1. Pathophysiology of the pituitary and adrenal glands
The State Education Institution of Higher Professional Training
The First Sechenov Moscow State Medical University
under Ministry of Health of the Russian Federation
 Department of Pathophysiology
Pathophysiology of the pituitary and adrenal glands
Lecture presentation
Professor Pirozhkov S.V.
education year

2. Classification of disorders of the endocrine system (based on the location of disorder)
■ Disorders of the central regulation of the endocrine function due to defects of the hypothalamus (tertiary) or pituitary (secondary)
■ Disorders of the peripheral endocrine glands (primary)
■ Extraglandular disorders:
- abnormal transport of hormones;
- resistance to the effects of hormones;
- abnormal metabolism of hormones

3. ● pituitary surgery or irradiation ● closed head trauma, hematoma
Etiology of hypopituitarism
● pituitary adenoma
● pituitary surgery or irradiation
● closed head trauma, hematoma
● infarction during the postpartum period (Sheehan’s syndrome)
● lymphocytic hypophysitis and other types of inflammation
● hypothalamic or pituitary stalk damage (sarcoidosis, metastatic carcinoma, germinoma etc.)
● “functional” hypopituitarism (anorexia nervosa, severe stress)
● congenital malformation of the pituitary/abnormal synthesis of the pituitary hormones

4. The major manifestations of the Sheehan syndrome
Pituitary necrosis
Pallor (decrease of MSH)
Hypothyroidism
Failure of lactation
(decrease of prolactin)
Adrenal insufficiency
(decrease of ACTH)
Ovarian failure with amenorrhea (decrease of LH, FSH)
The major manifestations of the Sheehan syndrome

5. Common syndromes of partial hypopituitarism
Deficit of somatotropin pituitary
nanism
Deficit of TSH pituitary
hypothyroidism
Deficit of gonadotropins pituitary
hypogonadism
Deficit of β–lipotropin pituitary
obesity
Deficit of ACTH chr. secondary
adrenal insuff.

6. Etiology of the pituitary hormones excess
● Adenomas of uncertain provinance of pituitary or, rarely, of hypothalamus
● Decreased inhibitory action of hypothalamus (injury to pituitary stalk)
● Extraglandular production of hormones (secretion of ACTH or GHRH by malignant tumors)

7. Common syndromes produced by pituitary tumors
Prolactin-secreting tumors galactorrhea
and/or hypogonadism
GH-secreting tumors gigantism or
acromegaly
ACTH-secreting tumor Cushing’s disease
TSH-secreting tumor hyperthyroidism
Large pituitary tumors partial or complete
hypopituitarism,
visual field and other
neurologic disturbances

8. Thickened calvaria
Somatotropic adenoma of pituitary
Acromegalic facies
Goiter
Hyperostosis (thoracic vertebrae)
Cardiomegaly (hypertension)
Barrel chest
Abnormal glucose tolerance
Male sexual disfunction
Increased size (hand, feet)
Degenerative arthritis
Peripheral neuropathy
Thickened skin (hypertrophy of sebaceous and sweat glands)
C l i n i c a l m a n i f e s t a t i o n s o f a c r o m e g a l y

9. Impairment of water reabsorption Decreased renal water reabsorption
Neurohypophysis
Adenohypophysis
Lesions:
● Idiopathic
Sporadic mutations
Familial (30%)
● Tumors
● Trauma
● Post-hypophysectomy (20%)
● Other
ADH Deficiency
Impairment of water reabsorption
Collecting duct
Urine
Decreased renal water reabsorption
Inappropriately dilute urine
Diabetes insipidus
P a t h o g e n e s i s o f t h e ADH d e f i c i e n c y

10. CAUSES OF THE ADRENAL CORTEX HYPOFUNCTION
Primary – inability of the adrenals to elaborate sufficient quantities of hormone
Secondary – low production of adrenal hormones due to inadequate ACTH formation or release

11. Etiology of the primary chronic adrenocortical insufficiency (Addison’s disease)
► Idiopathic atrophy (autoimmune)
► Chronic granulomatous diseases: tuberculosis, histoplasmosis, criptococcosis
► Bilateral hemorrhage
► Tumor metastases
► Amyloidosis of adrenals
► Adrenomyeloneuropathy
► Sarcoidosis of adrenals
► Familial adrenal insufficiency

12. ● anorexia, nausea, vomiting ● diarrhea, abdominal pain ● weight loss
CLINICAL SIGNS AND SYMPTOMS OF CHRONIC ADRENOCORTICAL INSUFFICIENCY (Addison’s disease)
Insidious onset of:
● fatigability, weakness
● anorexia, nausea, vomiting
● diarrhea, abdominal pain
● weight loss
● cutaneous and mucosal pigmentation
● arterial hypotension
● occasionally - hypoglycemia
● excessive irritability, restlessness

13. HYPERFUNCTION OF THE ADRENAL CORTEX
Excess of hyperaldosteronism
aldosterone
Excess of Cushing’s
cortisol syndrome/disease
Excess of adrenal virilism
androgens

14. SIGNS AND SYMPTOMS OF PRIMARY HYPERALDOSTERONISM (Conn’s syndrome)
◘ Hypersecretion of aldosterone that is not suppressed appropriately in response to volume expansion (salt loading)
◘ Low plasma renin activity
◘ Hypernatremia, hypokalemia
◘ Nonrespiratory excretory alkalosis
◘ Diastolic arterial hypertension
◘ Headaches
◘ Muscle weakness, fatigue
◘ Polyuria (at advanced stages)
◘ ECG: arrhythmia, the presence of U-wave

15. ETIOLOGY OF THE HYPERCORTISOLISM
CUSHING’S excessive production
DISEASE of ACTH (secondary form)
or CRF (tertiary form)
SYNDROME of cortisol in the
adrenal glands
(primary form)

16. THE MAIN SYMPTOMS OF CUSHUNG’S DISEASE OR SYNDROME
Emotional disturbance
Enlarged sella turcica
Moon face
Osteoporosis
Cardiac hypertrophy
Buffalo hump
Obesity
Adrenal tumor or hyperplasia
Thin, wrinkled skin
Abdominal striae
Amenorrhea
Muscle weakness
Purpura
Skin ulcers
(poor wound healing)