WEEK 1: Pituitary & hypothalamus

Overall week objectives:

1.       Describe the embryology, anatomy, histology and function of the

hypothalamus, pituitary, and pineal gland including their blood supply

2.       Describe the topography of hypothalamus and pituitary and their correlation

with the surrounding structures

3.       Describe the anatomic and functional relations of the pituitary gland with the
hypothalamus

4.       List the hormones secreted by anterior and posterior pituitary and describe the
function and control of each (GH, FSH, LH, TSH, ACTH, prolactine, vasopressin,
oxytocin)

5.       Describe hypothalmo-pituitary axis and feedback mechanism

6.       Describe the hormone secreted by pineal gland and its correlation with
circadian rhythms.

7.       In histological slide, recognize the adeno and neurohypophysis; identify the
principal cell types in both. Relate the different cell types to hormone production.

8.       Describe the patophysiology of disorders which caused by pituitary-hormone-

secreting disorder

9.       Describe the natural history of pituitary tumour and its classification

10.   Describe correlation of clinical finding with hypothalamus-hypophysis disorders

Case Objectives:

1.       Describe the embryology, anatomy, histology and function of the pituitary

gland

2.       Describe the anatomic and functional relations of the pituitary gland with the
hypothalamus
3.       List the hormones secreted by anterior and posterior pituitary and describe the
function and control of each

4.       Describe the role of Growth Hormone in growth and metabolism

5.       Describe Growth-promoting action of GH on bones and tissue

6.       Correlate clinical findings with abnormal secretion of GH and describe the

natural history of untreated acromegaly/gigantism

7.       Describe the mechanism of action of drugs used in the management of

pituitary disorders

Tutorial 1 page 1

Hagrid is a 16 years old student from SPH who present with his mother to the neurology
clinic at Siloam Hospital because of frontal headache and blurred vision for the past 2
months. He has otherwise felt well. You are sitting at the desk when Hagrid and his mother
walk into the room. (Please see the photograph).

Questions:

 
 1. What are Hagrid’s problems?

- Frontal headache and blurred vision for 2 months

- Body habitus large

1. What are the possible causes for his problem?

Frontal lobe headaches have many possible triggers. The most frequent
trigger is stress. Some headaches seem to run in families. So, genetics
may be involved. Other triggers can include:

 sinus infection
 jaw or neck pain
 allergies
 eye strain from computer use
 insomnia or other sleep disorders
 certain foods, such as meats with nitrates
 alcohol, especially red wine
 dehydration
 depression and anxiety
 weather changes
 poor posture
 tension

Why you may have blurred vision

and a headache
The following conditions can cause blurred vision and headache at the same time.

Migraine
Migraine is a headache disorder that affects over 39 million people in the United
States. Of these, 28 million are women. Migraine causes moderate to severe pain
that’s often made worse by light, sound, or movement.

Aura is another word for blurred vision that accompanies a migraine. Other
symptoms of aura include blind spots, temporary vision loss, and seeing bright
flashing lights.

Migraine pain typically lasts three or four days. Common symptoms include
nausea and vomiting.

Traumatic brain injury

Traumatic brain injury (TBI) is a type of head injury that causes damage to the
brain. There are different types of brain injuries, such as concussions and skull
fractures. Falls, motor vehicle accidents, and sports injuries are common causes of
TBI.

Symptoms of TBI can range from mild to severe, depending on the extent of the
damage. Other symptoms include:

 dizziness
 ringing in ears
 fatigue
 confusion
 mood changes, such as irritability
 lack of coordination
 loss of consciousness
 coma

Low blood sugar

Low blood sugar, or hypoglycemia, often occurs in people who have diabetes.
However, there are other things that can cause your blood sugar to drop, including
fasting, certain medications, and consuming too much alcohol.

Signs and symptoms of low blood sugar include:

 fatigue
 hunger
 irritability
 shakiness
 anxiety
 paleness
 irregular heartbeat

Symptoms become more severe as hypoglycemia worsens. If untreated,

hypoglycemia can lead to seizures and loss of consciousness.

Carbon monoxide poisoning

Carbon monoxide poisoning is an emergency that requires immediate medical care.

It results from a buildup of carbon monoxide in your bloodstream. Carbon
monoxide is an odorless, colorless gas produced by burning wood, gas, propane, or
other fuel.

Apart from blurred vision and headache, carbon monoxide poisoning may cause:

 dull headache
 fatigue
 weakness
 nausea and vomiting
 confusion
 loss of consciousness
Pseudotumor cerebri

Pseudotumor cerebri, also called idiopathic intracranial hypertension, is a condition

in which cerebrospinal fluid builds up around the brain, increasing pressure.

The pressure causes headaches that are usually felt at the back of the head and are
worse at night or upon wakening. It can also cause vision problems, such as
blurred or double vision.

Other symptoms may include:

 dizziness
 persistent ringing in the ears
 depression
 nausea and/or vomiting

Temporal arteritis

Temporal arteritis is an inflammation of the temporal arteries, which are the blood
vessels near the temples. These blood vessels supply blood from your heart to your
scalp. When they become inflamed, they restrict blood flow and can cause
permanent damage to your eyesight.

A throbbing, persistent headache on one or both sides of your head is the most
common symptom. Blurred vision or brief vision loss is also common.

Other symptoms may include:

 jaw pain that worsens with chewing

 scalp or temple tenderness
 muscle aches
 fatigue
 fever
High or low blood pressure

Changes in your blood pressure can also cause blurred vision and headache.

High blood pressure

High blood pressure, also called hypertension, happens when your blood pressure
increases above healthy levels. High blood pressure typically develops over years
and without any symptoms.

Some people experience headaches, nosebleeds, and shortness of breath with high

blood pressure. Over time, it can cause permanent and serious damage to the
retina’s blood vessels. This can lead to retinopathy, which causes blurred vision
and may result in blindness.

Low blood pressure

Low blood pressure, or hypotension, is blood pressure that has dropped below
healthy levels. It can be caused by dehydration, certain medical conditions and
medications, and surgery.

It can cause dizziness, blurred vision, headache, and fainting. Shock is a serious

possible complication of very low blood pressure that requires emergency medical
treatment.

Stroke

A stroke is a medical emergency that occurs when the blood supply to an area of
your brain is interrupted, depriving your brain tissue of oxygen. There are
different types of strokes, though the ischemic stroke is the most common.

Stroke symptoms may include:

 a sudden and severe headache

 trouble speaking or understanding
  blurred, double, or blackened vision
 numbness or paralysis of the face, arm, or leg
 trouble walking

1. What is the possible mechanism of the causes?

Tutorial 1 page 2

Hagrid tells you that he has grown very quickly in the past 2 years. Two years ago, his
height was 160 cm but has increased 20 cm in a year and increased another 30 cm
this recent year. He has also noted that his fingers became longer and enlarged in
the past year and he now needs a very large pairs of shoes (size 14).

He began having headache about 1 year ago and developed blurring of his vision in
the past 2 months.

On examination, he is alert and cooperative; BP 120/70 mmHg, pulse 84 x/min, RR 16

x/min, temperature 36,5 C. His body height is 210 cm and weight is 110 kg.
His general and neurological examination is normal except for decreased vision on
confrontation testing in both temporal fields.

Questions:

1. How does the information help you?

- Ada growth disorder menyebabkan gigantism

- Chronic headache
- Decreased vision on confrontation testing in both temporal fields

1. How do you explain the findings in this case?

- Gangguan hormone atau kelenjar pituitary

-

1. What further information do you need to understand this case?

- History taking: family history of glandular problems,

- Physical exam:
- cbc