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Pituitary

The pituitary gland, also known as the master gland, is about the size of a pea and regulates several hormones that affect organs throughout the body. It is located at the base of the brain. The pituitary gland has two main parts - the anterior pituitary which regulates hormones such as growth hormone and prolactin, and the posterior pituitary which regulates oxytocin and ADH. Pituitary tumors are relatively common and can be functional, secreting hormones, or non-functional. Functional tumors may cause side effects from excess hormones while non-functional tumors usually present with mass effect symptoms.

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Bivek Pokhrel
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157 views15 pages

Pituitary

The pituitary gland, also known as the master gland, is about the size of a pea and regulates several hormones that affect organs throughout the body. It is located at the base of the brain. The pituitary gland has two main parts - the anterior pituitary which regulates hormones such as growth hormone and prolactin, and the posterior pituitary which regulates oxytocin and ADH. Pituitary tumors are relatively common and can be functional, secreting hormones, or non-functional. Functional tumors may cause side effects from excess hormones while non-functional tumors usually present with mass effect symptoms.

Uploaded by

Bivek Pokhrel
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Pituitary Gland

Anatomy:

Pituitary gland or Hypophysis Cerebri, is an endocrine


gland about the size of a pea and weighing 0.5 g and is
situated in a bony hollow(Sella Turcica) just below the
bridge of the nose.

Often referred to as the “master gland”, the pituitary


gland synthesizes and releases various hormones that
affect several organs throughout the body.
These are the Hormones Secreted By the Pituitary:

Anterior Pituitary: Posterior Pituitary:


• GH • Oxytocin
• Prolactin • ADH
• TSH
• FSH Intermediate Lobe:
• LH • MSH
• ACTH • Beta Endorphins
Embryologic Development:
• Ectodermal in Origin.

• Composed of 2 functionally distinct structures:


Adeno-hypophysis and Neuro-hypophysis.

• The Adenohypophysis develops from the Rathke’s


pouch, which is an upward invagination of oral
ectoderm from the roof of Somatodeum.

• The Neurohypophysis develops from the


infundibulum which is the downward extension of
Neural ectoderm from the Floor of Diencephalon.
• The release of these pituitary hormones is
mediated by hypothalamic neurohormones that
are secreted from the median eminence.

• The pituitary gland is enveloped by dura and sits


within the sella turcica of the sphenoid bone.

• The sella turcica is a saddle-shaped depression that


surrounds the inferior, anterior, and posterior
aspects of the pituitary.
• The superior aspect of the pituitary is covered by
the diaphragma sellae, which is a fold of dura
mater that separates the CSF filled subarachnoid
space from the pituitary.

• The infundibulum pierces the diaphragma sellae in


order to connect the pituitary to the
hypothalamus.

• The Lateral Aspect of Pituitary are adjacent to the


Cavernous Sinuses.
Blood Supply:

• The Adenohypophysis receives the majority of its


blood supply from the paired superior hypophyseal
arteries, which arise from the medial aspect of the
internal carotid artery, within the ophthalmic
segment.

• The Neurohypophysis is supplied by the inferior


hypophyseal arteries. These vessels are terminal
branches of the meningo-hypophyseal trunk, which
arises from the cavernous portion of the internal
carotid artery.
Pathophysiologic Variant:
• Pituitary tumors are relatively common,
accounting for about 15% of all primary brain
tumors.
• The vast majority originate in the
Adenohypophysis and are typically nonsecretory
benign adenomas. These adenomas frequently
go undiagnosed, and meta-analyses of
postmortem studies have demonstrated an 11-
14% overall prevalence of silent pituitary
adenomas in the general population.

• Tumor of Neurohypophysis are rare.


Pituitary Adenomas:

Microadenomas(<1cm) Macroadenomas(>1cm)

• Macroadenomas, when large, have a mass effect on


adjacent structures, with clinical consequences.

• Compression of the pituitary gland itself may cause


hypopituitarism, and compression of the optic
chiasma results in bitemporal hemianopsia. Headache
is also a common symptom of pituitary tumors.
• Secretory adenomas are typically monoclonal that
is, they secrete a single hormone.

• Approximately 1 to 2% of adenomas secrete 2 or


more hormones, with growth hormone (GH) and
prolactin (PRL) being the hormones most
commonly elevated concomitantly.

• Prolactinoma are the most common secretory


adenoma.

• Although prolactinomas classically present with


galactorrhea, this symptom is not always present.
• GH-secreting adenomas are next most common
adenomas, followed by adrenocorticotropic
hormone (ACTH) secreting tumors and
gonadotroph adenomas (tumors that secrete
luteinizing hormone [LH] and follicle-stimulating
hormone [FSH]).

• Thyrotroph tumors account for fewer than 1% of


pituitary adenomas.

• Pituitary carcinomas are quite rare, requiring the


demonstration of metastasis for diagnosis.
EPIDEMIOLOGY:

Pituitary tumors represent ≈ 10% of intracranial


tumors (incidence is higher in autopsy series). They
are most common in the 3rd and 4th decades of life,
and affect both sexes equally.

The incidence is increased in multiple endocrine


adenomatosis or neoplasia (MEA or MEN)”
Clinical Presentation:

Classically Pituitary Tumors are categorised as


Functional(Secreting) and non-functional( inactive).

“Nonsecreting tumors usually do not present until of


sufficient size to cause neurologic deficits by mass
effect, whereas the former frequently present earlier
with symptoms caused by physiologic effects of excess
hormones that they secrete”

“Main modes: Endocrine syndromes, mass effect,


incidental finding, pituitary apoplexy.”
Endocrinologic Disturbances:

1. Hormone Oversecretion:
65% of adenoma secretes an active hormone
(48% prolactin, 10% GH, 6% ACTH, 1% TSH)
 Prolactin may cause amenorrhoea-galactorrohea
syndrome in female and impotence in male.
 Elevated growth hormone in adults causes
acromegaly.
 In Prepubertal children causes Pituitary Gigantism.
 ACTH secreting tumor causes Cushing’s disease,
Nelson Syndrome.
 Secondary Hyperthyroidism in TSH secreting
tumor.

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