metabolism

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

Hypothalamus and anterior pituitary

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

Hypothalamus and posterior pituitary

Midsagital view illustrates


that magnocellular neurons
nuclei secrete oxytocin and
vasopressin directly into
capillaries in the posterior
lobe

Hypothalamic releasing hormones


Hypothalamic releasing
hormone
Corticotropin releasing
hormone (CRH)
Thyrotropin releasing
hormone (TRH)
Growth hormone releasing
hormone (GHRH)
Somatostatin
Gonadotropin releasing
hormone (GnRH)
Prolactin releasing hormone
(PRH)
Prolactin inhibiting hormone
(dopamine)

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

Anterior pituitary cells and hormones


Cell type

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

All tissues, liver

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

Etiology of Pituitary Tumor


Non-Functioning Pituitary Adenomas
Endocrine active pituitary adenomas
Prolactinoma
Somatotropinoma
Corticotropinoma
Thyrotropinoma
Other mixed endocrine active adenomas
Malignant pituitary tumors: Functional and non-functional pituitary
carcinoma
Metastases in the pituitary (breast, lung, stomach, kidney)

Abnormal Pituitary Function


Associated with Pituitary Tumors

Hypopituitarism
Hypersecretion of Pituitary Hormones

Hypopituitarism

Pituitary adenomas most common cause


Sequence of function loss from mass
effect:
Growth hormone GH deficiency
Gonadotropins
hypogonadism
ACTH
hypoadrenalism
TSH
hypothyroidism

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 vs. Cushings


Disease
Cushings syndrome is a
syndrome due to excess cortisol
from pituitary, adrenal or other
sources (exogenous
glucocorticoids, ectopic ACTH,
etc.)
Cushings disease
hypercortisolism due to excess
pituitary secretion of ACTH (about

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

Central Obesity in Cushings


Disease

liams Textbook of Endocrinology. 8th Ed. Foster, DW, Wilson, JD (Eds), WB Saunders, Philadelphia, 1996

Progressive Obesity of Cushings


Disease

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

Buffalo Hump in Cushings


Disease

Orth, D. UpToDate

Striae in Cushings Disease

Orth, D. UpToDate

SIGNS & SYMPTOMS: Cushings

Evaluation of Pituitary Mass

Clinical Evaluation
Hormonal Evaluation
Radiologic Evaluation

Clinical Evaluation

examined for clinical signs suspicious for


pituitary hyperfunction or hypofunction

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)

Mulinda, J. Pituitary Macroadenomas, 9/19/05. http://www.emedicine.com/med/topic1379.htm

Hormonal Evaluation
Dynamic stimulation/suppression testing :
may be useful in select cases to further
evaluate pituitary reserve and/or for
pituitary hyperfunction

Dexamethasone suppression testing


Oral glucose GH suppression test
GHRH
CRH stimulation
TRH stimulation
GnRH stimulation
Insulin-induced hypoglycemia

Mulinda, J. Pituitary Macroadenomas, 9/19/05. http://www.emedicine.com/med/topic1379.htm

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

Mulinda, J. Pituitary Macroadenomas, 9/19/05. http://www.emedicine.com/med/topic1379.htm

Radiologic Evaluation
CT-scan

Better at visualizing bony structures and


calcifications within soft tissues
Better at determining diagnosis of tumors with
calcification, such as germinomas,
craniopharyngiomas, and meningiomas
May be useful when MRI is contraindicated, such as
in patients with pacemakers or metallic implants in
the brain or eyes
Disadvantages include:
less optimal soft tissue imaging compared to MRI
use of intravenous contrast media
exposure to radiation

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

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