the pituitary gland

Dr.Nawal M. AL-Sharabi
Assistant prof. of internal medicine UOST
Functional anatomy, physiology

 The pituitary glandv is enclosed in the sella

turcica and bridged over by a fold of dura
mater called the diaphragma sellae, with the
sphenoidal air sinuses below and the optic
chiasm above. The cavernous sinuses are
lateral to the pituitary fossa and contain the
3rd, 4th and 6th cranial nerves and the
internal carotid arteries. The gland is
composed of two lobes, anterior and
posterior, and is connected to the
hypothalamus by the infundibular stalk,
which has portal vessels carrying blood from
the median eminence of the hypothalamus to
the anterior lobe and nerve fibres to the
posterior lobe.
By far the most common disorder is an
adenoma of the anterior pituitary gland.
Acromegaly
is a condition due to Increased and unregulated growth
hormone (GH) production, usually caused by a GH-
secreting pituitary adenoma
Symptoms develop insidiously, taking years to decades
to become apparent, with a mean duration of symptom
onset to diagnosis of 12 years.. Additionally, the mass
effect of the pituitary tumor itself can cause symptoms.
Acromegaly clinical feature

Soft tissue swelling and enlargement of

extremities
Increase in ring and/or shoe size
Sweating(symptome of active acromegaly)
Coarsening of facial features
Prognathism
Macroglossia
Erectile dysfunction in men and menstrual cycle
disturb in women
Increased chest diameter
hepatosplenomegaly
Diagnosis of acromegaly
 Laboratory Studies
 Random GH measurements are not diagnostic because
of the episodic secretion of GH,
 Because GH secretion is inhibited by glucose,
baseline GH levels are obtained prior to ingestion of
75 of oral glucose, and additional GH measurements
are made at 120 minutes following the oral glucose
load.
 Patients with active acromegaly are unable to
suppress GH concentration below 2 ng/mL 120
minutes after a 75-g oral glucose load..
 -Measurement of IGF-1 Is also a useful test for
acromegaly
Treatments and drugs
 Surgery
Can remove most
pituitary tumors by
transsphenoidal surgery.
 Medications
Drugs used to lower the
production or block the
action of GH include :
 Somatostatin analogues
(octreotide) Dopamine
agonists.
 Radiation
Complications
 Complications may include :
 Hypertension
 Cardiovascular disease, particularly enlargement of the
heart muscle (cardiomyopathy (
 Osteoarthritis
 Diabetes mellitus
 Precancerous growths (polyps) on the lining of colon
 Sleep apnea,
 Carpal tunnel syndrome
 Uterine fibroids(benign tumors in the uterus)
 Spinal cord compression
 Vision loss
 Hyperprolactinemia
 is a condition of elevated serum prolactin.
 Prolactin is produced in the anterior pituitary gland.
 Its primary function is to enhance breast development
during pregnancy and to induce lactation.
 Secretion is pulsatile and therefore must be drawn
after fasting.
 Normal fasting values are generally less than 25-30
ng/mL, depending on the individual laboratory,
 Nonpuerperal hyperprolactinemia is a state in which
pituitary lactotroph adenomas produce prolactin.
Pathological causes:
 Pituitary adenoma
 Liver cirrhosis
 Chronic kidney disease
 Hypothyroidism
 Epileptic seizures
 Drugs(H2 blocker, estrogen, antiemetic drugs)
Physiological causes:
Causes
pregnancy of Hyperprolactinemia
,lactation,
Stress ,exercise
Nipple and or chest stimulation
Coitus
 Clinical features
 Hyperprolactinaemia usually presents with:
 ■ galactorrhoea, spontaneous or expressible (60% of
cases)
 ■ oligomenorrhoea or amenorrhoea
 ■ decreased libido in both sexes
 ■ decreased potency in men
 ■ infertility
 ■ delayed or arrested puberty in the peripubertal
patient
 ■ mild gynaecomastia is often seen in men due to the
associated hypogonadism rather than a direct effect of
prolactin.
Treatment

 Promocriptine (Parlodel)
 Initial: 1.25-2.5 mg PO qDay
 May increase by 2.5 mg/day q2-7Days
 Usual therapeutic dosage 5-7.5 mg/day, ranges from
2.5-15 mg/day
 cabergoline (Rx)(Dostinex)
 Initital:0.25 mg 2 times per week PO
 May increase by 0.25 mg q4Weeks (or longer) up to 1
mg 2 times per week
 Therapy should be continued for approximately 12-24
months (depending on the degree of symptoms or
tumor size) and then withdrawn if prolactin levels have
returned to the normal range.