Diseases of the pituitary gland

Dr Junaid Shaik
Diagnostics IB
 Anatomy of the pituitary
gland
Pea-sized, oval gland
Suspended by the pituitary stalk (infundibulum)
Rests on the sella turcica
Divided into an anterior and posterior lobe
The anterior lobe is derived from an out pouching of the roof
of the pharynx
Posterior lobe is an extension of the hypothalamus

Hormones secreted by the anterior pituitary:

Growth hormone (GH) Hormones
Prolactin secreted by
TSH the
ACTH intermediate
pituitary:
Follicle stimulating hormone (FSH)
Luteinising hormone (LH) Melanocyte
stimulating
Hormones secreted by the posterior pituitary: hormone
(MSH)
Antidiuretic hormone (ADH)
Oxytocin
 Functions of the pituitary hormones
GH Prolactin TSH ACTH FSH LH ADH Oxytocin

Release is controlled Prolactin Also called Also called FSH is released LH is released in Blood osmolarity is Stimulates
by the hypothalamus releasing thyrotropin corticotropin in response to response to constantly uterine
through GHRH and hormone by gonadotropin- gonadotropin- monitored by contraction
GHIH hypothalamus Released by the The release of releasing releasing osmoreceptors— and dilatation
results in anterior pituitary ACTH is hormone hormone (GnRH) specialized cells of the cervix
Anabolic function of release of in response to regulated by the (GnRH) by the by the within the
protein synthesis prolactin thyrotropin corticotropin- hypothalamus hypothalamus hypothalamus that It is released
releasing releasing are particularly continuously
Stimulates liver to Promotes hormone (TRH) by hormone (CRH) FSH stimulates Responsible for sensitive to the throughout
break down lactation in the hypothalamus from the the production ovulation and concentration of childbirth
glycogen to glucose women after hypothalamus and production of sodium ions and
pregnancy Triggers the maturation of oestrogen and other solutes. It is also
Stimulates adipose release of thyroid Stimulates the sex cells, or progesterone in responsible for
cells to break down In non- hormones by the adrenal glands gametes, women and ADH is also known the “milk-
stored fat pregnant thyroid gland to secrete including ova stimulates as vasopressin ejection reflex”
women cortisol in women and testosterone in after childbirth
prolactin sperm in men men In response to high when the child
secretion is blood osmolarity begins to
inhibited by ADH is released suckle
prolactin- and the target
inhibiting MSH cells are those of May assist in
hormone (PIH Stimulates melanin production in skin in response to the renal tubules, promoting
which is UV light exposure causing water maternal-child
actually MSH with oestrogen = darker skin pigmentation during reabsorption bonding
dopamine) pregnancy especially around the areolas and labia
 Hypopituitarism
Causes: Clinically (those of deficient hormones):
Compression of the
gland by an FSH & LH: amenorrhoea, oligomenorrhoea, infertility, loss of libido, loss of
adenoma or Ca sexual function, osteoporosis
Infection e.g. GH: decrease in muscle mass, central obesity, growth retardation
meningitis, ACTH: leads to adrenal insufficiency, failure to thrive, delayed puberty,
encephalitis features similar to Addison’s disease
Sheehan’s syndrome TSH: features of hypothyroidism
Brain injury Prolactin: inability to breastfeed
Congenital ADH: features of diabetes insipidus
hypoplasia Oxytocin: probably stunted social development

Investigations: Management:
Blood tests for the respective hormones Correct hormonal imbalance
(Note: basal levels, when samples were Addressing the underlying
taken (e.g. morning) cause
Addressing the clinical
If any stimulation
presentation
No direct way to measure ADH
 Pituitary adenoma
Causes: Clinically:
Tumours of the pituitary
gland (most are benign) GH: Increased bone growth
Most are Prolactin: Unexpected lactation (in men and women)
macroadenomas (> Compression of the optic nerve at the optic chiasma: bitemporal
10mm) hemianopia
Headache
Features of raised intracranial pressure (RIP)
Investigations:
Blood tests (hormones)
CT or MRI of the head

Treatment:
Medical and/or surgical
intervention depending
on the type of tumour
 Hyperprolactinaemia
Causes: Clinically:
Compression of the pituitary
stalk (e.g. craniopharyngioma) Amenorrhoea
Prolactinoma Menorrhagia
Drugs that block the effects of Galactorrhoea in non-pregnant women and in men
dopamine at the pituitary stalk In men: features of hypogonadism
(e.g. phenothiazines) Headache
(Dopamine supresses prolactin
secretion) Treatment:
No treatment in
Excess prolactin inhibits mild cases
secretion GnRH which inhibits Dopamine
FSH and LH = decreased sex agonist (e.g.
hormone production cabergoline and
(hypogonadism) bromocriptine)
Occasionally
Investigations: radiotherapy or
Blood test (prolactin) (elevated)
surgery
MRI (tumour)
 Acromegaly and gigantism
Causes: Clinically:
Gigantism: Severe headaches
Excess growth and Large hands, feet, nose, lips, ears
height before closure Thick skin
of the epiphyseal Deep voice
plates Frontal bossing
Prognathism
Acromegaly: Macroglossia
Excess growth Increased sweating
following closure of Spinal stenosis
the epiphyseal Cranial nerve palsies
plates Carpal tunnel syndrome
Most common cause
is a pituitary
adenoma Investigations:
GH suppression test following oral
Treatment: glucose intake
Surgery MRI
Radiotherapy
Medical intervention
 Craniopharyngioma
Cause: Treatment:
Tumour of the pituitary Surgery
gland derived from Radiotherapy
embryonic tissue

Clinically:
Bitemporal hemianopia
Headache
Excessive sleepiness
Diabetes insipidus
(resistance to ADH)
Polydipsia
Stunted growth (GH
insufficiency)
Fatigue and low BP (low
ACTH)
 Diabetes insipidus
Cause: Clinically:

Deficiency of ADH (vasopressin) Excessive thirst

Central: no ADH production
(injury to hypothalamus or
pituitary gland; brain tumour)
Nephrogenic: kidneys do not
respond to ADH
Dipsogenic: damage to
hypothalamic thirst mechanism
= excess fluid intake
Gestational DI: only during
pregnancy (pregnant women
produce vasopressinase in the
placenta which breaks down
ADH)
Passing large volumes of urine
frequently
Possible hypokalaemia, dehydration
and seizures
Investigations:
Blood glucose
U & E (high sodium, low K+)
Desmopressin test
MRI
Medical management of the condition
Prevent dehydration
 How to study for this section?
 Know the production and functions of the pituitary hormones
 All slide notes on pituitary hormone disease must be supplemented from
the prescribed text references (see study guide) which are testable and
examinable
 Know how to recognise the clinical features of the conditions covered here
 Know what tests (laboratory and radiographic) to order and how to
interpret these
 A good video on pituitary hormones
https://www.youtube.com/watch?v=Uzg0LKPcaGQ