Lect 1-pituitary insufficiency

Pituitary Gland Diseases SMS ????? Dr. Mohanad R. Alwan

Pituitary Gland ,[object Object],[object Object],[object Object],[object Object],[object Object]

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Pituitary Development ,[object Object],[object Object],[object Object]

Hypothalamic ,[object Object],[object Object]

Hypothalamic releasing hormones Hypothalamic releasing hormone Effect on pituitary Corticotropin releasing hormone (CRH) Stimulates ACTH secretion Thyrotropin releasing hormone (TRH) Stimulates TSH and Prolactin secretion Growth hormone releasing hormone (GHRH) Stimulates GH secretion Somatostatin Inhibits GH (and other hormone) secretion Gonadotropin releasing hormone (GnRH) a.k.a LHRH Stimulates LH and FSH secretion Prolactin releasing hormone (PRH) Stimulates PRL secretion Prolactin inhibiting hormone (dopamine) Inhibits PRL secretion

Hypothalamic -Pituitary communication

Anterior Pituitary ,[object Object]

Produces six major hormones: ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Anterior Pituitary Insufficiency

Etiology ,[object Object],[object Object]

Causes of hypopituitarism ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Developmental and Genetic Causes of Hypopituitarism ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Acquired Hypopituitarism ,[object Object],[object Object],[object Object],[object Object],[object Object]

ANTERIOR PITUITARY HYPOFUNCTION (hypopituitarism) ,[object Object],[object Object],[object Object],[object Object]

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Clinical features Hormone Features of deficiency GH Children: growth retardation Adults: ↓muscle bulk Tendency to hypoglycaemia. Prolactin Failure of lactation Gonadotrophins Children: delayed puberty Female: oligomenorrhoea, infertility,atrophy of breast & genitalia Male:Impotence,azoospermia,testicular atrophy Both sexes: LO libido,LO body hair ACTH Weight loss, hypotension, hypoglycaemia, decrease skin pigmentation TSH Weight gain, cold intolerence,fatique Vasopressin Thirst, polyuria

Posterior Pituitary hypofunction Causes ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Posterior Pituitary hypofunction Effects ,[object Object],[object Object]

PITUITARY HYPERFUNCTION (HYPERPITUITARISM) ,[object Object],[object Object],[object Object],[object Object],[object Object],Hyperpituitarism - excessive production of adenohypoph y s eal hormones

PITUITARY HYPERFUNCTION (HYPERPITUITARISM) Prolactin excess Hyperprolactinaemia GH excess Acromegaly/ gigantism ACTH excess Cushing’s disease TSH excess (rare) Secondary hyperthyroidism Gonadotrophin excess menstrual disorders and infertillity

Consequences: ,[object Object],[object Object],In men: impotency, decreased libido In women: amenorrhea, galactorrhea b) Excessive Secretion of somatotrophine (growth hormone )  acromegaly (in adults)  gigantism (in adolescents whose epiphyseal plates have not yet closed)

b)-continuing Pathomechanisms involved : ,[object Object],[object Object],- A totally unpredictable secretory pattern of GH occurs ,[object Object],[object Object],- C onnective tissue proliferation - B ony proliferation  characteristic appearance of acromegaly -  P hosphate reabsorbtion in renal tubules  hyperphosphatemia - I mpairement of carbohydrate tolerance -  M etabolic rate ,[object Object],[object Object],[object Object],In adult s :

c) Excessive Secretion of corticotrophin ( ACTH)  central form of Cushing syndrome (Cushing disease) Causes: micro- or macroadenomas of adenohypoph y sis, hypothalamic disorders Pathophysiology: C hronic hypercortisolism is the main disturbance of  ACTH Symptoms and signs: ,[object Object],[object Object],[object Object], glucose intolerance  DM type 2  polyuria: osmotic polyuria due to glycosuria

[object Object],[object Object],[object Object], in bone: - loss of protein matrix  osteoporosis -  blood calcium concentration  renal stones  in skin: - loss of collagen  thin, weakened integumentary tissues  purple striae; rupture of small vesels ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

[object Object], alteration of mental status - from irritability and depression up to schizophrenia ,[object Object],-  hair growth (especially facial hair) - acne - oligoamenorrhea - changes of the vois ,[object Object],[object Object]

Measurement of anterior pituitary hormones ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Treatment ,[object Object],[object Object]

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Lect 1-pituitary insufficiency

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Lect 1-pituitary insufficiency