Dr.

Farrukh Majeed
Department of Physiology
Endocrinology lecture
Anterior Pituitary gland
 Learning objectives
At the end of this lecture student should be able
to:
• Enlist anterior pituitary hormones and discuss
regulation and function of each hormone.
• Discuss pathophysiology of Pan
hypopituitarism, Sheehan’s syndrome and
hyperpituatrism
 Case scenario:
• A 42-year-old obese woman with type 2 diabetes, diabetic retinopathy,
hyper­tension, and hirsutism (male pattern of hair growth in female)
presents to discuss an elevated prolactin level of 144.8 ng/mL (normal
range, 4.8 to 23.3 ng/mL) found by her Ob-Gyn two months ago.
• She complained of galactorrhea (milky nipple discharge unrelated to
the normal milk production of breast-feeding) and no menses for one
year. A repeated prolactin level was also elevated, at 109 ng/mL.
• Pituitary MRI
with microadenoma.” 
Adreno Cortico Trophic Hormone (ACTH)
Gonadotropins: Follicle stimulating hormone
and luteinizing hormone
Thyroid stimulating hormone (TSH)
 Disorders Of Pituitary Gland
• Hypopituitarism: If there is decreased secretion of one specific pituitary
hormone, the condition is known as selective hypopituitarism.
– Pituitary dwarfism- GH
– adrenal insufficiency (hypoadrenalism)- ACTH
– Secondary hypothyroidism TSH

– If there is decreased secretion of most or all pituitary hormones, the

term panhypopituitarism (pan meaning "all")
– Simmond’s disease - all pituatry hormones

• Hyperpituitarism: with the increased function

– Acromegaly - GH
– Cushing disease - ACTH
– Hyperprolactinaemia - prolactin
 Pan-Hypopituitarism
• loss of all hormones released by the anterior pituitary i.e.
“complete pituitary failure”
• Clinical features: produced by deficiency of all hormones.
• Causes:
– Ischemia or infarction
– Iatrogenic: radition, surgery
– Tumor
– Infection: meningitis, tuberculosis
– Congenital: kallmann;s syndrome
– autoimmune
 Simmond’s Disease

• Decrease levels of all pituitary hormones due

to necrosis
– Sheehan’s syndrome: Necrosis of pituitary gland
due to post partum haemorrhage.
– Labs: all pituitary hormones decrease.
– Treatment: hormone replacement
 Hyperpituitarism
• Due to the primary hypersecretion of pituitary
hormones
– Cause: pituitary adenoma.
– Symptoms:
• Hirsutism
• Visual field loss or double vision
• Lethargy
• Headache
• Muscle weakness
 Case scenario:
• A 42-year-old obese woman with type 2 diabetes, diabetic retinopathy,
hyper­tension, and hirsutism (male pattern of hair growth in female)
presents to discuss an elevated prolactin level of 144.8 ng/mL (normal
range, 4.8 to 23.3 ng/mL) found by her Ob-Gyn two months ago.
• She complained of galactorrhea (milky nipple discharge unrelated to
the normal milk production of breast-feeding) and no menses for one
year. A repeat prolactin level was also elevated, at 109 ng/mL.
• Pituitary MRI
with microadenoma.” 
 Hyperprolactinemia
Causes:
• pregnancy,
• nursing,
• physiologic stress,
• estrogen use,
• polycystic ovary syndrome,
• hypothyroidism, and
• chronic renal or hepatic failure.
• Head trauma,
• use of certain medications (verapamil, neuroleptics,
antipsychotics, and antidepressants)
Signs and symptoms:
• effect of excess hormone secretion (ie, galactorrhea
and amenorrhea) or
• local compression (ie, new-onset or persistent
headache, dizziness, visual changes, and vision loss)
Treatment:
• dopamine agonist
• Irradiation
• surgery
 Reading material
• Guyton 11th edition, chapter # 75, page no,
918-921