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    Pituitary Disorders: Harsinen Sanusi / Husaini Umar

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    Rey Alwiwikh
    1. Pituitary disorders involve hormones secreted by the pituitary gland that regulate important bodily functions and homeostasis. Common pituitary tumors are adenomas that can cause hypersecretion or insufficiency of hormones like growth hormone, prolactin, ACTH, TSH, and others. 2. Specific pituitary disorders discussed include Acromegaly caused by excess growth hormone, Cushing's disease from excess ACTH, diabetes insipidus related to antidiuretic hormone, and hyperprolactinemia. Diagnosis involves hormonal tests, imaging of the pituitary gland, and assessing clinical signs and symptoms. 3. Treatment depends on the type of pituitary disorder but may involve surgery to remove tumors, medication to

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    Pituitary Disorders: Harsinen Sanusi / Husaini Umar

    Uploaded by

    Rey Alwiwikh
    11 views70 pages
    1. Pituitary disorders involve hormones secreted by the pituitary gland that regulate important bodily functions and homeostasis. Common pituitary tumors are adenomas that can cause hypersecretion or insufficiency of hormones like growth hormone, prolactin, ACTH, TSH, and others. 2. Specific pituitary disorders discussed include Acromegaly caused by excess growth hormone, Cushing's disease from excess ACTH, diabetes insipidus related to antidiuretic hormone, and hyperprolactinemia. Diagnosis involves hormonal tests, imaging of the pituitary gland, and assessing clinical signs and symptoms. 3. Treatment depends on the type of pituitary disorder but may involve surgery to remove tumors, medication to

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    1. Pituitary disorders involve hormones secreted by the pituitary gland that regulate important bodily functions and homeostasis. Common pituitary tumors are adenomas that can cause hypersecretion or insufficiency of hormones like growth hormone, prolactin, ACTH, TSH, and others. 2. Specific pituitary disorders discussed include Acromegaly caused by excess growth hormone, Cushing's disease from excess ACTH, diabetes insipidus related to antidiuretic hormone, and hyperprolactinemia. Diagnosis involves hormonal tests, imaging of the pituitary gland, and assessing clinical signs and symptoms. 3. Treatment depends on the type of pituitary disorder but may involve surgery to remove tumors, medication to

    Copyright:

    © All Rights Reserved
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    11 views70 pages

    Pituitary Disorders: Harsinen Sanusi / Husaini Umar

    Uploaded by

    Rey Alwiwikh
    1. Pituitary disorders involve hormones secreted by the pituitary gland that regulate important bodily functions and homeostasis. Common pituitary tumors are adenomas that can cause hypersecretion or insufficiency of hormones like growth hormone, prolactin, ACTH, TSH, and others. 2. Specific pituitary disorders discussed include Acromegaly caused by excess growth hormone, Cushing's disease from excess ACTH, diabetes insipidus related to antidiuretic hormone, and hyperprolactinemia. Diagnosis involves hormonal tests, imaging of the pituitary gland, and assessing clinical signs and symptoms. 3. Treatment depends on the type of pituitary disorder but may involve surgery to remove tumors, medication to

    Copyright:

    © All Rights Reserved
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    of 70

    Pituitary disorders

    Harsinen Sanusi / Husaini Umar

    Bagian Endokrin Metabolik


    Fakultas Kedokteran
    Universitas Hasanuddin

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    ACTH
    GH

    5
    All hormones affect homeostasis

    Thyroid
    hormone
    controls about 25% of basal metabolism in most tissues

    exerts a permissive action for many hormones in addition to


    Cortisol
    its own direct effects

    PTH regulates calcium and phosphorus levels

    control vascular volume and serum electrolyte (Na, K) Mineralo


    corticoid
    concentration

    Vasopres regulates serum osmolality by controlling renal free water


    sin clearance

    maintains euglycemia in the fed and fasted states Insulin


    7
    8
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    Pituitary Tumors
    > Pituitary tumors are the most
    common diseases of the pituitary
    gland

    > Benign and monoclonal - arise from


    single type of anterior pituitary cells

    > Variable presentation

    10
    Pituitary tumors
    Microadenoma

    Size
    Macroadenoma

    Hypersecretion

    Function
    Insufficiency

    11
    Classification of pituitary tumors according to
    size,invasiveness and expansion

    Microadenomas Macroadenomas
    (D < 10 mm) (D > 10 mm)

    Intrasellar Extrasellar

    Non invasive Invasive

    12
    Excessive pituitary GH-Secretion Normal pituitary GH-Secretion
    Pituitary Adenoma
    • Commonest causes
    • Majority are hypersecreting

