The pituitary gland is a small, bean-shaped gland situated at the base of your brain, somewhat behind your nose and between your ears. Despite its small size, the gland influences nearly every part of your body. The hormones it produces help regulate important functions, such as growth, blood pressure and reproduction.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
2. Diseases of the Pituitary and Hypothalamus
Contents:
1. Hypo/hyperpituitarism
2. Prolactinoma
3. Acromegaly
4. Cushing’s Disease
5. Non-functioning Pituitary Adenoma
6. Craniopharyngioma
7. Kallmann Syndrome (Hypogonadotropic Hypogonadism)
8. Hypophysitis
9. Diabetes Insipidus
10. Syndrome of Inappropriate Antidiuretic Hormone Secretion (SIADH, SIAD) and
the Clinical Management of Hyponatremia
3. Topic Outline:
• Introduction to Pituitary Gland
• Anatomy: Gross and Microscopical of Pituitary Gland
• Hypothalamic Pituitary Axis
• Hormone secreted from Pituitary Gland
• Diseases Found in pituitary Gland
• Causative of the disease
• Clinical Manifestation
• Investigation of the disease
• Management of the disease
4. Introduction to Pituitary Gland
• The pituitary gland is found at the base of the brain, inferior
to the hypothalamus.
• It releases hormones into the blood in response to signals from
the hypothalamus known as ‘stimulating hormones’.
• Hormones from the pituitary gland regulate the function of
peripheral endocrine tissues throughout the body.
5. Anatomy of Pituitary Gland
Pituitary Gland :(Hypophysis Cerebri)
Small oval endocrine gland , ½ gm
in weight, measuring 12 mm in
transverse diameter and 8 mm in
anteroposterior diameter.
It lies in the hypophyseal
(pituitary) fossa under cover of the
diaphragma sellae and consists of
2 lobes (large anterior lobe and
small posterior lobe).
6. Anatomical Relations:
1. Superior : Diaphragma sellae , Optic
chiasma and infundibulum connecting the
pituitary gland to hypothalamus.
2. Below: Body of sphenoid & Sphenoidal air
sinuses.
3. Posterior : Dorsum sellae and brain stem.
4.Anterior : Tuberculum sellae is the anterior
wall of the pituitary fossa.
5.On each side: Cavernous sinus containing
internal carotid artery and abducent nerve.
7.
8. Blood supply Of Pituitary
1. Inferior hypophyseal artery: Arises from
internal carotid artery inside the cavernous
sinus and supplies the posterior lobe.
2. Superior hypophyseal artery: arise from
internal carotid artery after leaving the
cavernous sinus, they supply the
infandibulum.
3. Hypothalamo-hypophyseal portal system of
veins supplies the anterior lobe and carries the
hormone-releasing factors from the
hypothalamus down to the anterior lobe.
4. Large hypophyseal veins drain the gland into
the cavernous sinus.
9.
10. Normal Microscopical of Pituitary Gland
When looking under microscopic in
normal Pituitary Gland (Histological)
It is divided into:
a) Anterior lobe
(adenohypophysis): dark &
cellular.
b) Posterior lobe(neurohypophysis):
pale & fibrous
11. Anterior lobe (Adenohypophysis)
• It lies anterior to the
hypophyseal cleft.
• It is subdivided into 3 parts:
1- Pars distalis.
2- Pars tuberalis.
3- Pars intermedia.
12. 1- Pars distalis
• It is composed of :
A. Irregular cords of polygonal
cells,
B. Surrounded by fenestrated
blood capillaries,
C. Supported by a network of
reticular fibers.
13. 1- Pars distalis
It consists of 2 types of cells:
1- Chromophobes (52%):
Have weak affinity to stains.
They are cells smaller than the chromophils
Have a non granular pale cytoplasm ( few organelles).
• Function: They do not secrete hormones. They are reserve cells or
degranulated chromophils.
2- Chromophils (48%):
Have great affinity to stains.
They have granular darkly stained cytoplasm
They are classified according to their granules into two types:
• Acidophils: which have great affinity to acidic stains.
• Basophils: which have great affinity to basic stains.
14. Chromophils Chromophobes
1- Percentage 48% 52%
2- size Larger Smaller
3- Cytoplasm Granular, dark Non granular, pale
4- Function Secretion of hormones A- act as a reserve.
B- degranulated chromophils.
15. a- Acidophils (37%)
• They secrete hormones of protein
in nature.
• They are periodic acid Schiff (PAS)
negative.
• They are smaller than the
basophils but contain larger
secretory granules.
• EM: protein secreting cells.
