Pituitary Disorders Flashcards
What are the main disorders affecting the pituitary gland
Hypopituitarism underproduction of any of the ant. pituitary hormones e.g. Growth Hormone Deficiency leading Childhood Dwarfism, Panhypopituitarism with their various causes and clinical manifestation
• Hyperpituitarism (most commonly pituitary adenoma) overproduction of hormones giving rise to pituitary disorders e.g. Childhood Gigantism, Acromegally
•The importance of laboratory diagnosis of pituitary disorders e.g. CAPFT
What are the hormones of the anterior pituitary gland
Posterior Pituitary Anti-Diuretic Hormone (ADH) Oxytocin
•Anterior Pituitary Adrenocorticotrophic Hormone (ACTH) Thyroid-Stimulating Hormone (TSH) Luteinising Hormone (LH) Follicle-Stimulating Hormone (FSH) Prolactin (PRL) Growth Hormone (GH) Melanocyte-Stimulating Hormone (MSH)
What is pituitary dwarfism in childhood
The lack of growth hormone in childhood results in dwarfism
What are some causes of pituitary dwarfism
Idiopathic(i.e. the cause of which is not really known)
•Secondary to tumours in and around the pituitary e.g. craniopharyngioma
•In the idiopathic type, shortness of stature first noticed at the age of 2 to 3 years. The body proportions are normal
•There is usually delay in tooth eruption and bone show retarded growth. As years go by, height remains shorter even when compared to bone age, more so to chronological age
•The facial features are immature. Muscle bulk is below normal
•There is also sexual infantilism(underdevelopment of sex organs with absence of 20 sex cx’s
What is panhypopituitarism in adult life
The syndrome of panhypopituitarism is often due to atrophy or degeneration of the anterior pituitary and is also known as Simmond’s disease. In some instances the cause of the anterior pituitary involvement may be due to;
•Granulomatous lesions
•Invasion of tumour
•Surgery or radiation
The resulting lack of trophic hormone e.g. gonadotropins, corticotropin etc. become manifest in due course
What are the clinical manifestations of panhypopituitarism in adult life
Gradual loss of 20 sex CX’s
•Loss of pubic auxiliary hair
•Genital hypoplasia
•Secondary amenorrhoea
•Sensitivity to cold
•Absence of sweating, depigmentation with pallor of skin
•Poor tolerance of infection, tendency to coma
What are some causes of pituitary hypofunction
Tumour
•Infarction
•Trauma
•Congenital malformation
•Infection
•Hypothalamic disorder
What is pituitary gigantism
Gigantism results from excessive production of growth hormone in the prepubertal period and this is usually associated with eosinophilic adenoma of the pituitary, CAH, Hyperthyroidism or inherited disorders such as Klinefelter’s syndrome
•Tallness can be to the extent of 7 to 9 feet usually with postural defects. Normal pubertal growth is absent. Hands and feet may be very large
What is acromegaly
Acromegally results from over-function of the pituitary hormones especially in the production of somatotropin in adult life. The most likely cause is a pituitary adenoma
The clinical manifestation are:
•Overgrowth of endochondral bone and skeletal changes become most marked in acral portions
•Skin is thickened, coarse and greasy. Increase in folds especially on the forehead gives a bull-dog like appearance
•Hands and feet become spatulate in appearance
•Body hair may increase and result in mild hirsutism
•Protruding jaw (prognathism)
•Larynx changes result in alteration which become deep and gruffly
•Sweating
•Impaired glucose tolerance
• or DM, Goitre, hypertension, adrenal hyperfunction, gonadal hypofunction
•Headaches, visual defects due to pressure defects
How do you diagnose acromegaly
X-ray of the pituitary fossa
•Assessment of heel-pad thickness and assay of GH(the basal serum are elevated)
•GTT- A normal person will suppress GH in response to glucose load (expected metabolic response) The acromegallic patient’s GH levels do not suppress in response to a high glucose load
•IGF1- Elevated levels of IGF1 in serum confirm
the diagnosis of acromegally
5. The Triple function test
What is the triple function test
This involves the silmultaneous administration of: Insulin(stimulates ACTH, GH and Prolactin), TRH(stimulates TSH and Prolactin) and GnRH(stimulates FSH and LH).
•Measure baseline and at time 30,60, 90, and 120 of all hormones.
•Results- Normal Response, Cortisol- x5 fold increase,
•GHx50 Fold increase, LH x 20 fold, FSH x 5fold, TSH x20 fold.
• Draw Graphs
What is the anatomy of the pituitary gland
The pituitary gland (hypophysis) is located at the base of
turcica (Turkish saddle). The gland is small-1 cm or less in height and width -and weighs approximately 500 mg.
It is anatomically divided into the anterior (adenohypophysis) and the posterior (neurohypophysis) lobes. A third lobe (the intermediate lobe is present in most vertebrates and in the human fetus; this lobe is rudimentary in the adult human.
Arterial blood reaches the pituitary gland via the superior hypophyseal artery. Venous blood, carryingneurosecretoryhor-mones from the hypothalamus, reaches the pituitary through the hypothalamic hypophyseal portal system. These hypotha lamic factors stimulate or inhibit the release of hormones from the adenohypophysis.
