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

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 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 Sheehan’s 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 > 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 h igh 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

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. Cushing’s 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 ….