Pituitary

Pituitary tumors
Pituitary tumors are abnormal growths that develop in your pituitary gland. Some pituitary tumors
result in too much of the hormones that regulate important functions of your body. Some pituitary
tumors can cause your pituitary gland to produce lower levels of hormones.

Almost all pituitary tumors are benign (not cancer) glandular tumors called pituitary adenomas. These
tumors are called benign because they don’t spread to other parts of the body, like cancers can. Still,
even benign pituitary tumors can cause major health problems because they are close to the brain,
may invade nearby tissues (like the skull or the sinuses), and because many of them make excess
hormones.

Pituitary cancers (called pituitary carcinomas) are very rare

Three principal types of pituitary tumors represent an overgrowth of (1) eosinophilic cells, (2)
basophilic cells, or (3) chromophobic cells (i.e., cells with no affinity for either eosinophilic or basophilic
stains).

Clinical manifestations
Signs and symptoms vary depending on the type of tumor and the affected area of the pituitary gland

Eosinophilic tumors
 Gigantism- the affected person may be more than 7 ft tall and large in all proportions, yet so
weak and lethargic that he or she can hardly stand if it started in in the early life.

If it is started in adult life, excessive skeletal growth occurs only in the feet, the hands, the
super ciliary ridge, the molar eminences, the nose, and the chin, giving rise to the clinical
picture called acromegaly
 OTHER SYMPTOMS
 severe headaches
 visual disturbances because the tumors exert pressure on the optic nerves.
*That is why Assessment of central vision and visual fields may reveal loss of color
discrimination, diplopia (double vision), or blindness in a portion of a field of vision
 Decalcification of the skeletonmuscular
 Weakness
 endocrine disturbances which is similar to those occurring in patients with hyperthyroidism

Basophilic tumors
These tumors give rise to Cushing syndrome with features largely attributable to hypoadrenalism,
including:
 masculinization and amenorrhea in females
 truncal obesity
 hypertension
 Osteoporosis (disease of the bone)
 Polycythemia (increase number of rbc in the body)
Chromophobic tumors represent 90% of pituitary tumors.
 These tumors usually produce no hormones but destroy the rest of the pituitary gland, causing
hypopituitarism.
 People with this disease are often obese and somnolent(antukin) and exhibit fine, scanty hair;
dry, soft skin; a pasty complexion; and small bones. They also experience headaches, loss of
libido( sex drive), and visual defects progressing to blindness.

Other signs and symptoms

 Polyuria(palaihi)
 Polyphagia( excessive hunger)
 subnormal body temperature. ( body temperature below the normal range of 97.5 to 99.5
degrees farenheight or in 36-37

Assessment and Diagnostic Findings Diagnostic

Pituitary tumors often go undiagnosed because their symptoms resemble those of other
conditions. And some pituitary tumors are found because of medical tests for other
conditions.

 careful history and physical examination, including assessment of visual acuity and visual fields
 CT and MRI scans are used to diagnose the presence and extent of pituitary tumors.
 Serum levels of pituitary hormones may be obtained along with measurements of hormones of
target organs (e.g., thyroid, adrenal) to assist in diagnosis

ADDITIONAL

 Blood and urine tests. These tests can determine whether you have an
overproduction or deficiency of hormones.

 Brain imaging. A CT scan or MRI scan of your brain can help your doctor judge the
location and size of a pituitary tumor.

 Vision testing.This can determine if a pituitary tumor has impaired your sight or
peripheral vision.

 Biopsy. During this test, the provider removes a tissue sample with a needle or during
surgery. It is then checked under a microscope. A biopsy can tell if cancer or other
abnormal cells are present

Medical Management
 Surgical removal of the pituitary gland (hypophysectomy) through a transsphenoidal approach
is the usual treatment.
  Stereotactic radiation therapy, which requires the use of a neurosurgery-type stereotactic
frame, may be used to deliver external-beam radiation therapy precisely to the pituitary tumor
with minimal effect on normal tissue
 Other treatments
 conventional radiation therapy
 bromocriptine (Parlodel, a dopamine antagonist)
 octreotide (Sandostatin, a synthetic analog of GH).
These medications inhibit the production or release of GH and may bring about marked
improvement of symptoms
 Octreotide and lanreotide (Somatuline Depot, a somatostatin analog) may also be used
preoperatively to improve the patient’s clinical condition and to shrink the tumor

Diabetes Insipidus

DI is the most common disorder of the posterior lobe of the pituitary gland and is characterized by a
deficiency of ADH (vasopressin). Excessive thirst (polydipsia) and large volumes of dilute urine( a urine
that called hypotonic urine where in it contains more water but less salt) are manifestations of the
disorder.

