Pituitary disorders occur when there is too much or too little production of hormones by the pituitary gland. Some key pituitary disorders include hypopituitarism, hyperpituitarism, gigantism, acromegaly, and diabetes insipidus. Hypopituitarism is characterized by a loss of pituitary function and hormone deficiencies. Hyperpituitarism involves excessive hormone production and can manifest as gigantism in children or acromegaly in adults. Diabetes insipidus is caused by a deficiency or resistance to antidiuretic hormone, leading to excessive urination and thirst. These disorders are diagnosed through medical history, physical exams, imaging, and blood tests, and treatments aim to replace missing hormones

1. Salale University College of Health Sciences Department of
Adult Health Nursing Medical Surgical Nursing 2st Year 1nd
Semester, Msc Program
GROUP Seminar Presentation on: PITUITARY DISORDERS
Presented TO TADELE K. (Assistant Professor)
Presented by MESFIN SHIFERA 185-15
MESFIN ASSEFA 186-15
SEPT, 2023
Fitche,Oromia, Ethiopia
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2. Course Outline
Introduction
Anatomy
Definition
Etiology
Clinical Manifestations
Management
Prevention
Summary
Reference
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3. Objective
After completing this presentation, Students will able
to:
Identify anatomy of pituitary
Define pituitary disorders.
List causes of pituitary disorders.
Identify different management of pituitary disorders.
Define pituitary disorders and its management.
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4. Introduction
Located at the base of the brain and connected to the
hypothalamus.
Master gland because it controls the other endocrine
glands.
Divided into anterior and posterior lobes
(adenohypophysis &neurohypophysis).
Hypothalamus controls pituitary secretions.
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5. Introduction cont.…
5
Anterior pituitary lobe produces six major hormones:
Adrenocorticotropin hormone (ACTH) – stimulate adrenal
gland to secrete ACTH.
GH – bone and tissue growth.
TSH – stimulate thyroid gland to secrete T3 & T4.
Prolactin - act on breast to stimulate milk production.
FSH - sperm production & development of egg.
LH - secrete sex hormones (testosterone in male and estrogen
& progesterone in females).
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6. Anatomy of Pituitary Gland.
The pituitary is located at the
base of the brain, in a small
depression of the sphenoid
bone .
Purpose: control the activity of
many other endocrine glands.
“ Master gland” Has two lobes,
the anterior & posterior lobes.
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7. Anatomy cont....
Anterior lobe: glandular tissue,
accounts for 75% of total weight.
Hormones in this lobe are controlled
by regulating hormones from the
hypothalmus (stimulate or inhibit)
Posterior: nerve tissue & contains
axons that originate in the
hypothalmus. Therefore this lobe does
not produce hormones but stores
those produced by the neurosecretory
cells in the hypothalmus. Release of
hormones is triggered by receptors in
the hypothalmus.
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8. Review - Hormones
Anterior Pituitary
GH: growth hormone
ACTH: adrenocorticotropic
hormone
TSH: thyroid-stimulating hormone
PRL: prolactin and FSH.
LH and MSH: melanocyte
stimulating hormone.
Posterior Pituitary
ADH: anti-diuretic
hormone(vasopressin)
OT: oxytocin
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9. Anterior Pituitary Disorders
Hormone Increased level Decreased level
GH Gigantism (child)
Acromegaly (adult)
Dwarfism (child)
Lethargy, premature aging
ACTH Cushing’s Disease Addison’s Disease
TSH Goiter, increased BMR, HR,
BP , Graves disease
Decreased BMR, HR, CO,
BP ,Cretinism (children)
Prolactin amenorrhea Too little milk
FSH Late puberty, infertility
LH Menstrual cycle
disturbance
Amenorrhea, impotence
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10. Posterior Pituitary Disorders
Hormone Increased Decreased
Oxytocin Precipitates childbirth,
excess milk
Prolonged
childbirth,
diminished milk
ADH
(vasopressin)
Increased BP, decreased
urinary output, edema.
SIADH
Diabetes insipidus ,
dilute urine &
increased urine
output
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11. Disorders of the Pituitary Glands
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Disorders occur most often in the anterior pituitary.
The anterior pituitary hormones regulates growth,
metabolic activity and sexual development.
Major causes include: tumors, pituitary infarction and
genetic disorders.
Pathologic consequences of pituitary disorders are:
1) hyperpituitarism, 2) hypopituitarism, 3) local
compression of brain tissue by expanding tumor

12. PITUITARY DISORDERS
Pituitary disorders are conditions caused by too much or
too little one or more of the hormones produced by the
pituitary gland and can produce a variety of symptoms
depending on which hormones and target tissues are
affected.
