The pituitary is a small gland located at the base of the brain, just beneath the optic (eye) nerve in a

bony area called the sella turcica and is held by an infundibular stalk.

Also called the “master gland” because it produces a number of hormones that regulate other
hormone glands in the body. The pituitary is regulated by the hypothalamus (hypophyseal gland); a
portion of the brain that responds to a variety of nerve and hormonal signals from the environment and
the rest of the body.

2 distinct lobe

anterior (adenohypophysis) and

posterior (neurohypophysis) pituitary gland.

Secretes hormones that affect the thyroid, adrenal gland, ovaries and testes, the liver, and mammary
glands.

Anterior pituitary hormones include

Growth hormone GH

Thyroid-stimulating hormone TSH (thyroid gland),

Adrenocorticotropin hormone ACTH (adrenal gland),

LH and FSH (reproduction) and

prolactin (lactation for breast feeding). Posterior pituitary hormones include AHD (water and salt
balance) and oxytocin (childbirth).

Pituitary disorders can be due to either too much, or too little pituitary hormone secretion. These
disorders can result in a wide variety of different clinical conditions, depending on which hormone
signal(s) are disrupted. See below for specific information about different pituitary disorders.
Growth hormone (Somatotropin):

It stimulates the growth rate of body by increasing the tissue mass (protein synthesis), maintaining
epiphyseal growth of bones and stimulating cell division.

Hyposecretion in young person causes dwarfism (marked closure of epiphyseal disks of bones and no
growth of body).

Hypersecretion in young person causes gigantism (the person continues to grow to 7 to 8 feet, looking
like a giant).

After normal growth has stopped, overproduction of growth hormone causes acromegaly (bones in
head, hands, and feet start thickening rather than lengthening).

• Excess GH secretions due to pituitary

adenoma. Onset is usually in the 20s -40s.

Symptoms

 Enlargement of hands/feet, facial features

 Coarse, oily, thickened skin

 Excessive sweating and body odor

 Fatigue and joint or muscle weakness

 Deepening of voice

 Vision problem

Complications

 Hypertension

 Heart failure

 Osteoarthritis

 Enlargement of the thyroid gland (goiter)

 Carpal tunnel syndrome

 Spinal cord compression or fractures

 Vision changes or loss

Treatment

 Best initial test is an IGF-1 level after 100g glucose administration.

Low blood glucose stimulate GH release

 Growth hormone suppression test

 MRI is needed for definitive diagnosis.

 Best initial and most effective therapy is transsphenoidal surgery.

  Best medical therapy is octreotide, a man-made version of somatostatin. In a body, a brain
hormone called somatostatin works against GH production.

 Radiation therapy

Acromegaly is a rare, slowly progressive, disorder that affects adults. It occurs when the pituitary gland
produces too much growth hormone (GH)

In most patients, acromegaly is caused by the growth of a benign tumor (adenoma), arising from the
pituitary gland.

Symptoms of acromegaly include abnormal enlargement in bones of the hands, arms, feet, legs and
head. Enlargement of the bones in the jaws or the jaw protrudes (prognatism) and an underbite may
cause a wide separation and misalignment between the teeth (malocclusion). Affected individuals may
also have an abnormally large tongue and unusually thick, full lips. People with acromegaly eventually
develop a deep and husky voice due to thickening of the vocal cords and enlargement of the sinuses.

Acromegaly also results in a gradual enlargement of the hands and feet. Affected individuals may notice
that rings feel tighter or no longer fit at all, and that their shoe size and width has increased. Overgrowth
(hypertrophy) of bone and enlargement of cartilage in the joints may result in inflammation and gradual
degeneration of involved joints (osteoarthritis). Joint and muscle pain (arthralgia and myalgia) often
develops, especially affecting the large joints such as the knees, shoulders, hands, wrists and hips.

Acromegaly may also cause thickening of the soft tissues of the body, including the heart, lips and
tongue. If untreated, acromegaly can potentially cause serious illness and life-threatening complications.
When excessive secretion of growth hormone occurs before puberty, the disorder is known as
gigantism, not acromegaly.