• Acidophils are of two types:
1- Somatotrophs: secret growth
hormone.
2- Mammotrophs: secret prolactin.
16. Mammotrophs
• The secretory granules in these cells
are small, but in pregnant and
lactating females they become large
and numerous & are called
pregnancy cells or Erdheim cells.
• When suckling is terminated,
lysosomes eliminate the excess
secretory granules, a process known
as crinophagy.
17. b- Basophils (11%)
• They secrete hormones of glycoprotein in nature.
• They are PAS +ve (except the corticotrophs which secrete a
polypeptide hormone ( so, it is PAS –ve).
• They are larger than the acidophils, but contain smaller secretory
granules.
– EM: protein secreting cells.
• Basophils are of three types:
1- Thyrotrophs: secrete thyroid stimulating hormone (TSH).
2- Gonadotrophs: They secrete two hormones:
Follicle stimulating hormone (FSH).
Luteinizing hormone (LH)
3- Corticotrophs: secrete adrenocorticotrophic hormone (ACTH)
19. 2- The pars tuberalis
• It is a superior extension
that surrounds the
infundibulum.
• It is highly vascular.
• It is formed of
chromophobe-like cells.
• Function: non specific.
20. 3- The pars intermedia
• It lies between the pars
distalis and pars nervosa.
• In humans, it is a
rudimentary region. It is
made up of cords of faint
basophilic cells with few
secretory granules.
• Function: non specific.
21. II- Posterior lobe (neurohypophysis)
• It lies posterior to the hypophyseal cleft.
• It consists of 3 parts:
1- The median eminence: a funnel shaped
downward extension of the hypothalamus.
2- The infundibulum: which together with
the pars tuberalis constitute the
infundibular stalk.
3- The pars nervosa: which is connected to
the base of the brain by the infundibulum
and the median eminence
22. Pars Nervosa
• It consists of:
1- Unmyelinated axons of neurosecretory cells:
Their cell bodies present in the supraoptic&
paraventricular nuclei of the hypothalamus.
Their axons form the hypothalamo-hypophyseal
tract carrying the neurosecretion from the
hypothalamic nuclei to the pars nervosa.
2- Herring bodies:
acidophilic homogenous bodies.
Represent accumulation of neurosecretory
granules at the dilated terminal ends of axons.
3- Pituicytes: modified glial cells for support
nutrition& isolation.
4- Rich fenestrated blood capillaries.
24. Hypothalamic Pituitary Axis
Endocrine Function responds to feedback control
Hypothalamus, Pituitary stalk and Pituitary Gland
create an anatomical and functional integrated (Neuroendocrine
System)
• Neuron groups in hypothalamus secrete a number of factors that stimulate
Anterior Pituitary secretion of hypothalamic factors, in turn, are
antagonized by hormones secreted by peripheral target organs, thereby
completing a feedback loop.
• In addition, specific hypothalamic inhibitory hormones have been identified
– e.g. Dopamine inhibits pituitary secretion of prolactin.
Hypothalamus regulates secretion of hormones from adenohypophysis
(anterior pituitary gland) by releasing
Stimulating factors (corticotropin-releasing hormone, CRH; Growth
hormone-releasing hormone, GHRH; gonadotropin-releasing
hormone, GnRH; thyrotropin-releasing hormone, TRH, and.
25. Cont..
• Inhibitory factors (growth hormone inhibitory hormone, GHIH or
Somatostatin; Prolactin inhibitory factor, PIF or Dopamine these in
turn modulate release of six hormones from anterior pituitary;
Anterior Pituitary:
1. Growth Hormone (GH): Regulated by GHRH
2. Prolactin (PRL): Inhibited by dopamine from hypothalamus,
stimulated by thyrotropin-releasing hormone (TRH)
3. Adrenocorticotrophic hormone (ACTH): Regulated by corticotropin-
releasing hormone(CRH)
4. Thyroid-stimulating hormone (TSH): Regulated by TRH
5. Follicle –Stimulating Hormone (FSH): Regulated by Gonadotrophin-
releasing Hormone (GnRH)
6. Luteinizing hormone (LH): regulated by GnRH
– FLAT PiG: FSH, LH, ACTH, TSH, PRL, GH
26. Posterior Lope
Posterior pituitary gland contains pituicytes a
modified glial cells ,with no secretary function, axon
terminal and unmyelinated nerve fibers containing
ADH and Oxytocin
Both are Synthesized in neurons of hypothalamus and transported
along axons to neurohypophysis. Stored and released from there.
