2011 Endocrine Pituitary Gland 2

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Neurosecretory cells in the hypothalamus respond to

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input from the body.

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Each hypothalamic neurohormone then has a

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corresponding anterior pituitary target cell.

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Hypothalamic neurohormones are released into

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a capillary bed of the hypothalamus in the median eminence.

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Hypothalamic hormones travel from

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the capillary plexus of the median eminence, down the pituitary stalk, in a specialized vascular system, the hypothalamic-hypophyseal portal vessels.

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With the anterior pituitary lobe, the hypothalamic hormones are released in

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high concentrations into capillary sinuses located among the glandular cells.

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Hypothalamic hormones then locate and bind to

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their specific target cell types on the anterior pituitary.

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Hypothalamic Hormones
Anterior Pituitary

effect on their corresponding anterior pituitary

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Either inhibitory or stimulatory effect on their corresponding anterior pituitary target cells.

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Synthesis and release of most anterior pituitary hormones depend on

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a positive stimulatory signal from hypothalamic hormones.

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Hormones released by the posterior pituitary are regulated by

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the hypothalamus; the posterior pituitary does not produce the hormone.

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Posterior pituitary hormones are synthesized with in

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2 large nuclei of the hypothalamus

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2 large nuclei of the hypothalamus.

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Supraoptic nuclei (antidiuretic hormone)
and
paraventricular nuclei (oxytocin).

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Posterior pituitary hormones are synthesized with in 2 large nuclei of the hypothalamus. Supraoptic nuclei (antidiuretic hormone) and paraventricular nuclei (oxytocin). These hormones are then stored ....,

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in the posterior pituitary lobe.

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7 Hormones of the HypothalamusStimulating Hormones

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Follicle stimulating hormone releasing factor
Melanocyte stimulating hormone releasing factor
Prolactin releasing hormone factor
Thyrotropin releasing hormone
Corticotropin releasing hormone
Growth hormone releasing hormone
Gonadotropin releasing hormone

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Hormones of the Hypothalamus Inhibitory Hormones

3

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Prolactin inhibiting factor

Growth hormone inhibiting hormone

Melanocyte stimulating hormone inhibitory factor

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Most common type of pituitary tumor

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Adenomas

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Adenomas

Most commonly seen in

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middle aged women

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Classification of pituitary tumors is based on

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the hormone secreted from the tumor

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Classification:  Pituitary Tumors

Functioning
Non-functioning
Mixed

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Functioning - secreting

Non-functioning - nonsecreting

Mixed - may secret more than one hormone

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Pituitary Tumor: Signs & Symptoms

Mass effect

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occurs when tumor size reaches a stage where it begins to exert pressure on surrounding structures

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Pituitary apoplexy

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sudden hemorrhage & infarction of pituitary gland caused by rapid expansion of tumor

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Pituitary Tumor: Diagnosis

4 ways

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Clinical manifestations of abnormal hormone production

CT & MRI

Angiogram to visualize location of internal carotids

24° urine to asses pituitary function

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Pituitary Tumor: Treatment

most common

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Surgical intervention

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Pituitary Tumor: Treatment
Radiological therapy

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- if radiosensitive and/or hard to resect

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Pituitary Tumor: Treatment
Pharmacological therapy

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bromociptine mesylate & octreotide acetate to reduce tumor size

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Panhypopituitaryism: Adults

Cause:

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Tumor or thrombosis of pituitary blood vessels

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Panhypopituitaryism: Adults

2 Signs & symptoms:

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Hypothyroidism

Depressed production of glucocorticiods by the adrenals & suppressed secretion of gonadotropic hormones

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Panhypopituitaryism:  Adults

Treatment:

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Replace with specific hormones

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Hyposecretion: Anterior Pituitary

All of the major pituitary hormones, besides growth hormone, exert their principle effects by

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stimulating target glands

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Growth hormones exerts its effects on

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almost all tissues in the body

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Growth Hormone (somatotropin)

Causes growth to

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almost all tissues of the body that are capable of growing

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Growth Hormone:  Metabolic effects

Produces linear bone growth by

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stimulating the epiphyseal cartilage and growth plate at the ends of long bones.

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Growth Hormone:  Metabolic effects

Increased rate of ______________ in all cells of the body

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protein synthesis

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Growth Hormone:  Metabolic effects

____________ rate of glucose utilization

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Decreased

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Growth Hormone:  Metabolic effects

3 big metabolic effects

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Enhances the body’s proteins, uses up fat stores and conserves carbohydrates

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Growth Hormone: Metabolic Effects

Ketogenic effect

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fat mobilization from adipose tissue can be so great that large quantities of acetoacetic acid are formed by the liver & frequently causes a fatty liver

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Growth hormone - age

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decreases with age
at age 70 it is about 25% of that as a child

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Growth hormone secretion is highest at

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sleep & with exercise

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Dwarfism results from

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deficiency of anterior pituitary secretion during childhood

Child has appropriate proportions, but rate of development is greatly decreased

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Most common type of dwarfism

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Achondroplasia

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Dwarfism:Results from

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from the mutation of a single gene

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Achondroplasia: 3 Clinical Features

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Short limb length

Large head with a prominent forehead

Flattened mid-face with a depressed nasal bridge & a prominent mandible

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Achondroplasia: 4 Common Procedures
fyi

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PE tubes
Decompression suboccipital craniotomy
CSF shunting
Obstetrical

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Achondroplasia: Anesthetic Concerns

Intubation

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due to instability of first two cervical vertebrae

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Achondroplasia: Anesthetic Concerns

Ventilation

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due to abnormal curvature of the spine may impair lung expansion

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Hypersecretion:  Anterior Pituitary (GH)

may cause 2 issues

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Gigantism


Acromegaly

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Hypersecretion:  Anterior Pituitary

Gigantism

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large quantities of growth hormone are produced due to over activity of acidophillic growth hormone producing cell or due to a tumor (20%)

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Gigantism

All body tissues grow rapidly, including the bones
if the condition occurs before adolescence

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(before epiphysis of the long bone have not yet become fused with the shafts) height can be up to 8-9 feet tall