The pituitary gland regulates the endocrine system by integrating chemical signals from the brain with regulatory feedback from the concentration of hormones in the circulation to stimulate intermittent hormone release from target endocrine glands.’ Historically, because the Dituitary gland is intimatelv involved in the regulation of (1) growth, (2) development, (3) thyroid function, (4) adrenal function, (5) gonadal function, and (6) water and salt homeostasis, it has been called the
“master endocrine organ.»,I
The adenohypophysis secretes (I) growth hormone (GH),
(2) prolactin (PRL), (3) thyrotropin (TSH), (4) adrenocor-ticotropin (ACTH), (5) follicle-stimulating hormone (FSH), and (6) luteinizing hormone (LH), all of which are proteins or peptides (Table 39-1). The adenohypophysis also secretes B-lipotropin (B-LPH) and a number of smaller peptides of undetermined significance.’ Vasopressin (ADH) and oxytocin are produced in the hypothalamus and are carried through the neurohypophyseal nerve axons to the neurohypophysis. Thus the neurohypophysis is not a discrete endocrine organ, but rather functions as a reservoir for these two hormones.
Of the six major hormones from the adenohypophysis, GH and PRL act primarily on diffuse target tissue, with TSH, ACTH, and the gonadotropins (LH and FSH) acting primarily on specific target endocrine glands such as the thyroid gland, adrenal cortex, and gonads, respectively. These peptide hormones originating from the pituitary and related hormones elaborated by the placenta during pregnancy have been classified based on their molecular structure and biochemical evolution.
How is the hypothalamus regulated
Secretion of hormones from the anterior lobe of the pituitary gland is controlled by the hypothalamus, which manufactures small peptide hormones known as releasing or inhibitory factors (Figure 39-2). Several have been characterized includ-ing: (1) corticotropin-releasing hormone (CRH),’ (2) thyrotcopin-releasing hormone (TRH), (3) GH-releasing hormone (GH-RH), (4) somatostatin (also called somatotropin release-inhibiting factor (SRIF]), (5) gonadotropin-releasing hormone (Gn-RH, also called luteinizing hormone-releasing hormone), and (6) PRL-inhibiting factor (PIF) that is actually the neurotransmitter dopamine. In addition, Gn-RH stimulates the secretion of FSH and LH. However, a separate and distinct releasing factor for FSH has not yet been established, although negative feedback control of this gonadotropin is affected by inhibin, a peptide of gonadal origin.
CRH, GH-RH, Gn-RH, and TRH have all been used to test for pituitary hormone reserve. In addition, pulsatile On-RH administration is used to initiate puberty and to induce ovulation or spermatogenesis.Alternately, Gn-RH antagonists that inhibit the action of endogenous Gn-RH are used to treat patients with (1) precocious puberty, (2) endometriosis, (3) uterine fibroids, and (4) prostate carcinoma. GH-RH is yet another hypothalamic peptide that is used to treat patients with GH deficiency caused by hypothalamic disease.
The neurons that elaborate hypophysiotropic hormones are themselves influenced by hypothalamic neurotransmitters, such as (1) dopamine, (2) norepinephrine, (3) serotonin, (4) acetylcholine, and (5) endorphins. These neurotransmitters also modify the secretory activity of anterior pituitary hormones (Table 39-2). Indeed basal and episodic secretion, diurnal rhythm, and nocturnal release of pituitary hormones are all considered to be secondary to central nervous system events that are mediated through hypothalamic hormones.
In addition to higher center regulation of the hypothalamic-pituitary axis by classic neurotransmitters, chemical mediators released by inflammatory cells (cytokines)+ have been discovered that participate in altering the control mechanisms associated with the neuroendocrine axis. For example, modulation of the feedback loop between the hypothalamic-pituitary-adrenal axis by cytokines, such as interleukin 1 (IL-1) and IL-6, released as a result of infection or stress has been shown to diminish the immune system.
Control of the functional relationship between the pituitary gland and its target organs is based on the principle of feedback control, which is primarily negative between the blood concentration of circulating hormones and the pituitary gland and hypothalamus (Figure 39-2). The effect of negative feedback is typically opposite to that of the initial stimulus. For example, an elevated concentration of cortisol (initial stimulus) reduces the synthesis and release of CRH, resulting in decreased secretion of ACTH and, ultimately, reduced secretion of cortisol (final response). Such feedback control maintains an optimal concentration of hormone in the blood under a fluctuating variety of circumstances.
What is growth hormone and IGFs
The most abundant hormone produced by the adenohypophy-sis is GH. Insulin-like growth factors (IGFs) I and I are polypeptides synthesized and release in response to GH that have considerable amino acid sequence and functional similarity to insulin.
How is the secretion of growth hormone regulated
The release of G H is thought to be controlled by hypothalamic
GH-RH and SRIF. The former stimulates GH release and the latter inhibits G H release. SRIF is also found in the delta cells of the pancreatic islets and in many other sites in the digestive tract. It has important effects on gastrointestinal hormone secretion and causes inhibition of insulin and glucagon release.
The hypothalamic influence on G H release appears to be primarily inhibitory through the action of SRIF (Figure 39-3).
Release of these two hypothalamic factors is in turn influenced by higher centers of the brain. Thus different stimuli, such as
(1) exercise, (2) physical and emotional stress, (3) hypoglyce-mia, (4) increased circulating amino acid concentrations (par-ticularly arginine), and (5) hormones, such as testosterone, estrogens, and thyroxine, evoke an increase in GH secretion (see Figure 39-3). In the presence of abnormally high concentrations of glucocorticoids, GH secretion is suppressed. Other hypothalamic hormones, such as TH and Gn-RH, do not affect GH release in healthy subjects, but may provoke GH release in patients with acromegaly.
Isolation and discovery of ghrelin support another control system for G H release in addition to GH-RH and SRIF. Ghrelin is a small 28-amino acid peptide released from neuroendocrine cells in the gastric mucosa that binds to the G H secretagogue receptor to induce the secretion of both GH-RH and G H itself.
Ghrelin also induces food intake and the development of obesity.