1. Pituitary Gland Disorders
Omar DHAIMAT MD
9/16/2018

2. Introduction
Six hormones are secreted by the anterior pituitary gland:ACTH,TSH,LH,FSH,GH,PrL.
Two hormones are secreted by the posterior part:ADH,Oxytocin.
Understand hypopituitarism.
Pituitary tumors.
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3. Hypopituitarism
Causes of hypopituitarism(hypothalamic versus pituitary).
Either will result in deficiency of the hormones: (hypothyroidism ,hypogonadism, adrenal insufficiency,postpartum lactation failure,short stature).
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4. Diagnosis:
Low serum levels of the appropriate pituitary hormone concurrent with low levels of the target –organ hormone.
Stimulation tests:
1.GH: insulin,Arginine,l-dopa with or without propranalol.
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5. Diagnosis: 2. PrL: TRH,Metoclopramide. 3.TSH: TRH.
4.LH&FSH: GnRH,Clomiphene.
5.ACTH: insulin,Metyrapone,Cosyntropin.
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6. Treatment: Give the deficient end organ hormones.
Pituitary hormone replacement:growth hormone,HCG(for LH).
Bracelet identification.
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7. Apoplexy .Means loss of consciousness followed by paralysis.
Classic pit.apo is an acute life threatening event characterized by severe headache and collapse with evidence of pituitary hemorrhage.
Cranial nerves affected:2,3,4,6 ,7.
Associated with hypopit.No post.
Sub acute forms(dm,Scell).
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8. Pituitary Tumors: 10% of brain tumors. Benign.
Most common:PrL(26%),Nonfun(23%),
Least common: TSH(1%).
S&S related to mass effect,and excessive hormone production.
Macro adenoma (>1cm).
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9. Acromegaly&gigantism
Features: gigantism:increased stature,before closure of epiphysis.Sweating,CTS,arthritis,hypertension,dm,Hypercalciuria,galactorrhea,sleep apnea,colon polyps.Enlargement of facial features,hands and feet.
DX: most sensitive IGF1 are elevated.No suppression to O.Glucose.Base line PrL can be high due to mixed tumors.Imaging study: MRI,CT.Visual field examination.
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10. Acromegaly&gigantism
Treatment :surgery(TSS) then radiotherapy or Octreotide.Bromocriptine can be used with less effect.
Cure: 1.Fasting growth hormone<5ng/ml.2.GH level<1 ng/ml following oral glucose.3.Normal level of IGF1.
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11. Prolactinoma: Most common.
Features: women(amenorrhea,with or without galactorrhea).Men(decreased libido&potency).Also,mass effect.
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12. Prolactinoma:
Dx :exclude pregnancy,hypothyrodism and renal failure.Persistent PrL >200ng/ml.Stimulation test: TRH ,show no response.
Treatment:dopamine agonist(Bromocriptine,Lisuride,pergolide and CABERGOLINE).Surgery &RT are second line.
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13. Pituitary Tumors
TSH secreting tumors:rare,Hyperthyroidism features with goiter,high TSH,T4,T3 AND HIGH ALPHA SUBUNIT.No response to TRH.
9/16/2018

14. Pituitary Tumors Treatment: surgery or RT.
Gonadotropin-secreting tumors:are responsible for most non functioning tumors.FSH,LH AND alpha or beta subunit.Macro adenomas:headaches,visual changes and occasionally hypopituitarism.Testicular enlargement in men with FSH tumors.Treatment:surgery with RT.
9/16/2018