1. ADH Promotes water reabsorption from distal renal tubules
2. Oxytocin stimulates contraction of pregnant uterus at term and also of cells
around lactiferous ducts in breast
30. Definition
• The pituitary gland also called the hyophysis, is a small gland that lies in the
sella turica, a bony cavity at the base of the brain, the arachnoid membrane
(diaphragm sellae) separates it from and prevents cerebrospinal fluid from
entering the sella turcica.
• Optic chiasm is 5-10 mm above this diaphragm.
• The pituitary gland is connected to the hypothalamus by the pituitary
(hypophyseal) stalk.
• Pituitary stalk (also known as the infundibular stalk or the infundibulum) is the
connection between the hypothalamus and the pituitary gland. Compression of
the pituitary stalk by suprasellar tumor causes a decrease in all anterior
pituitary hormones except prolactin which increases leading to prolactinemia.
31. • Physiologically, the pituitary gland is divisible into two distinct portions:
- Anterior pituitary: also known as adenohypophysis originates from the Rathke’s
pouch,
• which is an embryonic invagination of the pharyngeal epithelium.
- Posterior pituitary: also known as the neurohypophysis originates from a
neural tissue outgrowth from the hypothalamus.
• Anatomically, there is an intermediate lobe of pituitary which synthesizes
and secretes melanocyte stimulating hormone (MSH).
• Six important peptide hormones plus several less important ones are
secreted by the anterior pituitary, and two important peptide hormones are
secreted by the posterior pituitary. The hormones of the anterior pituitary
play major roles in the control of metabolic functions throughout the body.
32. Hypopituitarism
• Hypopituitarism is a rare condition charactered by the complete
or partial absence of one, or more, or all of the hormones in the
anterior lobe of pituitary gland that is sometimes
associated with the absence of hormones of the
posterior lobe as well.
• The clinical presentation is variable and depends on the
underlying lesion and the pattern of resulting hormone deficiency.
• The most common cause is a pituitary macroadenoma but other
causes are listed in next Slide.
37. Hypopituitarism in adults (Simmonds's Disease)
Its decline of pituitary function with the resultant decrease of
gonadal adrenocortical and thyroid functions.
• Etiology:
1. Sheehan’s Syndrome(infraction of anterior PG)
• Pituitary infection following post-partum haemorrhage, due
to pituitary gland increase in size or doubles in size during
pregnancy without increasing of blood supply, so it may
become liable to ischemic injuries.
2. Pituitary Tumors, Pi- irradiation or hypophysectomy
3. Tuberculoma, Sarcoidosis, haemochromatosis
44. Hormone Features of deficiency
GH Children: growth retardation
Adults: ↓muscle bulk
Tendency to hypoglycaemia.
Failure of lactation
Children: delayed puberty
Female: oligomenorrhoea, infertility,atrophy of breast &
genitalia, los of libido
Male:Impotence,azoospermia,testicular atrophy, loss of
libido
Both Sexes: Loss of libido, loss of body hair, weight loss,
hypotension, hypoglycemia, decreased pigmentation,
hyponatremia, nausea, vomiting
Prolactin
Gonadotrophins
ACTH
TSH Weight gain, cold intolerance, hair loss, constipation, dry skin,
hoarseness,bradycardia, fatigue
Thirst, polyuria
Vasopressin
45. Clinical Manifestations
• GH is the first to be compromised followed by deficiencies
Gonadotropin, TSH, and ACTH.
1. GH Deficiency in adulty causes wrinkling around the eyes and
mouse with decreased strength and exercise capacity.
2. Gonadal Dysfunction; Loss of Libido, Amenorrhea, Impotence.
3. Thyroid Dysfunction; apathy, bradycardia and so on
4. Adrenal Dysfunction; hypoglycemia, hypotension, tiredness.
5. Neurological; with pituitary tumors.
46. Clinical of acute onset pituitary
• Acute onset is rare:
– And coused by hemorrhage or infarction in a
pituitary adenoma.
• E.g. Pituitary Apoplexy;
– Signs and symptoms are : Severe headache
with life-threatening hypopituitarism and visual
loss.
• Its treated by trans-sphenoidal decompression of
the pituitary gland.