    Endocrinologic abnormality

    13
    Pituitary hypersecretion due pituitary adenoma

    PITUITARY ADENOMA
    Somatothroph Adenoma :
    ACROMEGALY – GIGANTISM (15%)
    Lactothroph adenomas :
    PROLACTINOMA (25%)

    Thyrotroph adenomas : Secondary


    Hyperthyroidism (< 1%)
    Corticotroph adenomas :
    Plurihormonal : CUSHING`S DISEASE (< 12%)
    Gonadothrop adenomas : FSH/LH
    GH+prolactin+hyperthr
    raise (< 10%)
    14
    Pituitary Hypersecretion

    • PRL  most commonly


    secreted by adenoma
    Hyperprolactinemia

    • G H  Acromegaly
    • ACTH  Cushing’s disease

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    ACROMEGALY
    • Etiology : excessive pituitary GH
    secretion
    • GH-secreting pituitary adenoma  2nd
    frequency
    • Sex incidence : equal
    • Mean age at diagnosis is + 40 years
    • Adults : linear growth does not occur,
    because of prior fusion of the epiphyses
    of long bones
    • Childhood & adoloscence  Gigantism
    18
    ACROMEGALY

    Clinical manifestations :

    • Chronic GH hypersecretion  overgrowth of


    bone is the classic feature particularly of the
    skull and mandible
    • Duration of symptoms usually 5-10 years
    before the diagnosis established
    • Increased late morbidity and mortality if
    untreated  slowly progressive and
    spontaneous remission
    • Death : cardiac diss, diabetes, colon cancer
    19
    20
    ACROMEGALY

    PITUITARY ADENOMA

    GH
    INCREASE

    DERMATOLOGIC : EXCESSIVE SWEATING, OILY SKIN, ENLARGING SKIN TAG


    MUSC.SKELETAL : ARTHRARLGIA,OSTEOARTHRITIS, LARGER HAT,RING, OR
    SHOE SIZE, GAPS BETWEEN THE TEETH, KYPHOSCOLIOSIS
    ENDOCRINE : HYPOTHYROIDISM, HYPOGONADISM, DM
    NEUROLOGIC : HEADACHE, PERIPHERAL PARESTHESIA, VISUAL
    DISTURBANCES
    PULMONARY : OBSTRUCTIVE SLEEP APNEA
    CARDIAC : INCREASED LEFT VENTRICULAR MASS, HYPERTENSION
    GI : ORGANOMEGALY
    21
    RENAL : HYPERCALCIURIA
    Clinical manifestations

    • Manifestation of GH excess
    • Disturbance of other endocrine function
    • Local manifestation

    22
    Clinical manifestations
    Clinical manifestations

    1.Manifestation of GH Excess
    Acral enlargement Parethesis
    Soft tissue overgrowth Joint pain
    Hyperhydrosis Hypertrichosis
    Lethargy or fatigue Goiter
    Weight gain Hypertension

    23
    Gigantisme
    24
    G
    I
    G
    A
    N
    T
    I
    S
    M

    Adults : linear growth does not occur, because of prior fusion of the
    25
    epiphyses of long bones. Childhood & adoloscence  Gigantism
    Acromegaly

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    Clinical manifestations
    Clinical manifestations

    2. Disturbance of other endocrine function


    Hyperinsulinemia,
    Glucose intolerance  other type of diabetes
    Irregular or absent menses,
    Decreased libido,
    Hypothyroidism,
    Galactorrhea,
    Gynaecomastia,
    Hyperadrenalism.

    30
    Clinical manifestations

    3. Local manifestations
    Enlarged sella
    Headache
    Visual deficit

    31
    Laboratory findings

    GH hypersecretion > 10 ng /mL


    Increase IGF-1 levels

    postprandial hyperglycemia
    serum insulin is increased
    elevated serum phosphorus
    hypercalciuria
    32
    Initial steps diagnosis :

    Neuro-radiologic studies w/ MRI


    and
    Neuro-ophthalmologic evaluation

    33
    Imaging study
    > Plain films/ x-ray :
    Sellar enlargement (90% cases),
    Enlargement of the frontal, maxillary
    sinuses, and the jaw
    Thickening of the calvarium
    Increased thickness of the heel pad
    > MRI

    34
    Increase in heel pad thickness

    35
    Visual Field Defects

    • Bitemporal hemianopsia
    • Visual loss
    • Large tumor  diplopia, cranial
    nerve dysfunction (N.III, IV, VI)

