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Anatomy
Histology
Physiology
Diseases of pituitary gland
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
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
VASOPRESSIN
OXYTOCIN
hypopituitarism
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
Clinical feature
cold intolerance
dry skin,loss of hair
mental dullness
constipation
increase in wt
bradycardia,slow reflexes
hoarseness, puffiness of the face
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
Hypopituitarism 3
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
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
ACTH
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
Frequency
Prl secreting
26%
nonfunctioning
23%
ACTH secreting
15%
GH-secreting
14%
plurihormonal
12%
LH or FSH secreting
8%
TSH-secreting
1%
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)