It is important

1. •Shape Oval
•Weight 0.5-0.6g
•Location base of cranium, under
hypothalamus, (Sella turacica)
Anatomophysiology of
Pituitary gland

2. Anatomophysiology of Pituitary
gland
 Master gland
 Functionally secreted different hormones:
– Effect directly or
– Indirectly
 Effect on secretion of other gland
– Growth & organ maturity
– Function of different part of body

3. Anatomophysiology of Pituitary
gland
 It has tow parts:
1. Neurohypophase
 Effect on Kidney & Uterus
– Oxytocin
– Vasopressin
 Antidiuretic hormone (ADH)

4. Anatomophysiology of Pituitary
gland
2. Adenohypophase:
 Secrete different hormones effect on:
– Thyroid
– Adrenal
– Testes
– Ovaries

5. Anatomophysiology of Pituitary
gland
– Growth hormone
 Somatotropin = STH
– Essential effect of epiphyseal cartilage
 Increased during childhood Gigantism
 Increased after growth Acromegaly

6. Anatomophysiology of Pituitary
gland
 Prolactin or Mammotropin
 TSH Thyroid stimulating hormone
 ACTH (effect on growth & adrenal gland)
 FSH
 LH
 ICSH

7. Acromegaly
Definition:
Excess of growth hormone causes chronic
disease with progressive fatigue.
Over growth of soft tissues and bone tissue

8. Pathophysiology
 Almost all acromegaly pts has invisible
adenoma
 Tumors located along sella torsica
 Growth hormone level is due to tumor size
 If primary sign of acromegaly occur, either
the tumor is not too big we can Dx.

9. Etiology
 Increase hypothalamus (GRH) gonadotrpin
releasing hormone & Decrease
somatostatine
 Primary disease of pituitary gland or
hypophyse

10. Etiology
 Carcinomas secreted GRH rarely
 Pancreas tumor & CA of branches
– Secreted GRH
 Gangliocytoma of hypothalamus
– GRH or Somatostatine

11. Clinical finding
 Excess of GH causes:
– Chronic disease with progressive fatigue
– Over growth of soft tissue & bone
– Occur middle age
 Excess of GH in age before closeness of
Epiphase membrane

12. Markedly increased soft tissue bulk and
blunt fingers

15. Clinical finding
 Over growth of:
– Bones
– Soft tissues
– Hands & legs
– Large cranium
– Big tongue
– Extended dental space
(Proganthism)

16. Clinical finding
 Acromegaly pts are similar to each other
 But not similar to their family
 Harsh breathing sound (hollow sounding)
– Due to larynx & sinus hypertrophy
 Warm and wet hands
 Skin oily & hairy

17. Clinical finding
 Change appear
 Fatigue and tiredness
 Hyper metabolism
– Excess sweat
 Long sleep
 Neurological & muscular skeletal signs:
– Headache, numbness of extremities

18. Clinical finding
 Muscular weakness
 Joint pain
 Shoulder pain
 Knee pain
 Kyphosis
 HTN 1/3
– Due to ↓ rennin & aldosteron and ↑
plasma volume and sodium

19. Clinical finding
 Half of pts have LVH without HTN
 Either No history of heart disease due
to acromegly, but CHF will occur
 Amenorrhea
 Impotence
 Hirsutism
 Temporary depression after treatment

20. Clinical finding
 Kidney hypertrophy
 Hepatomegly
– Without dysfunction
 Goiter is common
 2.7% Hyperthyroidism
 Increase mortality:
– Death occur due to:
 CVS, Neuro vascular disorder & Resp. disease
 New treatment method decrease mortality

21. Lab exam
 Abnormal GTT 20-40%
 Diabetes mellitus 13-20%
 Insulin resistance 80%
 Due to ↑ Vit.D:
– ↑ Urine calcium
– 1/5 pts. Renal stone

22. Lab exam
 Hypercalcimia is due to primary
Hyperparathyroidism, not acromegaly
 Hyperprolactinemia in half of pts and causes:
– Glactorrhea
– Amenorrhea
– Decrease libido

23. Dx:
 Acromegaly pts after 9 year shows signs
 When pts is doubtful for acromegaly
 Previous photo should compare to new
 GH evaluation is not good method,
because maybe normally high specially in
female.

24. Dx:
 Standard test:
– Evaluation of GH 60min after 100g glucose orally
– >2ng/ml in male and
– >5ng/ml in female is diagnostic for acromegaly

25. Dx:
 If Lab exam is not supported
 Radiologic exam required
 90% pts cranium & sphenoidal
radiography is diagnostic.
 Cranial radiography shows:
– Increased bone density
– Big sinus (proganthism)
 CT and MRI size of tumor

26. Dx:
 Bone radiographies:
– Increase vertebral size, finger bones, ribs &
clavicles length, tilt femurs
– Acromegaly sometime combine with:
 Hyperparathyroidism & pancreases tumor in
Multiple endocrine neoplasia type1
– Rarely combine with:
 Pheochromocytoma or hyperaldosteronisme

27. Treatment
 Goal of treatment:
– Return GH level to normal
– Extenuate tumor size or
– Avoid tumor growing
– Preservation normal function of pituitary gland

28. Treatment
 Either with routine manner can’t recover all
those goals.
 Surgery:
– Transsphenoidal pituitary microsurgery
– Treatment of choice
– Recover the disease

29. Treatment
 GH level become normal in few hours
 Soft tissue change to normal
 Chance of relapse & tumor growth either
surgery is successful

30. Treatment
 Radiotherapy:
– Decrease GH level
– With this treatment:
 50% 5 year
 70% 10year

31. Treatment
 Medical treatment:
– Long acting Dopamin agonist
 Bromochriptine not so effective if used alone, but
it is effective when used with other manners
 90% pts has good response with 20-60mg
 Rather than no effect on GH, but size of hands and
head become smaller.