BAÑAGADO, NOREEN B.

BS – Medical Technology 3

INTRODUCTION TO HORMONES AND PITUITARY FUNCTION

Clinical Chemistry

Pituitary

 “Master gland”: secretes hormones that regulate other glands

 Needed for metabolism & gonadal, thyroidal, & adrenal function
 A transponder that translates neural into a hormonal or endocrinologic product
 Distinguishing features of pituitary function
- Feedback loops
- Pulsatile secretions
- Diurnal rhythms
- Environmental or external modification of its performance

EMBRYOLOGY & ANATOMY

 Three parts
- Anterior pituitary or adenohypophysis. the largest portion of the gland, originates from
Rathke’s pouch, an evagination of buccal ectoderm that progressively extends upward
and is eventually enveloped by the sphenoid bone
- Posterior pituitary or neurohypophysis. arises from the diencephalon, is responsible
for the storage and release of oxytocin and vasopressin (also called antidiuretic hormone
[ADH])
- Intermediate lobe or pars intermedialis. poorly developed in humans and has little
functional capacity other than to confuse radiologists by forming nonfunctional, benign,
cystic enlargements of the pituitary
 Creation of the median eminence, the inferior portion of the hypothalamus, and the pituitary
stalk are the other critical events in the formation of the hypothalamic–hypophysial unit
BAÑAGADO, NOREEN B.
BS – Medical Technology 3
 Pituitary function can be detected between the seventh and ninth weeks of gestation
 Sella turcica – a pocket of sphenoid wherein the pituitary resides, defines as “Turkish saddle”
which is surrounded by dura mater
 Diaphragma sella – The reflection of dura that separates the superior portion of the
pituitary from the hypothalamus, it is penetrated by the infundibulum or pituitary stalk,
which connects the adenohypophysis to the median eminence and hypothalamus
 Pituitary stalk contains both neural and vascular structures that terminate in the hypophysis
 Posterior pituitary
- connected to the supraoptic and paraventricular hypothalamic nuclei (where
vasopressin and oxytocin are produced) by way of two, distinct neurosecretory tracts, the
supraopticohypophyseal and tuberohypophyseal tracts, which pass through the stalk
 Anterior pituitary
- receives 80% to 90% of its blood supply and many hypothalamic factors via the
hypothalamic–hypophysial portal system, also contained in the stalk

FUNCTIONAL ASPECTS OF THE HYPOTHALAMIC–HYPOPHYSIAL UNIT

 Afferent pathways (inputs) to the hypothalamus are integrated in various specialized nuclei,
processed, and then resolved into specific patterned responses.
 the hypothalamus has many efferent neural connections (outputs) to higher brain centers (the
limbic system, the autonomic nervous system, and the pituitary), these responses appear to be
rather diffuse but are actually stereotypical
 Negative feedback resembles a typical servomechanism and forms the basis of our understanding
of hypothalamic–pituitary function
 A simple example of an endocrine feedback loop is the hypothalamic-pituitary-thyroidal axis.
- The hypothalamus produces the hypophysiotropic hormone, thyrotropin-releasing
hormone (TRH), and releases it into the portal system where it directs the thyrotrophs (or
TSH-producing cells) in the anterior pituitary to secrete thyroid-stimulating hormone
(TSH).
BAÑAGADO, NOREEN B.
BS – Medical Technology 3

HYPOPHYSIOTROPIC OR HYPOTHALAMIC HORMONES

 Peptides and bioactive amines are most common products of hypothalamus

 Hypothalamic hormones often have multiple actions:
- TRH (thyrotropin-releasing hormone) stimulates both TSH & prolactin
- GnRH (gonadotropin-releasing hormone) stimulates LH & FSH production
- Somatostatin inhibits GH & TSH release from pituitary
- CRH (corticotropin-releasing hormone) releases ACTH from pituitary
- GHRH (Growth hormone-releasing hormone) releases GH
- Dopamine (prolactin inhibitory factor) inhibits prolactin release
 Hypophysiotropic hormones are found throughout central nervous system, gut, pancreas, & other
endocrine glands

