Pituitary%20and%20hypothalamic%20diseases

1
Pituitary and hypothalamic diseases

• Dr.Malith Kumarasinghe
• MBBS( Colombo)

2
Overview

• Anatomy and physiology
• Pituitary disorders
• Hypothalamic disorders

3
Pitutary gland
4

• Location
• Sella turcica
• Floor of the brain
• Parts of the Pituitary Gland
• Anterior Pituitary
• Posterior Pituitary

5
(No Transcript)
6

• Anterior Lobe Hormones
• Growth Hormone
• Prolactin
• Thyroid Stimulating Hormone - TSH
• AdrenoCorticoTrophic Hormone - ACTH
• Follicle Stimulating Hormone
• Lutenizing Hormone

7
Posterior pituitary hormones

• Oxytocin
• Milk ejection mechanism
• Uterine Contraction
• Vasopressin or ADH

8
Hypothalamus
9

• Lies superior to the pituitary at the base of the
  brain

10
Hypothalamic functions

• homeostasis.
• controls the autonomic nervous system,
• regulates eating and drinking, controls body
  temperature
• controls pituitary gland secretions.

11
Hypothalamic actions on the pituitary

• Posterior pituitary The hypothalamic nuclei
  produce ADH and oxytocin. These move down the
  axon and are stored in the posterior pituitary.
  Following stimulation of the hypothalamus these
  hormones are then released into the bloodstream.
  

12

• Anterior pituitary the hypothalamus is linked
  to the anterior pituitary by a network of
  microcapillaries - Control is maintained by
  release of hypothalamic hormones, some of which
  stimulate release and others inhibit release of
  pituitary hormones

13
Hypothamo pituitary axis
14
Pituitary disorders

• Tumors
• primary
• -benign -non functional
• -adenomas-macroadenoma/microadenoma
• -malignant
• secondary

15

• Infections
• Infiltrative diseases-TB
• Vascular disorders-Sheehans syndrome

16
Pituitary tumors-features
17
Pituitary tumors-features

• Pituitary tumors may produce one or more hormones
  causing endocrine dysfunction
• Some pituitary tumors compress rest of the gland
  causing deficiency of hormones

18
Pituitary tumors-features

• Symptoms caused by pressure from a larger
  pituitary tumor
• Headache
• Visual changes
• Double vision
• Visual field loss

19
Hypopituitarism-deficiency of pituitary hormones

• Causes
• Pituitary tumour
• Sheehans syndrome
• TB,sarcoidosis

20
GH deficiency

• High body fat content
• ? fracture risk
• Fatigue, muscle weakness

21
Gonadotrophin deficiency

• Male
• ? testicular volume
• Loss of facial body hair
• ? sexual function and libido
• Female
• Amenorrhoea
• Vaginal dryness

22
ACTH deficiency

• Weakness, tiredness
• Hypotension
• Vomiting
• Hypoglycaemia
• Hyponatraemia
• Myalgia

23
TSH deficiency

• Features of hypothyroidism

24
Investigation of hypopituitarism
25

• Prolactin
• TSH
• Cortisol
• Testosterone/Estradiol
• LH, FSH
• IGF-1, GH
• Water deprivation test (assess ant pituitary
  hormones first)

26
Treatment of hypopituitarism
27

• Growth hormone defficiency-Recombinant GH S-C
  injections
• ACTH Deficiency- Hydrocortisone-IV/oral
• TSH Deficiency-Thyroxin
• Gonadotrophin Deficiency
• - Female
• estrogen /progesterone
• -Male
• Testsosterone injection

28
Diabetes insipidus

• Absence/defficincy of ADH
• 30-50 idiopathic
• Trauma, tumours
• Clinical features
• Polyuria urine output gt 3 litres/day

29
Investigation, treatment

• Water deprivation test
• Normal urine osmolality rises in water
  deprivation
• DI Urine fails to concentrate
• ADH deficiency ? urine osmolality with
  desmopressin
• Nephrogenic DI no response to desmopressin
• Treatment
• Desmopressin
• Nasal fluid/aerosol, tablet

30
Pituitary hormone excess
31
GH excess

• Causes
• Pituitary tumour causing high growth hormone
  secretion

32
gigantism

• Excessive GH Production during childhood causes
  increased height

33
acromegaly
When growth hormone excess occurs in adulthood
34
Clinical features

• Enlargement of hands, altered shoe and ring size
• sweating
• Thyroid enlargement
• Sleep apnoea
• Diabetes, hypertension
• Colonic polyps, GI malignancies

35
(No Transcript)
36
Treatment

• Surgery Usually transsphenoidal
• Radiotherapy
• Somatostatin analogues
• Octreotide/Lanreotide

37
Hyperprolactinaemia

• Can occur due to
• -prolactin secreting pituitary tumour(prolactinoma
  )
• -disconnection hyperperolactinemia-commonly due
  to non functioning pituitary tumors
• Hyperprolactinaemia
• ? Reproductive function
• Nipple discharge

38
Treatment

• Dopamine agonists
• Bromocriptine
• Surgery

39
Cushings disease

• Due to high ACTH
• Usually microadenoma
• Central obesity
• Proximal weakness
• Osteopenia
• hypertension
• Purple striae

40
Treatment

• Pituitary surgery
• Radiotherapy

41
Hypothalamic disorders

• Causes
• -trauma
• -malignancy
• -malnutrition
• -anorrexia nervosa

42
Features

• Endocrine dysfunction
• Eating disorders
• Problems related to autonomic control

43
Questions .