• (RARELY, pituitary apoplexy produces
(Autohypophysectomy) with cure of acromegaly,
Cushing disease or hyperprolactinemia. Both
anticoagulants and radiotherapy predispose to
hemorrhagic infarction
Causes of coma in patients
with Hypopituitarism:
1. Hypoglycemia due to GH
and Cortisol Deficiency
2. Hypothermia due to
hypothyroidism
3. Water intoxication as
cortisol and thyroxine are
essential for water
excretion (plasma Na and
K are Low)
47. Investigations
• GH
– Clonidine
– GHRH test
– Insulin tolerance test
– L-Arginine
– L-Dopa test
• Prolactin
– Serum levels
– TRH test
• ACTH
– CRH test
– Insulin tolerance test
• TSH
• Basal TSH
• TRH test
• LH/FSH
• Basal LH, FSH
• Testosterone
• Estrogen
• GnRH test
48. Imaging & Others Tests
• MRI
• Fundus, Perimetry
• Na, K
• Osmolarity Urine/serum
• Water deprivation test
49. Investigations Cont.
1. Panhypopituitarism must be differentiated from primary
polyglandular deficiency states affecting Thyroid, adrenal and
gonads e.g. Schmidt’s Syndrome.
How to Differentiate
• If the is Decreased Hormone
Plus Increased of trophic
pituitary hormones.
• e.g. Cortisol, Thyroid
(ACTH,TSH)= Defect in the
gland itself
• E.g. Thyroid, adrenal or
gonadal primary hypofunction
• If there is decreased in
tropic pituitary hormones,
this means hypothalamic or
pituitary defect.
50. Cont.
2. To differentiate whether the defect is pituitary or hypothalamus, we
can use “Hypothalamic releasing hormone tests’’
3. GH levels my be undetectable under basal conditions so, we use
stimulating test.
– E.g. Insulin stimulation test (Insulin Hypoglycemia Release of GH)
– Infusion of GH (Arginine) releasing hormone may be used if the
insulin test is uncertain.
– Note: Stimulation test is unessential if there are decrease of
three or more of the other pituitary hormones (TSH, ACTH, LH,
FSH)
4. CT, MRI for pituitary gland.
51. Differential Diagnosis of Panhypotuitarism in adult
1. A) Primary hypothyroidism
B)Primary adrenal hypofunction
1. Anorexia Nervosa: (Functional Hypopituitarism)
Young Female: Anorexia with loss body weight,
amenorrhea (Axillary &pubic are normal) to be
differentiated from panhypopituitarism
54. Treatment of Panhypopituitarism in adult
• Drugs:
1. Hydrocortisone 20mg am, 10mg pm or
Prednisalone 5mg am, 2.5mg pm.
2. Cyclical estrogen / progesterone for Women and
Testosterones for Men
3. Thyroxine 100-150
56. Definition
• Abnormally short height in childhood due to the lack of
growth hormone.
• Often referred to as growth hormone deficiency
• People with pituitary dwarfism lack growth hormone that is
produced in the pituitary gland, located at the base of the
brain.
57. Etiology (causes)
• GHRH (growth hormone releasing hormone deficiency) deficiency.
• GH deficiency.
• Deficient local secretion of IGF-1 by chondrocytes.
• GH insensitivity: mutation of GH receptor gene leading to defective
growth hormone receptors which will lead to decrease in linear growth
and is called Laron dwarfism. It is characterized by high serum levels of
growth hormone in the presence of low IGF-1 levels.
58. • Reduction in GH secretion in infancy or early childhood
• It occurs because of the following reasons:
a. Tumor of chromophobes, which compresses and destroys the normal
cells secreting GH
b. Deficiency of GH-releasing hormone secreted by hypothalamus
c. Atrophy or degeneration of acidophilic cells in the anterior pituitary
• Pan-hypopituitarism
– I. Reduction in the secretion of all the hormones of anterior pituitary
gland.
– II. This type of dwarfism is associated with other symptoms due to the
deficiency of other anterior pituitary hormones
• Chromosomal abnormalities
59. Treatments
• Growth hormone
injections given at
home several times a
week or daily
• Most common side
effects include fluid
retention and muscle
and joint aches
61. Definition of the Disease
• The hormone prolactin (lactotroph hormone) is produced in the
anterior pituitary gland.
• Hyperprolactinemia means the overproduction of prolactin.
• Prolactin is a major hormone regulating breast milk production, but it
has several other activities, as well.
• In contrast with other anterior pituitary hormones that are stimulated by
releasing hormones from the hypothalamus; prolactin is under a tonic
suppression by dopamine produced by hypothalamic cells.
62. Cont..
• Prolactinoma is mostly a benign tumor (>98%); however, some
rare malignant cases are also known.
• A pituitary adenoma smaller than 1 cm in diameter is called
microadenoma (microprolactinoma), whereas over 1 cm, it is
termed macroadenoma (macroprolactinoma).
• Prolactin is the only pituitary hormone whose serum level may
refer to the tumor size.