Antidiuretic Hormone *ADH (vasopressin) which is a hormone that produced by the brain that
instructs the kidneys to retain water*

Types of diabetes insipidus

The types of diabetes insipidus include
• central
• nephrogenic
• dipsogenic
• gestational

Central Diabetes Insipidus

Central diabetes insipidus happens when damage to a person's hypothalamus or pituitary gland causes
disruptions in the normal production, storage, and release of vasopressin

Nephrogenic Diabetes Insipidus

Nephrogenic diabetes insipidus occurs when the kidneys do not respond normally to vasopressin and
continue to remove too much fluid from a person's bloodstream

Dipsogenic Diabetes Insipidus

A defect in the thirst mechanism, located in a person's hypothalamus, causes dipsogenic diabetes
insipidus. This defect results in an abnormal increase in thirst and liquid intake that suppresses
vasopressin secretion and increases urine output
 Gestational Diabetes Insipidus
Gestational diabetes insipidus occurs only during pregnancy. In some cases, an enzyme made by the
placenta—a temporary organ joining mother and baby—breaks down the mother's vasopressin

Causes:
It may occur secondary to
 head trauma,
 brain tumor, or
 surgical ablation or irradiation of the pituitary gland
 It may also occur with infections of the central nervous system (meningitis, encephalitis,
tuberculosis)
 with tumors (e.g., metastatic disease, lymphoma of the breast or lung).
 Another cause of DI is failure of the renal tubules to respond to ADH;
 this nephrogenic form may be related to hypokalemia, hypercalcemia, and a variety of
medications (e.g., lithium, demeclocycline [Declomycin]).

Clinical manifestation

 enormous daily output (greater than 250 mL per hour) of very dilute urine with a
specific gravity of 1.001 to 1.005
 extreme thirst that can’t be quenched(polydipsia)
 excessive amount of urine(polyuria
 colorless urine instead of pale yellow
 waking frequently through the night to urinate(nocturia)+
 dry skin
 constipation
 weak muscles
 bed wetting

Assessment and diagnostic test

• medical and family history
• physical exam
• urinalysis
• blood tests
• fluid deprivation test
• magnetic resonance imaging (MRI)

Medical and Family History

Taking a medical and family history can help a health care provider diagnose diabetes insipidus. A
health care provider will ask the patient to review his or her symptoms and ask whether the patient's
family has a history of diabetes insipidus or its symptoms.

Physical Exam
A physical exam can help diagnose diabetes insipidus. During a physical exam, a health care provider
usually examines the patient's skin and appearance, checking for signs of dehydration.
Urinalysis
Urinalysis tests a urine sample
The test can show whether the urine is dilute or concentrated. The test can also show the presence of
glucose, which can distinguish between diabetes insipidus and diabetes mellitus

Blood Tests
The blood test measures sodium levels, which can help diagnose diabetes insipidus and in some cases
determine the type.

Fluid Deprivation Test

A fluid deprivation test measures changes in a patient’s body weight and urine concentration after
restricting liquid intake

Magnetic Resonance Imaging

Magnetic resonance imaging (MRI) is a test that takes pictures of the body's internal organs and soft
tissues without using x-rays.

Medical Management

The objectives of therapy are (1) to replace ADH (which is usually a longterm therapeutic program), (2)
to ensure adequate fluid replacement, and (3) to identify and correct the underlying intracranial
pathology. Nephrogenic causes require different management approaches

1.Desmopressin (DDAVP), a synthetic vasopressin without the vascular effects of natural ADH, is
particularly valuable because it has a longer duration of action and fewer adverse effects than other
preparations previously used to treat the disease.

2. Chlorpropamide (Diabinese) and thiazide diuretics are also used in mild forms of the disease because
they potentiate the action of vasopressin.

3. Thiazide diuretics, mild salt depletion, and prostaglandin inhibitors (ibuprofen [Advil, Motrin],
indomethacin [Indocin], and aspirin) are used to treat the nephrogenic form of DI
Syndrome of Inappropriate Antidiuretic Hormone Secretion

The syndrome of inappropriate antidiuretic hormone (SIADH) secretion includes excessive ADH
secretion from the pituitary gland even in the face of subnormal serum osmolality. Patients with SIADH
cannot excrete a dilute urine, retain fluids, and develop a sodium deficiency known as dilutional
hyponatremia

Syndrome of inappropriate antidiuretic hormone secretion (SIADH) is a condition in which the body
makes too much antidiuretic hormone (ADH). This hormone helps the kidneys control the amount of
water your body loses through the urine. SIADH causes the body to retain too much water

Causes:
 Disorders of the central nervous system such as head injury, brain surgery or tumor, and
infection, are thought to produce SIADH by direct stimulation of the pituitary gland
 Some medications (e.g., vincristine [Oncovin], phenothiazines, tricyclic antidepressants,
thiazide diuretics) and nicotine have been implicated in SIADH; they either directly stimulate
the pituitary gland or increase the sensitivity of renal tubules to circulating ADH.

SYMPTOMS
With SIADH, the urine is very concentrated. Not enough water is excreted and there is too much water
in the blood. This dilutes many substances in the blood such as sodium. A low blood sodium level is the
most common cause of symptoms of too much ADH.

When symptoms do occur, they may include any of the following:

• Nausea and vomiting
• Headache
• Problems with balance that may result in falls
• Mental changes, such as confusion, memory problems, strange behavior
• Seizures or coma, in severe cases

Exams and Tests has been expanded.

The health care provider will perform a complete physical examination to help determine the cause of
your symptoms.
Lab tests that can confirm and help diagnose low sodium include:
• Comprehensive metabolic panel (includes blood sodium)
• Osmolality blood test
• Urine osmolality
• Urine sodium
• Toxicology screens for certain medicines
• You may need imaging studies done for young lungs and brain Lung and brain imaging tests in
children suspected of having SIADH

Medical Management
Interventions include eliminating the underlying cause, if possible, and restricting fluid intake (John &
Day, 2012). Because retained water is excreted slowly through the kidneys, the extracellular fluid
volume contracts and the serum sodium concentration gradually increases toward normal. Diuretic
agents such as furosemide (Lasix) may be used along with fluid restriction if severe hyponatremia is
present