The symptoms of acromegaly generally occur slowly and become more noticeable as affected individuals
age. The specific symptoms that develop may vary greatly from one person to another.

In some people with acromegaly, the spine may abnormally curve from side to side and from front to
back (kyphoscoliosis). Overgrowth of tissue may trap nerves, causing numbness and weakness of the
hands (carpal tunnel syndrome). Abnormal darkening and thickening of patches of skin in certain areas
of the body (acanthosis nigricans), an excessive amount of body hair (hirsutism) and small abnormal
outgrowths of extra skin (skin tags) may also be present.

In some patients, acromegaly may cause abnormal enlargement of certain organs including the heart.
Symptoms may include difficulty breathing upon exertion (dyspnea) and/or irregular heartbeats
(arrhythmias). Heart involvement in acromegaly can ultimately lead to congestive heart failure, in which
the heart cannot properly circulate blood to the lungs and the rest of the body.

Causes

Acromegaly is a rare disorder that is caused by excess levels of growth hormone (GH) in the body. In
most patients, excess levels of GH are causes by a benign (noncancerous) tumor in the pituitary gland
(pituitary adenoma). Most adenomas form from excessive growth of a pituitary cell called a
somatotrope cell (the pituitary cell that normally secretes GH). One of the functions of GH is to stimulate
the production of another hormone, known as insulin-like growth factor-1 (IGF-1). Consequently,
individuals with acromegaly also have elevated levels of IGF-1.

Diagnosis
A diagnosis of acromegaly is sometimes difficult to make because the development of symptoms occurs
slowly over several years. A diagnosis is made based upon a detailed patient history, a thorough clinical
evaluation, identification of characteristic findings and specialized tests such as blood tests, a glucose
tolerance test, magnetic resonance imaging (MRI) or computerized tomography (CT).

Physicians may test the blood for elevated levels of growth hormone or IGF-1 (insulin growth factor)
associated with acromegaly. Measurement of IGF-I is the most accurate available screening blood test.
Measurement of growth hormone is often done in conjunction with a glucose tolerance test. During a
glucose tolerance test, individuals ingest a specific amount of sugar that should lower GH levels in the
blood. In individuals with overproduction of growth hormone, this reduction does not occur.

Physicians may also order an MRI, preferably, or CT scan of the brain to reveal the presence and size of a
pituitary tumor. During MRI, a magnetic field and radio waves are used to create cross-sectional images
of organs and structures in the body. During CT scanning, a computer and X-rays are used to create a
film showing cross-sectional images of an organ’s tissue structure.

Treatment

The goals of treatment of acromegaly are to return growth hormone levels to normal, decrease the size
of a pituitary adenoma (if present).

Acromegaly is usually treated by surgery, medications and/or radiation therapy.

Acromegaly is usually treated by transsphenoidal surgery; a procedure in which all or part of a pituitary
tumor is removed. Surgery often results in a rapid therapeutic response, immediately relieving pressure
on surrounding brain structures and lowering growth hormone levels. Surgery will improve the hormone
levels, but not return them to normal, which necessitates further treatment, often with medications.

In some patients, removal of the entire tumor may not be possible.

Three different classes of medications are often used to treat individuals with acromegaly. These are
somatostatin analogues including octreotide, lanreotide and pasireotide; growth hormone receptor
antagonists such as pegvisomant; and dopamine antagonists.

The U.S. Food and Drug Administration (FDA) approved the drug octreotide acetate (Sandostatin® LAR)
for its use in the treatment of acromegaly. Octreotide is an artificially produced (synthetic) compound
similar to somatostatin (somatostatin analog), a natural hormone produced by the hypothalamus that
serves to inhibit the secretion of growth hormone. Treatment with octreotide has demonstrated
decreases in serum levels of GH and IGF-I and tumor shrinkage in some patients receiving the drug.

Surgery and drug therapy may be supplemented by radiation treatment (proton beam, heavy particle,
and supravoltage irradiation.) Radiation therapy is most often used in individuals in whom surgery has
failed to sufficiently reduce tumor size or growth hormone levels.