Pituitary Disorders

Dr. Othman Al-Shboul Department of Physiology

The Pituitary gland (Hypophysis)

Small gland ( 1cm diameter; 0.5 to 1 gm weight). Lies in sella turcica, a bony cavity at the base of the brain. Connected to the hypothalamus by the pituitary stalk (or infundibulum).

Anatomy of the pituitary gland

Two Distinct Parts: * The Anterior lobe (adenohypophysis) * The Posterior lobe (neurohypophysis)
glandular epithelial tissue

nervous tissue

The hypothalamus is a collecting center for information

o Receives signals from many sources in the nervous system

o Hypothalamus in turn controls the secretion the pituitary hormones

Almost all secretions by the pituitary are controlled by either hormonal or neural signals from hypothalamus
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Hypothalamic-pituitary Relationship

Hypothalamus-anterior pituitary vascular link Factors (or hormones) released from hypothalamus reach anterior pituitary via circulation

Hypothalamus-posterior pituitary neural link

Axons from hypothalamus extend into posterior pituitary

Anterior Pituitary Hormones

Hypothalamus Controls Anterior Pituitary Secretion

Secretion by the anterior pituitary is controlled by hypothalamic hormones transported through hypothalamic-hypophysial portal vessels

Hypothalamus Controls Anterior Pituitary Secretion

Hypothalamic hormones are either releasing or inhibitory hormones (or factors)

Hypothalamic hormones or factors

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Growth Hormone (GH)

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Growth Hormone (GH)

Also called somatotropic hormone or somatotropin. Small peptide hormone that contains 191 amino acids in a single chain, MW 22,005Da. Has great effect in growth & metabolism. In contrast to other hormones, it does not function through a target gland but exerts its effects directly on all or almost all tissues of the body.
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i.

Growth Effects of GH

o Growth-promoting actions on:

Soft tissues (increases the number and size of cells) Skeleton 1. 2. increase in bone thickness increase in bone length

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i.

Growth Effects of GH

o Growth hormone exerts much of its effect through intermediate substances called "Somatomedins, another name: insulin-like growth factors (IGF) o The major source of circulating IGF is the liver, also locally by most other tissues

Growth

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Control of Growth Hormone Secretion

Hypothalamus

Ant. Pituitary

Liver

Hypothalamic factors: GHRH: growth hormone-releasing hormone GHIH or somatostatin: growth hormone inhibitory hormone

Target tissues
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ii.

Metabolic Effects of Growth hormone

rate of protein synthesis in all cells.

1. Protein metabolism: Anabolic,

2. Fat metabolism: Catabolic,

mobilization of FFAs from adipose tissue stores to provide energy.

3. CHO metabolism: Hyperglycemic,

rate of glucose utilization throughout the body, & glucose uptake by cells.

GH enhances body protein, uses up fat stores, & conserves carbohydrates

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Abnormalities of Growth Hormone Secretion

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Panhypopituitarism

secretion of all anterior pituitary hormones

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Panhypopituitarism in children

Causes: ? congenital from birth Signs & symptoms: 1. Dwarfism (stunted growth); the physical parts of the body develop
in appropriate proportion to one another, but the rate of development is greatly decreased

In other words: abnormally short stature with normal body proportions.

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Gary Parker 2011 / GaryParker.com 2011

Panhypopituitarism in children
2. Sexual immaturity (child will not pass through puberty); due to gonadotropic hormones (LH & FSH).
o In one third of such dwarfs, however, only growth hormone is deficient; these persons do mature sexually and occasionally reproduce o The African pygmy and the Lvi-Lorain dwarf, the rate of growth hormone secretion is normal or high, but there is a hereditary inability to form somatomedin C

Treatment: human growth hormone

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Panhypopituitarism in adults
ii. in adults:
? occur suddenly, or slowly at any time during life. Causes: craniopharyngiomas or chromophobe tumors, thrombosis of the pituitary blood vessels Effects:

Hypothyroidism, Depressed production of glucocorticoids by the adrenal glands, and Suppressed secretion of the gonadotropic hormones
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 Signs and Symptoms: lethargic person (from lack of thyroid hormones) who is gaining weight (because of lack of fat mobilization by growth, adrenocorticotropic, adrenocortical, and thyroid hormones) and has lost all sexual functions Treatment: Except for the abnormal sexual functions, the patient can usually be treated satisfactorily by administering adrenocortical and thyroid hormones.
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 GH secretion
Causes:
activity of the acidophilic GH- producing cells anterior pituitary gland. Acidophilic tumors in the gland.

