Composed of 2 pituitary

Posterior pituitary and anterior pituitary

Under the pituitary in the skull there is sella turcica ‫ هي اللي تكون‬involving the pituitary gland and surrounding pituitary gland

Pituitary Diseases

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Done by Sara alabdulkarim

Pituitary gland

Pituitary gland

Under the hypothalamus

Two component

• The pituitary gland is a small, bean-shaped structure that lies at

Or surround

the base of the brain within the confines of the sella turcica. •
Anterior (adenohypophysis) 80%
These are the function of pituitary gland which are alot of functions

• It is intimately related to the hypothalamus connected with a

stalk and a rich venous plexus.

If there is any pathology in somatotroph like adenoma or hypoplasia or

• Along with the hypothalamus, the pituitary has a central role in

cancer we will have some abnormalities

the regulation of most of the other endocrine glands.

Adrenocorticotropic hormone

T
Proopiomelanocortin

e
se
melanocyte-stimulating hormones

Pituitary gland

• Posterior (neurohypophysis); modified glial cells extending from

hypothalamus (axon terminals):

The hypothalamus and pituitary are inter related

The hypothalamus control the six hormones produced by the pituitary

• Oxytocin

(contraction of uterine and lactiferous ducts smooth muscle)

• Antidiuretic hormone (ADH) (vasopressin)

(water conservation)

Anterior pituitary
Posterior

Feed back effects

‫اخذتوه بالفسيولوجي‬

Adenohypophysis Neurohypophysis

• Pink acidophils
G Its modified neural tissue
And produce Oxytocin

→ GH , PRL Resembles neural tissue

• Dark purple basophils → ACTH , TSH,

FSH & LH (glial cells, nerve fibers, nerve endings,
• Pale staining chromophobes

(few cytoplasmic granules may & intra-axonal neurosecretory granules)

have secretory activity)

First disease

Clinical manifestations of pituitary gland disease

Pituitary adenoma

monomorphic cells ‫االدينوما تكون نوع واحد من الخاليا يسمونها‬

‫فتكون يا اسيدوفيليك يا ازينوفيليك‬

• Hyperpituitarism •
Pituitary adenomas are classified on the basis of hormone
Adenomas, hyperplasia, L
Related to

• carcinoma of anterior pituitary, Secretion of hormones by

produced by the neoplastic cells

some extra-pituitary tumors, etc

Pituitary adenomas can be efunctional or silent

Produce hormones

• Hypopituitarism •

• Ischemic injury, surgery, radiation, inflammation They don’t produce any hormones

• Local mass effect

Both functional and silent pituitary adenomas are composed of a

single cell type and produce a single hormone

The silent call , so they are not producer

Pituitary adenomas may also be hormone negative (Null cell)

Silent and hormone-negative adenomas are more likely to be

macroadenomas

Pituitary adenoma

Morpholgy

Of macro

• The pituitary adenoma is a well-circumscribed, soft lesion

Adenoma could be grossly

• The Small tumors is confined by the sella turcica

• The Large lesions extend superiorly into the suprasellar region

• Microadenomas: < 1 cm And it will have specific presentation

• Invasive adenomas: in 30% of cases the adenomas are
• Macroadenomas: > 1 cm And it will press the normal tissue around

it and it will have specific presentation

nonencapsulated and infiltrate bone, dura, and brain

• Mass effect of adenoma may compress

the fibers of optic chiasm causing

• Foci of hemorrhage and/or necrosis are common in larger

bitemporal hemianopsia

So the patient will have bifield vision problems

adenomas

Microscopically In macro

Adenomas are composed of uniform, polygonal cells arrayed in

The cellular monomorphism and the absence

sheets, cords, or papillae Reticulin is deferent from the normal

of a significant reticulin network distinguish

Sparse means little, so the normal tissue will have complete mesh of reticulin

• r → soft consistency
Sparse supporting reticulin
And adenoma will have less then the normal type of cell

pituitary adenomas from non-neoplastic

anterior pituitary parenchyma

• The nuclei of the neoplastic cells may be uniform or pleomorphic

• The cytoplasm of the constituent cells may be acidophilic,

The difference between pituitary and pituitary adenoma

-the reticulin network is little in the adenoma

basophilic, or chromophobic So it’s one type of cell only -the pituitary is multiple type of cell , while the adenoma is one type of cells

