Disorders of the

Hypothalamus &
Pituitary Gland

Advanced Pathophysiology
Hypothalamus &
Pituitary Gland
 Make hormones
 Connected by neurons and blood
vessels
 Hypothalamus receives input from
the body  sends releasing
hormones to the pituitary 
pituitary sends hormones to target
endocrine glands
Hormonal
Regulation by
Hypothalamus
 Hypothalamus sends releasing
hormones to anterior pituitary gland
 Posterior pituitary relies on feedback
from the body
 Pituitary gland sends hormones to
endocrine glands throughout the body
 Based on negative-feedback mechanism
Hypothalamus Hormones: Anterior Pituitary
 Stimulatory hormones: • Inhibitory hormones:
• Growth hormone inhibiting hormone (GHIH) aka
 Thyrotropin releasing hormone (TRH)
somatostatin
 Corticotropin releasing hormone (CTH) • Prolactin inhibiting factor (PIH) aka dopamine
 Gonadotropin releasing hormone (GnRH)
 Growth hormone releasing hormone (GHRH)
Stimulatory Hormones
Hypothalamus Pituitary Endocrine Gland Hormones
Thyrotropin-releasing Thyroid stimulating Thyroid Gland T3, T4
hormone (TRH) hormone (TSH)
Corticotropin-releasing Adrenocorticotropic Adrenal Glands Cortisol
hormone (CTH) hormone (ACTH)
Gonadotropin-releasing Gonadotropins: Follicle- Gonads (ovaries & testes) Ovum, sperm
hormone (GnRH) stimulating hormone Estrogen, progesterone,
(FSH) & luteinizing testosterone
hormone (LH)
Growth Hormone- Growth Hormone released into bloodstream - acts on most cells in body (long
releasing hormone bones & tissue)
(GHRH)
Inhibitory Hormones
Growth Hormone Inhibiting Hormone (GHIH)
 Also called somatostatin
 Also produced by the GI tract (pancreas)
 When secreted, signals the anterior pituitary
to decrease secretion of growth hormone
(GH)
Prolactin-Inhibiting Factor (PIH)
 Prolactin - needed for breastfeeding
 When not breastfeeding, hypothalamus
continuously secretes PIH
 Breastfeeding newborn  signals
hypothalamus to stop producing PIH
 Allows anterior pituitary to secrete prolactin
 Breastmilk production
Hypothalamus Hormones: Posterior Pituitary
Anti-diuretic Hormone (ADH) Oxytocin
 Also known as vasopressin  Levels are normally low
 Released in response to ↑ blood osmolarity  Released during childbirth and
or ↓ blood volume breastfeeding
 Signals body to:  Signals body to:
 Retain/conserve water  Dilate the cervix
 Vasoconstrict  Contract the uterus
 Release milk from breasts
Pituitary Adenoma
 Tumors originating from hormone-
producing cells of the anterior pituitary
 Cell types:
 Somatotrophs: GH
 Corticotrophs: ACTH  cortisol
 Thryotrophs: TSH
 Gonadotrophs: LH & FSH
 Forms when cell mutates, becomes
neoplastic, proliferates  forms tumor
 Do not metastasize
 Can compress surrounding structures:
 Meninges
 Optic nerve
 Other pituitary cells
Pituitary Adenoma
 Functional: secrete hormones  1. Prolactinomas:
 Classified according to cell and hormone type  Secrete prolactin
 Non-functional: do not secrete hormones  Symptoms:
 Women: amenorrhea, galactorrhea
 Men: ↓ libido, gynecomastia
Pituitary Adenoma
2. Growth-hormone secreting adenomas:
 Arise from somatotrophs
 Secrete growth hormone
 Symptoms:
 Gigantism: children (epiphyseal plates not fused)
 Acromegaly: adults; skull, hands, feet enlarge
 Enlargement of visceral organs (heart)  heart
failure
Pituitary Adenoma
3. Adrenocorticotropic hormone (ACTH) -
secreting adenoma:
 Results in excess cortisol
 Symptoms: (Cushing disease)
 Round face
 Buffalo hump
 Truncal obesity
Pituitary Adenoma Diagnosis & Treatment
 Diagnosis:
 Hormone levels in blood
 MRI of brain
 Treatment:
 Dependent on type and size
 Prolactinomas: medications
 Somatotrophs/corticotrophs: surgical removal
 Non-functioning: dependent on size/compression
Alterations in Vasopressin Secretion
 Osmoreceptors within the hypothalamus detect osmolality of blood
 Osmolality = concentration of particles (glucose, sodium, blood urea nitrogen)
 Normal range = 285 - 295 mOsm/kg
 Dehydration  higher concentration of particles (↑ blood osm)  detected in hypothalamus
(osmoreceptors)
 Signals sent to brain (thirst)  drinking water will re-balance osm
 Antidiuretic hormone (ADH)/Vasopressin released  acts on kidneys to retain water, vasoconstricts
 Normal urine osm = 300-900 mOsm/kg
 Process can be disrupted by stroke, hemorrhage, trauma, brain surgery, paraneoplastic syndromes
(SIADH)
Alterations in Vasopressin Secretion
DI
 Central DI (r/t hypothalamus/pit)
 Nephrogenic DI: kidneys resistant to ADH/vasopressin
 ↓ or no ADH/vasopressin
 Kidneys are not signaled to retain H2O
 Symptoms:
 Dumping of free water (polyuria)
 Thirst (polydipsia)
 Blood levels high: ↑ blood osm, Na
 Urine levels low: ↓ urine osm, specific gravity < 1.005
SIADH
 ↑ ADH/vasopressin
 Kidneys retain water  high blood volume (dilute) inhibits
release of aldosterone  sodium leaves the body (via kidneys)
 Symptoms:
 Blood levels low: ↓ blood osm, Na
 Urine levels high: ↑ urine osm, Na
 Symptoms of Dehydration (h/a, n/v) d/t hyponatremia
 No peripheral edema
 Swelling of neurons (confusion, hallucinations)
 Seizures, coma, death
Questions?