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Pituitary gland

Anatomy
Histology
Physiology
Diseases of pituitary gland

Anatomy of pituitary gland


Pituitary gland lies in the base of the skull in
a portion of sphenoid bone called s.t
It consist of tow lobe anterior lobe
(adenohypophysis),and posterior lobe
(neurohypophysis)
The size of the gland which the anterior lobe
consist 2/3 varies considerably
It measures 15X10X6 mml wt 500-900 mg
It may double in size during pregnancy

Location of the Pituitary

Sella turcica of the sphlenoid bone

Blood supply
Most richly vascularized of all mammalian
tissues,receiving 0.8 ml/min from portal
circulation.
It supply by middle inferior and superior
hypophysial arteries from the internal
carotid arteries

The Hypothalamic-Hypophyseal Portal System

2 capillary beds directly joined by blood vessels

Histology of the PG 1
Anterior pituitary cells were originally
classified as
Acidophils cells
Basophils cells
Chromophope cells

Histology of PG 2
Now with immunocytochemical and
electron microscopic techniques,classified
cells by their secretary products
Somatotrophs cells
a. GH secreting cells
b. Account about 50% of anterior P.G
c.
Acidophilic stained

Histology of PG 3
Lactotrophic
a. Prl secreting cells
b. acidophilic stained
c. 10-15% of anterior PG
Thyrotrophis
a. TSH secreting cells
b. basophilic cells
c. < 10% of anterior PG

Histology of PG 4
Corticotrophs
a. ACTH secretary cells
b. basophilic cells
c. 15-20% of anterior PG
Gonadotrophs
a. LH,FSH secretary cells
b. basophilic staining
c. 10-15% of anterior PG

Anterior pituitary hormone


GH
PRL
TSH
ACTH
LH
FSH

Posterior pituitary hormone

VASOPRESSIN

OXYTOCIN

hypopituitarism

Hypopituitrism is manifested by diminished or


absent secretion of one or more PH
The development of sign and symptom is often
slow and insidious
Hypo pit is either primary event caused by
destruction of APG or 2ndary resulting from
deficiency of hypothalamic SF
Treatment and prognosis depend on the extent of
hypofunction,the underlying cause and the
location of the lesion

Hypopituitarism
Is usually gradual and may have single
hormone deficiency or multiple hormone
GH deficiency
a. deficiency in children lead to short
stature
b. deficiency in adult lead to vague non
specific symptoms,fatigue decrease muscle
mass,loss of libido

Gonadotrophin H.D
(hypogonadism)
In women
a. before puberty primary amenorrhea and
failure of puberty development
b. after puberty 2ndary amenorrhea and
regression of 2ndary sexual characteristic
c. infertility

hypogonadism
In men
a. before puberty
failure of puberty development
b. after puberty
decrease libido or impotence
loss of 2ndary sexual characteristic
infertility

TSH deficiency lead to 2ndary


hypothyroidism

Clinical feature
cold intolerance
dry skin,loss of hair
mental dullness
constipation
increase in wt
bradycardia,slow reflexes
hoarseness, puffiness of the face

ACTH deficiency lead to 2ndary


adrenocortical insufficiency

Clinical feature
Weakness
Nausea and vomiting
Anorexia
Wt loss
Postural hypotension

Causes of hypopituitarism
Infarction
postpartum necrosis (Sheehan syndrome)
vascular disease
head trauma
Infections
tuberculosis , fungi
pyogenic , syphilis
toxoplasmosis

Hypopituitarism 2

Granulomas
Sarcoidosis
Histiocytosis
Autoimmune lymphocytic hypophysitis
Neoplasm's involving pituitary
Pituitary adenoma
Craniopharyngioma
Metastasis or or primary carcinoma (rare)

Hypopituitarism 3

Aneurysm of internal carotid artery


Hemochromatosis
Idiopathic or genetic
deficient production of pituitary hormone
synthesis of abnormal hormone
Iatrogenic
stalk section
radiation
hypophysectomy

Hypopituitarism 3

Primary hypothalamic disorders


tumor (craniopharyngioma)
granulomas (histiocytosis x)
genetic or idiopathic releasing H.D
head trauma
structural anomalies of hypothalamus

Diagnosis of PD by PH
stimulation test
Hormone
GH

Test agent
I H test 0.1 uint
L-dopa 250-500
Arginine 0.5 gm
Clonidine test
Glucagon test

N response
Serum GH >
10ng/ml at any
time

Prl

TRH 100-500
metoclopramide

Doubling of
baseline

TSH

TRH 500 ng

Peak value >5

Pituitary stimulation test 2


hormone
LH @FSH

Test agent
GnRH 100mmg
IV

N response
Doubling of the
base line
LH@FSH

ACTH

I H TEST
(short ACTH
stimulation test
cosyntropin test)
Metyrapone test
2-3 gm po

Peak serum
cortisol >20
ng/dl
Serum 11deoxycortisol
level >8 ng/dl

Treatment of hypopituitrism
Deficient
hormone

Therapy

TSH

L-thyroxin .05-.02 mg/d PO

ACTH

Hydrocortisone 20 mg/ m-10mg /e

LH@FSH

Men :testosterone
Women :cyclic estrogen and progesterone
For fertility HCG,HMG

GH

0.05 mg/kg

Pituitary tumors
Nearly always benign account for 10% of
intracranial neoplasm
Pituitary microaadenoma is intrasellar
adenoma less than 1 cm in diameter
Pituitary macroadenoma are those larger
than 1 cm in diameter

Type of pituitary tumors


Type of tumor

Frequency

Prl secreting

26%

nonfunctioning

23%

ACTH secreting

15%

GH-secreting

14%

plurihormonal

12%

LH or FSH secreting

8%

TSH-secreting

1%

Clinical presentation of pituitary tumours


Hormone hypersecretion
Space occupying lesion
Headaches
Visual loss (field defect)

Hormone deficiency states


Interference with surrounding
normal pituitary

Tumours of the anterior pituitary can


cause syndromes of hormone excess
GH

Acromegaly

ACTH

Cushings disease

TSH

Secondary thyrotoxicosis

LH/FSH

(Non-functioning pituitary
tumour)

PRL

Prolactinoma

Treatment of P.T
Surgical
Transfrontal or transsphenoidal
Radiological
Conventional irradiation,heavy particle I
Medical
Dopamine agonist (bromocriptin)
Somastatin analog (octreotide)

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