• The cytoplasm is uniform throughout the neoplasm

We have only one type of cells which is basophilic blue cells

reticulin Is complete forming nest reticulin Is incomplete

Normal pituitary Pituitary adenoma

w/ the breakdown of
w/ intact reticulin

network surrounding the reticulin network

the acini around the acini


Type of adenoma

Depends on type of adenomas cells

Like if the cells is produce specific hormones

Prolactinomas like prolactin it will be prolactenoma

If it produce other type like GH producing

adenoma or corticotroph cell adenoma

Growth Hormone-Producing Adenomas

• Commonest hyperfunctioning pituitary

adenoma Also the clinical manifestation is according to

the type of cells

• Second most common type of functional pituitary adenoma

• Ranges from microadenomas to

• GH stimulates the hepatic secretion of insulin-like growth

macroadenoma
factor I (somatomedin C) In children
e
Adenoma producing prolactin will make :

• Amenorrhea, galactorrhea,

infertility,
• Before the epiphyses close → Gigantism & After the

hyperprolactinemia

epiphyses close → Acromegaly In adult

Because GH will activate insulin like growth factor somatomedin c

• Other causes of hyperprolactinemia

t
• Abnormal glucose tolerance → Diabetes mellitus

include:

• Prolactin is demonstrable in a number of growth hormone-

producing adenomas ‫يعني البروالكتني يعتبر واحد من املوست كومن تايب اوف بيتوتري ادينوما‬

• Pregnancy, lactotroph hyperplasia

• Dopamine inhibitors e.g. (Tx, Dopamine

agonist)

Other Anterior Pituitary Neoplasms

Corticotroph Cell Adenomas Produce ACTH

Will cause disregulation of the sexual hormones

so (LH &FSH) producing adenomas

• Gonadotroph

• Microadenomas at the time of diagnosis

• Cushing syndrome (Hypercortisolism )

• Thyrotroph (TSH) producing adenomas →

• Cushing disease (Excessive production of ACTH by the pituitary)

hyperthyroidism

• Nelson syndrome (Corticotroph adenomas may develop after

• Nonfunctioning pituitary adenomas (silent

surgical removal of the adrenal glands)

Related to hypertrophy of pituitary gland after removal of the adrenal gland

gonadotroph adenoma) and true hormone-

So we will loose the negative feedback from the adrenal gland and it will cause hypertrophy of the
adrenal gland and cortecotroph cell adenoma

negative (null cell) adenomas)

• Pituitary carcinomas are exceedingly rare

Causes of hypopituitarism

Manifestations of Hypopituitarism

Congenital or acquired

- Hypothalamic origin (DI)

• Pituitary dwarfism (↓GH)

- Nonfunctioning pituitary adenomas

• Amenorrhea and infertility in women (↓FSH & LH)

- Ischemic necrosis (Sheehan syndrome)

• Hypothyroidism (↓ TSH)

- Radiation
• Hypoadrenalism (↓ACTH)

- Inflammation (sarcoidosis or tuberculosis)

• Failure of postpartum lactation (↓ Prolactine)

-Trauma
• Pallor (↓MSH)

- Metastatic neoplasms

Disorders of the Neurohypophysis

Disorders of the Neurohypophysis

Responsible for ADH secretion

Dysregulation of this hormone will cause increase or decrease of ADH

• Posterior pituitary syndromes:

Syndrome of inappropriate ADH (SIADH)

1 ADH deficiency → Diabetes Insipidus

• ↑ ADH → ↑ resorption water → hyponatremia , cerebral

2 Secretion of inappropriately high levels of ADH (SIADH)

edema , neurologic dysfunction & ↑ total body water

↓e ADH → ↓resorption of water in collecting tubules of the

Plays role in water reabsorption

→ SIADH

•
‫ماله عالقه في البتيوتري‬

kidney → polyuria, low specific gravity, high osmolality ,thirst

• Causes : secretion of ectopic ADH by malignant neoplasms

Produced by

and polydipsia → Diabetes insipidus (small-cell carcinomas

of the lung), local injury to the

Causes of diabetes insipidus (head trauma, neoplasms,

hypothalamus and/or neurohypophysis

inflammatory disorders, surgical procedures or idiopathic)