ANTERIOR PITUITARY HORMONES

 Larger and more complex than those from hypothalamus

 Also known as “adenohypophysis”
 Two types:
- Tropic hormones: actions are specific for another endocrine gland
BAÑAGADO, NOREEN B.
BS – Medical Technology 3
 LH (luteinizing hormone): ovulation and directs testosterone production from
Leydig cells
 FSH (follicle-stimulating hormone): ovarian recruitment; folliculogenesis,
spermatogenesis
 TSH (thyroid-stimulating hormone): directs thyroid hormone production from
thyroid
 ACTH (adrenocorticotropin hormone) regulates adrenal steroidogenesis
(increased in Cushing’s disease)
- Direct effector: act directly on peripheral tissue
 GH (growth hormone): affects substrate metabolism & stimulates liver to
produce growth factors
 Prolactin: target gland is the breast; it diffuses target tissue and lacks a single
endocrine end organ.

PITUITARY TUMORS

 Pituitary tumors account for 91% of the lesions removed from carefully selected patients who
have undergone transphenoidal surgery
 Prolactin-secreting pituitary tumors are the most common, followed by nonfunctioning or null
cell tumors, and tumors that secrete GH, gonadotropins, ACTH, or TSH account for the
remainder
 Enlargement of pituitary are seen during puberty and pregnancy
- During pregnancy: lactotroph hyperplasia
 Thyrotroph or gonadotroph hyperplasia can also be seen in longstanding primary thyroidal or
gonadal failure

GROWTH HORMONE

- also called somatotropin, structurally related to prolactin and human placental lactogen
- Release of somatotropin from the pituitary is stimulated by the hypothalamic peptide growth
hormone-releasing hormone (GHRH); somatotropin’s secretion is inhibited by somatostatin
(SS).
- Action of GH
BAÑAGADO, NOREEN B.
BS – Medical Technology 3
 Amphibolic: influences both anabolic & catabolic processes
 Allows effective transition from a fed state to a fasting state without shortage of
substrates
 Directly antagonizes effect of insulin on glucose metabolism
 Provides hepatic gluconeogenesis
 Stimulates lipolysis
 Enhances protein synthesis in skeletal muscle & other tissues
 Stimulates production of insulin-like growth factors
- Acromegaly
 Results from pathologic or autonomous growth hormone excess; in most cases, a
pituitary tumor
 Causes are the following:
 Gigantism
 Bony & soft tissue overgrowth
 Progressive enlargement of hands, feet, mandible, & skull
 Arthritis, diabetes, hypertension, atherosclerosis, muscle weakness, sleep
apnea; shortened life expectancy
- Growth Hormone Deficiency
 Occurs in both children & adults
 Children: genetic or due to tumors
 Adults: result of structural/functional pituitary abnormalities
 Results in growth failure in children
 Various genetic defects are associated:
 Recessive mutation in GHRH gene, failure of GH secretion
 Loss of GH gene
 GH insensitivity
 Structural lesions of pituitary or hypothalamus

PROLACTIN

- Characteristics
 Secreted by the anterior pituitary after stimulating TRH
 Structurally related to GH & placental lactogen
 Considered a stress hormone; has vital functions in reproduction
 Classified as a direct effector hormone
BAÑAGADO, NOREEN B.
BS – Medical Technology 3
 Regulates via tonic inhibition, not intermittent stimulation
 Its secretion is inhibited by dopamine
 Physiologic effect: lactation
 Excess prolactin usually leads to hypogonadism
- Prolactinoma
 A pituitary tumor that directly secretes prolactin
 Most common type of functional pituitary tumor
 Clinical presentation depends on patient/gender, tumor size:
 Premenopausal women: menstrual irregularity/amenorrhea, infertility,
galactorrhea
 Men/postmenopausal women: headaches or visual complaints
- Idiopathic Galactorrhea: lactation in women with normal prolactin levels