Hypothalamus

Anterior Pituitary
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 GH secretion in children
Gigantism
o All body tissues grow rapidly, including bones. o Height as it occurs before epiphyseal fusion of long bones with their shafts. o Hyperglycemia (diabetes), the beta cells of the islets of Langerhans in the pancreas are prone to degenerate because they become overactive owing to the hyperglycemia. o Panhypopituitarism eventually develops if they remain untreated

o Treatment: Microsurgical removal of pituitary gland tumor; or irradiation of

the gland.
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 GH secretion in adults
Acromegaly:
After the epiphyses of the long bones have fused with the shafts-the person cannot grow taller, but the bones can become thicker and the soft tissues can continue to grow o Enlargement of bones of hands & feet. o Enlargement of membranous bones including cranium, nose, forehead bones, supraorbital ridges. o Protrusion of lower jaw. o Hunched back (kyphosis) (enlargement of vertebrae).

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Growth Hormone and Aging

As one ages, the average plasma concentration of growth hormone in a normal person gradually decreases

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Growth Hormone and Aging

GH secretion accelerates aging features The aged appearance seems to result mainly from decreased protein deposition in most tissues of the body and increased fat deposition in its place.

Effects: increased wrinkling of the skin. diminished rates of function of some of the organs. diminished muscle mass and strength. Growth hormone therapy in older people ???
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Posterior Pituitary Hormones

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Hypothalamus & Posterior Pituitary

Posterior pituitary gland does not synthesize hormones

Posterior pituitary gland stores & releases hormones that are generated & secreted from hypothalamus
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Posterior Pituitary Hormones

1. OXYTOCIN 2. VASOPRESSIN (antidiuretic hormone, ADH)

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Oxytocin
Stimulates contraction of the uterine smooth muscle to help expel the infant during childbirth

Promotes ejection of the milk from the mammary glands (breasts) during breast-feeding

Oxytocin is concerned with releasing or ejection of milk, while prolactin (from the anterior pituitary) is concerned with synthesis & production of milk.

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Vasopressin (antidiuretic hormone, ADH)

Enhances the retention of H2O by the kidneys (an antidiuretic effect), more important Causes contraction of arteriolar smooth muscle (a vessel pressor effect, increasing resistance)

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Regulation of ADH Production

1. arterial blood pressure, due to blood volume ADH. 2. in plasma osmolarity, as in dehydration, ADH. 3. Age: ADH secretion water retention & hyponatremia.

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Abnormalities of ADH release

i.

Hyposecretion
diabetes insipidus

ii. Hypersecretion SIDAH

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Abnormalities of ADH release Hyposecretion

Lack of ADH Diabetes Insipidus (DI)

2 types of DI:
i. Neurogenic (central, or cranial) ii. Nephrogenic

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Diabetes insipidus
i. Neurogenic (central, or cranial):
Problem in Hypothalamus or Post. pituitary gland; Causes: idiopathic, infections, autoimmune, trauma.
Treatment: ADH.

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Diabetes insipidus
ii. Nephrogenic
Resistance of V2 receptors in collecting ducts of the kidneys. Primary (familial), or secondary (infection) Treatment: preventive (avoiding dehydration), but not ADH

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Diabetes insipidus
Symptoms:
Polyurea 20 L/day (N 1.5 L/d), (diluted urine) plasma osmolarity (hypernatremic dehydration, 170 mEq/L) Polydepsia and thirst Dehydration; dry mouth, muscle weakness, hypotension Electrolyte imbalance (hypernatremia& hyperchloremia); symptoms such as headache, fatigue, irritability and muscle pains Seizure secondary to hypernatremia can happen
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Abnormalities of ADH release Hypersecretion

Syndrome of inappropriate antidiuretic hormone (SIADH)
Excessive release of antidiuretic hormone Dilutional hyponatremia (below 120mEq/L) Cerebral edema causing: headache, nausea, vomiting, and confusion Severe hyponatremia may cause convulsions or coma Most common cause is the secretion of ectopic ADH by malignant neoplasms (particularly small-cell carcinomas of the lung)
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The END
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