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13. 1.HYPOPITUITARISM
Hypopituitarism is a rare disorder where there is a loss of
function in the pituitary and the failure to secrete
hormones that affect many of the body's functions.
Patients diagnosed with hypopituitarism may be deficient
in one or several hormones or have complete pituitary
failure.
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14. ETIOLOGY
Congenital
Tumor
Inflammation
Infection
Head injuries
Lesions
Surgery
Tuberculosis
Radiographic therapy
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15. DWARFISM
It is an endocrine disorder resulting
from hypo secretion of growth
hormone during critical development
period in children.
The term ‘short stature’ or little
people is often used too.
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16. 10/3/2023 16

17. 10/3/2023 17

18. Conti...
Lesion of the anterior pituitary due to infection or injury
results in hypo secretion of growth hormone.
Genetic disorders.
Hereditary.
Lesion of hypothalamus resulting in hypo secretion of
growth hormone releasing factor.
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19. CLINICAL FEATURES:
Stunted physical and skeletal growth.
The average height is 4 feet or less than that. But
dwarfism could apply to an adult who is less than 4 feet
10 inch height.
Low blood glucose level.
Developmental of gonads may be normal and the IQ may
be normal.
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20. DIAGNOSTIC EVALUATION:
History collection.
Physical examination.
CT scan, MRI scan of brain.
Blood test – to rule out hormone level.
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21. MANAGEMENT
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22. 2.HYPERPITUITARISM
Hyperpituitarism is the excessive production of growth
hormone.
Hyperpituitarism is a chronic, progressive, disease marked
by hormonal dysfunction and startling skeletal
overgrowth.
Hyperpituitarism appears in 2 forms.
1. Gigantism- affects infants and children.
2. Acromegaly- affects adults after epiphyseal closure.
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23. 2.1.GIGANTISM
Pituitary gland secretes GH which is responsible for overall
body development during childhood.
When too much growth hormone is secreted that augments
the growth of muscle, bones and connective tissue in
childhood or adolescence before the end of puberty, the
condition is called Gigantism.
The result is an increase in height and formation of additional
soft tissues.
Some individuals may achieve a height in excess of eight feet.
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24. ETIOLOGY
In most of the cases, non-cancerous pituitary gland
tumour is behind gigantism. Genetic mutation.
McCune-Albright syndrome is a disorder that causes
unusual growth of bone tissues, gland irregularities
and patches of lightbrown skin.
Carney complex is a hereditary condition which is
cancerous or non-cancerous endocrine tumors and
spots of darker skin.
Multiple endocrine neoplasia type 1 is also a
hereditary condition which cause tumours in the
pancreas, parathyroid glands and pituitary gland.
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25. CLINICAL FEATURES
Child will be much taller than other children of the same age.
Parts of the body may be visibly bigger than other parts.
Common signs of gigantism include.
large hands and feet,
Thick toes and fingers.
A bulging jaw and forehead.
Improper facial features and Children suffering from gigantism may
also suffer from large heads, lips, or tongues.
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26. The symptoms of gigantism depend on the size of the
pituitary gland tumor.
Some children may experience vision problems,
headaches and nausea from tumor.
Other symptoms include:
Large scale sweating.
Weakness .
Onset of puberty in boys and girls may be delayed .
Irregularity in menstrual cycle and Deafness.
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27. DIAGNOSTIC EVALUATION
History collection.
CT scan , MRI scan- to rule out pituitary tumour.
Oral Glucose Tolerance Test- to rule out hyperglycemia.
Blood test- to rule out growth hormone level, high
prolactin level, increase insulin level, growth factor - 1
levels
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28. MANAGEMENT
Gigantism requires early detection and strong treatment to
prevent excess production of growth hormone and to improve
life expectancy.
Surgery include. Transsphenoidal adenectomy.
Hypophysectomy surgery is the first line of treatment with the
objective of removing the tumor to minimize growth hormone
levels and reduce the pressure on the nerves.
Radiation therapy is another option if surgery has not provided
a complete cure.
It can take several years for radiation therapy to be effective.
Half of the patients achieve controlled growth hormone in 5-
10 years.
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29. Drug therapy may also be used in certain circumstances.
Drug therapy include:-
 Somatostatin analogs - reduces growth hormone release.
 Pegvisomant -blocks the effects of growth hormone.
Drug therapy is used :–
Prior to surgery in order to control symptoms and cause
the tumour to shrink.
Post surgery when growth hormone levels are not
managed.
While radiation therapy is going on.