HYPOPITUITARISM

- he failure of either the pituitary or hypothalamus results in the loss of anterior pituitary
function
- Complete loss of function is termed panhypopituitarism
- loss of only a single pituitary hormone, which is referred to as a monotropic hormone
deficiency
- The loss of a tropic hormone (ACTH, TSH, LH, and FSH) is reflected in function cessation
of the affected endocrine gland. Loss of the direct effectors (GH and prolactin) may not be
readily apparent
- Causes of Hypopituitarism
 Pituitary tumors
 Parapituitary/hypothalmic tumors
 Trauma 4. Radiation therapy/surgery
 Infarction 6. Infection
 Infiltrative disease
 Immunologic
 Familial
 Idiopathic
- Etiology of Hypopituitarism
BAÑAGADO, NOREEN B.
BS – Medical Technology 3
 Direct effects of pituitary tumors, or the sequelae of treatment of tumors, are the most
common causes of pituitary failure
 Parasellar tumors (meningiomas and gliomas), metastatic tumors (breast and lung),
and hypothalamic tumors (craniopharyngiomas or dysgerminomas) can also cause
hypopituitarism through similar mechanisms
 Hemorrhage into a pituitary tumor (pituitary tumor apoplexy) is rare
 Postpartum ischemic necrosis of the pituitary following a complicated delivery
(Sheehan’s syndrome) typically presents as profound, unresponsive shock or as
failure to lactate in the puerperium
 Panhypopituitarism can result from radiotherapy used to treat a primary pituitary
tumor or a pituitary that was inadvertently included in the radiation port; loss of
function, however, may be gradual and may occur over several years
- Treatment of Panhypopituitarism
 Replacement therapy for panhypopituitarism
 Patients are treated with thyroxine, glucocorticoids, and gender-specific sex steroids
 Pulsatile GnRH infusions have induced puberty and restored fertility in patients with
Kallmann’s syndrome, and gonadotropin preparations have restored
ovulation/spermatogenesis in people with gonadotropin deficiency

POSTERIOR PITUITARY HORMONES

 It is an extension of forebrain & represents storage region for oxytocin and vasopressin
 Also called as neurohypophysis
 Both of these small peptide hormones are synthesized in the supraoptic and paraventricular
nuclei of the hypothalamus and transported to the neurohypophysis via their axons in the
hypothalamoneurohypophysial tract

OXYTOCIN

- A cyclic nonapeptide, with a disulfide bridge connecting amino acid residues 1 & 6
- Has a critical role in lactation
- Likely plays a major role in labor or & parturition
BAÑAGADO, NOREEN B.
BS – Medical Technology 3
- Synthetic oxytocin, Pitocin, is used in obstetrics to induce labor
- Has been shown to have effects on pituitary, renal, cardiac, & immune functions

VASOPRESSIN

- Also known as antidiuretic hormone (ADH)

- A cyclic nonapeptide, structurally similar to oxytocin with an identical disulfide bridge;
differs by only 2 amino acids
- Major action is to regulate renal free water excretion & water balance
- A potent pressor agent & affects blood clotting
- Hypothalamic osmoreceptors & vascular baroreceptors regulate release of vasopressin from
posterior pituitary
- Deficiency can lead to Diabetes insipidu,characterized by excessive urine production
(polyuria) & intense thirst (polydipsia)

HORMONE TESTING

 Immunoassay
 Definitive testing for determining the autonomous production of GH relies upon the normal
suppressibility of GH by oral glucose loading
 On the other hand, several studies have shown that provocative GH testing may not be necessary
in patients with low IGF-1 levels and otherwise documented panhypopituitarism

REFERENCE:

Bishop, M. L., Fody, E. P., & Schoeff, L. E. (2009). Clinical Chemistry: Techniques,
Principles, Correlations (Bishop, Clinical Chemistry) (6th ed.). Jones & Bartlett
Learning.