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Pituitary and hypothalamic diseases

Pituitary and hypothalamic diseases

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Pituitary and hypothalamic diseases

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  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

  5. Anterior Lobe Hormones • Growth Hormone • Prolactin • Thyroid Stimulating Hormone - TSH • AdrenoCorticoTrophic Hormone - ACTH • Follicle Stimulating Hormone • Lutenizing Hormone

  6. Posterior pituitary hormones • Oxytocin • Milk ejection mechanism • Uterine Contraction • Vasopressin or ADH

  7. Hypothalamus

  8. Lies superior to the pituitary at the base of the brain

  9. Hypothalamic functions • homeostasis. • controls the autonomic nervous system, • regulates eating and drinking, controls body temperature • controls pituitary gland secretions.

  10. 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.

  11. 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

  12. Hypothamo pituitary axis

  13. Pituitary disorders • Tumors primary -benign -non functional -adenomas-macroadenoma/microadenoma -malignant secondary

  14. Infections • Infiltrative diseases-TB • Vascular disorders-Sheehans syndrome

  15. Pituitary tumors-features

  16. Pituitary tumors-features • Pituitary tumors may produce one or more hormones causing endocrine dysfunction • Some pituitary tumors compress rest of the gland causing deficiency of hormones

  17. Pituitary tumors-features Symptoms caused by pressure from a larger pituitary tumor • Headache • Visual changes • Double vision • Visual field loss

  18. Hypopituitarism-deficiency of pituitary hormones • Causes • Pituitary tumour • Sheehan’s syndrome • TB,sarcoidosis

  19. GH deficiency • High body fat content •  fracture risk • Fatigue, muscle weakness

  20. Gonadotrophin deficiency • Male •  testicular volume • Loss of facial & body hair •  sexual function and libido • Female • Amenorrhoea • Vaginal dryness

  21. ACTH deficiency • Weakness, tiredness • Hypotension • Vomiting • Hypoglycaemia • Hyponatraemia • Myalgia

  22. TSH deficiency • Features of hypothyroidism

  23. Investigation of hypopituitarism

  24. Prolactin • TSH • Cortisol • Testosterone/Estradiol • LH, FSH • IGF-1, GH • Water deprivation test (assess ant pituitary hormones first)

  25. Treatment of hypopituitarism

  26. Growth hormone defficiency-Recombinant GH S-C injections • ACTH Deficiency- Hydrocortisone-IV/oral • TSH Deficiency-Thyroxin • Gonadotrophin Deficiency - Female • estrogen /progesterone -Male • Testsosterone: injection

  27. Diabetes insipidus • Absence/defficincy of ADH • 30-50% idiopathic • Trauma, tumours • Clinical features • Polyuria: urine output > 3 litres/day

  28. 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

  29. Pituitary hormone excess

  30. GH excess • Causes • Pituitary tumour causing high growth hormone secretion

  31. gigantism • Excessive GH Production during childhood causes increased height

  32. acromegaly When growth hormone excess occurs in adulthood

  33. Clinical features • Enlargement of hands, altered shoe and ring size • sweating • Thyroid enlargement • Sleep apnoea • Diabetes, hypertension • Colonic polyps, GI malignancies

  34. Treatment • Surgery: Usually transsphenoidal • Radiotherapy • Somatostatin analogues • Octreotide/Lanreotide:

  35. Hyperprolactinaemia • Can occur due to -prolactin secreting pituitary tumour(prolactinoma) -disconnection hyperperolactinemia-commonly due to non functioning pituitary tumors • Hyperprolactinaemia: •  Reproductive function • Nipple discharge

  36. Treatment • Dopamine agonists: • Bromocriptine Surgery

  37. Cushing’s disease • Due to high ACTH • Usually microadenoma • Central obesity • Proximal weakness • Osteopenia • hypertension • Purple striae

  38. Treatment • Pituitary surgery • Radiotherapy

  39. Hypothalamic disorders • Causes -trauma -malignancy -malnutrition -anorrexia nervosa

  40. Features • Endocrine dysfunction • Eating disorders • Problems related to autonomic control

  41. Questions ….