Individuals not qualified for surgical process.
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30. 2.2.ACROMEGALY
Acromegaly is a chronic metabolic
disorder in which there is a secretion
of too much growth hormone and the
body tissues gradually enlarge.
INCIDENCE:- It occurs in about 6 of
every 100,000 adults.
Occurs in adulthood, usually during
middle age.
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31. ETIOLOGY
Pituitary tumour.
Benign tumour.
Adenoma of the pituitary gland.
Non pituitary tumour.
Benign or cancerous tumour of the other part of the body such as
lungs, pancreas, adrenal glands.
Excess growth hormone and growth hormone releasing factor in the
blood leads to changes in the physical appearance and functions of
body
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32. SYMPTOMS
Hand swelling , ‘ sausage like’ fingers.
Increase in shoe size. Diaphoresis .
Thickening of the facial features especial
nose.
Increase prominence in the jaw and
forehead.
Thickened skin.
Swelling of tongue.
Thickening or swelling of the neck.
Arthritis .
Sleep apnoea and Headache and Partial
loss of vision.
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33. SYMPTOMS Cont…
Pain , numbness, tingling or weakness in hands and
wrists.
Increased thirst and urination.
Hyperglycemia.
Chest pain.
Shortness of breath.
Palpitation and Heart failure.
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34. DIAGNOSTIC EVALUATION
History collection.
Physical examination.
CT scan , MRI scan of head, chest, abdomen, pelvis,
adrenal glands, ovaries,
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35. MANAGEMENT
Goal of the treatment is to relieve
and reverse the symptoms of
acromegaly.
Surgical treatment is the first line
treatment. Surgery brings remission
and in some people, but not all.
TRANSSPHENOIDAL HYPOPHYSECTOMY
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36. Radiation therapy- is an option to reduce the size of the
tumour and hence reduce the production of growth hormone.
Radiation therapy focuses on high intensity radiation at
pituitary tumour to destroy the abnormal cells.
Drug therapy – Somatostatin analogs- reduces growth hormone
release.
Dopamine agonists- prevents the release of growth hormone.
Growth hormone receptor agonist eg .Pegvisomant blocks the
effects of growth hormone.
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37. DIABETES INSIPIDUS
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38. Diabetes insipidus
DEFINITION :- Diabetes insipidus is a disorder of the
posterior lobe of the pituitary gland characterized by a
deficiency of antidiuretic hormone (ADH), or vasopressin.
Great thirst (polydipsia) and large volumes of dilute urine
characterize the disorder.
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39. 10/3/2023 39

40. TYPES OF DI
Central diabetes insipidus
Nephrogenic diabetes insipidus
Psychogenic diabetes insipidus
Gestational diabetes insipidus.
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41. CAUSES
A) Central diabetes insipidus .
Head trauma or surgery .
Pituitary or hypothalamic tumour .
Intracerebral occlusion or infection
B) Nephrogenic diabetes insipidus .
Systemic diseases involving the kidney .
Multiple myeloma .
sickle cell anemia .
Polycystic kidney disease .
Pyelonephritis and Medications such as lithium
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42. PATHOPHYSIOLOGY
A) Central diabetes insipidus .
Loss of vasopressin-producing cells.
Causing deficiency in antidiuretic hormone (ADH)
synthesis or release.
Deficiency in ADH, resulting in an inability to conserve water.
leading to extreme polyuria and polydipsia.
B) Nephrogenic diabetes insipidus .
Depression of aldosterone release or inability of the nephrons to
respond to ADH.
causing extreme polyuria and polydipsia
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43. SIGNS AND SYMPTOMS
Polyuria with urine output of 5 to 15 L daily.
Polydipsia, especially a desire for cold fluids .
Marked dehydration, as evidenced by dry mucous
membranes, dry skin, and weight loss.
Anorexia and epigastric fullness and Nocturia and
related fatigue from interrupted sleep
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44. DIAGNOSTIC TEST RESULTS
High serum osmolality, usually above 300 mOsm/kg of
water .
Low urine osmolarity, usually 50 to 200 mOsm/kg of
water.
low urine-specific gravity of less than 1.005 .
Increased creatinine and blood urea nitrogen (BUN)
levels resulting from dehydration .
Positive response to water deprivation test: Urine output
decreases and specific gravity increases
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45. MANAGEMENT
The objectives of therapy are :
(1) to replace ADH (which is usually a long-term therapeutic
program).
(2) to ensure adequate fluid replacement, and
(3) to identify and correct the underlying cause.
Treatments .
Replacement of vasopressin therapy with intranasal or
I.V. DDAVP (desmopressin acetate).