• Prolactinoma is the only pituitary tumor whose treatment is
primarily medical.
63. Cont…
• Prolactin inhibits the secretion of hypothalamic gonadotropin-releasing hormone
(GnRH) and also that of pituitary gonadotropins (luteinizing hormone (LH), follicle-
stimulating hormone (FSH)), and therefore prolactin overproduction can result in low
sex steroid levels in both sexes (secondary/ hypogonadotropic hypogonadism).
• It must be noted that hyperprolactinemia can have many different causes apart from
prolactinoma. These are presented in next Slides.
• One of the most important causes for hyperprolactinemia in clinical practice is
related to drugs having dopamine antagonistic properties.
• The major hormonal effects of hyperprolactinemia are related to the decreased
levels of some sex hormones and to galactorrhea (milk production in non-lactating
women or very rarely in men). Moreover,
• Pituitary macroadenomas can have mass effects/ compression symptoms due to the
large size of the tumor.
64. Causes of high plasma prolactin levels.
Hypothalamic disease:
1. Tumours compressing the hypothalamus
2. Infiltrative disease (sarcoidosis)
3. Large pituitary tumours causing stalk
compression
Metabolic:
1. Hypothyroidism
2. Chronic renal disease
Idiopathic hyperprolactemia
Physiological:
1. Pregnancy
2. Nipple stimulation
3. Sexual intercourse
4. Stress (simple venepuncture may cause PRL
elevation)
Pituitary tumours:
1. Prolactinoma
2. Non-functioning tumours (elevation of prolactin
is usually modest due to stalk compression and
lack of inhibition of prolactin secretion)
Drugs:
1. Large list including:
2. Anti-emetics
3. Antidepressants and antipsychotics
4. Opiates
5. Anti-HIV treatment
67. Clinical symptoms of
hyperprolactinemia in
premenopausal females:
• Menstrual irregularity: oligo-
/amenorrhea – most
common symptom
• Infertility
• Galactorrhea – 25–40% of all
cases
• Low bone mineral density
Compression symptoms/mass
effects with macroadenomas:
In postmenopausal women, these are often the
first symptoms, since estrogen levels are already
low:
• Headache.
• Impaired vision (visual loss – typically
bitemporal hemianopsia, dual vision).
• Signs of hypopituitarism (secondary
hypothyroidism, secondary adrenal
insufficiency).
• In severe cases tumors can infiltrate the
cavernous sinus leading to cerebral nerve
palsies, or even increased intracranial
pressure can occur.
68. Investigation
• Pregnancy should first be excluded before further investigations are performed in women of
child-bearing potential. The upper limit of normal for many assays of serum prolactin is
approximately 500 mIU/L (24 ng/mL).
• In non-pregnant and non-lactating patients, monomeric prolactin concentrations of 500–1000
mIU/L (24–47 ng/mL) are likely to be induced by stress or drugs, and a repeat measurement is
indicated.
• Levels between 1000 and 5000 mIU/L (47–236 ng/mL) are likely to be due to either drugs, a
microprolactinoma or ‘disconnection’ hyperprolactinaemia.
• Levels above 5000 mIU/L (236 ng/mL) are highly suggestive of a macroprolactinoma.
– Patients with prolactin excess should have tests of gonadal function , and T4 and TSH
should be measured to exclude primary hypothyroidism causing TRH-induced prolactin
excess.
• Unless the prolactin falls after withdrawal of relevant drug therapy, a serum prolactin
consistently above the reference range is an indication for MRI or CT scan of the
hypothalamus and pituitary. Patients with a macroadenoma also need tests for
hypopituitarism
69. Management
• Remember that there are four main known
causes of hyperprolactinemia and treatment is
based on that conditions.
• Pregnancy
• Drug use
• Hypothyroidism
• Pituitary tumors
70. Medical Treatment Goals
• Suppressing prolactin secretion and its
clinical and biochemicalconsequences,
• Reducing the size of the
prolactinoma, and
• Preventing its progression or
recurrence.
71. Dopamine agonists
• Are the preferred treatment for most
patients with hyperprolactinemic disorders.
• These agents are extremely effective in:
1. Lowering serum prolactin levels,
2. Eliminating galactorrhea,
3. Restoring gonadal function, and
4. Decreasing tumor size.
72.
73. Radiotherapy
• Stereotactic radiosurgery (SRS) has
become more popular because MRI allows more
accurate resolution and dose planning.
• Radiotherapy should be considered in
patients with macroadenomas who are
resistant to or intolerant of medical therapy
and in whom surgery has failed.