Correction of dehydration and electrolyte imbalances.
A thiazide diuretic to deplete sodium and increase renal
water reabsorption and Restriction of salt intake.
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46. SIADH- SYNDROME OF INAPPROPRIATE ADH.
SIADH is a disorder of impaired water excretion caused by
the inability to suppress secretion or due to excessive
secretion and action of Antidiuretic hormone .
If water intake exceeds the reduced urine output
(concentrated Urine), the water retention leads to the
development of hyponatremia.
Most common cause of HYPOOSMOLAR EUVOLEMIC
Hyponatremia.
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47. ETIOLOGY:
Neoplasms .
Carcinomas of Lung,
Duodenum ,Pancreas , Ovary
, Bladder, ureter , Other
neoplasms , Thymoma,
Mesothelioma , Bronchial
adenoma , Carcinoid ,
Gangliocytoma and Ewing's
sarcoma
Head trauma (closed and
penetrating) .
Infections .
Pneumonia, bacterial or
viral .
Abscess, lung or brain .
Cavitation (aspergillosis) .
Tuberculosis, lung or brain .
Meningitis, bacterial or
viral .
Encephalitis and AIDS.
Vascular and
Cerebrovascular occlusions,
hemorrhage .
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48. INVESTIGATIONS SENT FOR Dx OF SIADH:
Serum Na+, potassium, chloride, and bicarbonate .
Plasma osmolality .
Urine Sodium .
Urine osmolality .
Serum creatinine .
Blood urea nitrogen .
Blood glucose .
Serum uric acid .
Serum cortisol and Thyroid-stimulating hormone
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49. MANAGEMENT
Fluid restriction — is a mainstay of therapy in most.
patients with SIADH, with a suggested goal intake of less than 800
mL/day .
The associated negative water balance initially raises the Serum
sodium concentration toward normal and, with maintenance
therapy in chronic SIADH, prevents a further reduction in serum
sodium.
Intravenous saline — Severe, symptomatic, or resistant
hyponatremia in patients with SIADH often requires the
administration of sodium chloride.
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50. Nursing responsibility
Monitor for signs of fluid and electrolyte imbalance
Monitor in and out
Daily weight
Monitor for excessive thirst or output
Assess serum and urine values (decreased SG,
decreased urine osmolality, high serum osmolality are
early indicators
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51. POSSIBLE NURSING DIAGNOSIS
Fluid Volume Deficit
Risk for Injury r/t altered LOC
Risk for Altered Health Maintenance
Sleep Pattern Disturbance r/t urinary frequency or
anxiety
Altered Urinary Elimination r/t excess urinary output
Body Image and Altered sexuality
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52. Panhypopituitarism
When both the anterior and posterior fail to secrete
hormones, the condition is called panhypopituitarism.
Causes include tumors, infection, injury, iatrogenic (radiation,
surgery), infarction
Manifestations don’t occur until 75% of pituitary has been
obliterated.
Treatment involves removal of cause and hormone
replacement (adrenaocortical insufficiency, thyroid hormone,
sex hormones)
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53. SUMMARRY
The anterior pituitary gland releases a number of peptide
hormones, which are themselves regulated by hypothalamus
hormones that reach the pituitary via the portal blood system.
The anterior pituitary hormones include ACTH, TSH, LH and
FSH; the irrespective target organs are the adrenal and thyroid
glands and the ovaries/testes.
GH is also an anterior pituitary hormone but does not have a
specific target organ.
Hypopituitarism can be due to many conditions, such as
pituitary infiltration or destruction, and results in a deficiency
of all (panhypopituitarism) or some of the pituitary hormones.
Conversely, excess release of certain anterior pituitary
hormones can occur because of pituitary tumours. For
example, acromegaly is due to excess GH, and Cushing's
disease to excess ACTH release.
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54. REFERENCES
1. Levy A, Lightman SL. Molecular defects in the pathogenesis
of pituitary tumors. Frontiers in Neuroendocrinology
2003;24:94–127. c A comprehensive review of pituitary
tumour pathogenesis, including the familial pituitary cancer
syndromes.
2. Melmed S, Vance ML, Barkan AL, et al. Current status and
future opportunities for controlling acromegaly. Pituitary An
overview of treatment options in acromegaly.
3. Marcou Y, Plowman PN. Stereotactic radiosurgery for
pituitary adenomas.
4. McKeage K, Cheer S, Wagstaff AJ. Octreotide long-acting
release (LAR): a review of its use in the management of
acromegaly. Drugs 2003;63:247–9. c A review of somatostatin
analogue efficacy in acromegaly.
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