    36
    Effects of pituitary
    tumors on the
    visual apparatyus

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    ACTH Secreting Pituitary Adenoma
    (Cushing Disease)

    • Harvey Cushing  1932


    • ACTH hypersecretion  billateral adrenal
    hyperplasia
    • Spontaneous hypercorticolism (Cushing
    syndrome).
    • DD: Adrenocorticosteroid excess-Ectopic
    ACTH syndrome, and adrenal tumors
    • Onset insidious, usual 20 -40 y, F:M =
    8:1, Ectopic ACTH  M:F = 3:1
    52
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    Clinical Features of Cushing syndrome

    Central obesity violaceous striae


    hypertension hirsutism
    glucose intolerance acne
    gonadal disfunction poor wound healing
    moon facies fungal infection
    Plethora osteopenia

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    Diagnosis & Treatment of Cushing disease

    • Diagnosis :
    Basal plasma ACTH

    • Treatment :
    Surgical treatment: microsurgery
    Radiotherapy: Conventional radiotherapy
    Medical therapy: no drugs supresses pituitary
    ACTH secretion.
    * Ketoconazole to inhibit adrenal steroid biosynthesis,
    * Metyrapone, aminoglutethimide  reduce cortisol
    hypersecretion
    58
    Posterior pituitary Disorders

    59
    Posterior Pituitary

    Antidiuretic hormon ( ADH; Vasopressin )

    Diabetes Insipidus : Deficient ADH


    action

    Synd Inappropriate ADH : High


    plasma ADH concentration

    60
    DIABETES INSIPIDUS

    • Is disorder of water balance caused by


    nonsmotic renal losses of water

    • Etiology :
    deficient arginine vasopressin (AVP=ADH)
    secretion (central) or
    end organ unresponsivenes to AVP
    (nephrogenic)

    • ADH is released from cells in the posterior


    pituitary gland  increase water permeability
    at the distal tubule and collecting duct of the
    nephron
    61
    DIABETES INSIPIDUS

    Classification
    Central DI  hypophysectomy, idiopathic,
    familial, tumor/cyst, granuloma,
    autoimmune
    Nephrogenic DI  chronic renal disease,
    hypokalemia,hypercalcemia, familial, etc

    DD: Primary polydipsy (Psychogenic,


    compulsive water drinking)

    62
    DIABETES INSIPIDUS

    Symptoms:
    Thirst, polyurea, daily urine volume > 3 L
    Hypernatremia  weakness,altered mental
    status, coma, seizzures
    Signs n physical examination is` usually
    normal

    Laboratory Evaluation:
    Spesific gravity < 1.010
    Urine osmolality < 300 m Osm/kg
    Hypernatremia
    63
    Diagnosis

    • High plasma osmolality


    • Urine osmolality reduced
    • Water Deprivation test
    Spesific - Gravity < 1.005 (200 mosm
    /kg of water) and reduce 2% BW
    • Plasma Vasopressin
    ☼ Low in Neurogenic DI
    ☼ N/high in nephrogenic DI
    • ADH Radioimmunoassay
    64
    Syndrome of inappropriate secretion of ADH
    (SIADH)

    Definition
    Excess vasopressin becomes a clinical problem when there is
    concurrent retention of water producing hypo-osmolality
    Etiology
    Malignant lung disease, TBC, lymphoma, CNS trauma, drugs
    ( clofibrat, chlorpropamide, HCT), HIV infection, endocrine
    diseases ( adrenal insuff, myxedema)
    Diagnosis
    Hyponatremia
    High ADH

    66
    Syndrome of inappropriate secretion of ADH
    SIADH
    (SIADH)

    Treatment
    - Fluid therapy
    - Diuretics

    67
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    Hyperprolactinemia

    PRL hypersecretion is the most common endocrine


    abnormality due to hypothalamic-pituitary disorders,
    and PRL is the hormone most commonly secreted in
    excess by pituitary adenomas (prolactinoma)

    Indications for Prolactin Measurement


    - Galactorrhoe
    - Enlarged sella turcica
    - Suspected pituitary tumor
    - Hypogonadotropic, hypogonadism  
    - Unexplained amenorrhea  
    - Unexplained male hypogonadism or infertility
    Etiology of Hyperprolactinemia

    70
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    Clinical features
      Galactorrhea
      ♀ : amenorrhea , oligomenorrhea with
    anovulation, or infertility
      ♂ : decreased libido

    Diagnosis : prolactin levels > 300 ng/L

    Differential Diagnosis :
    hyperprolactinemia : pregnancy, hypothalamic -
    pituitary disorders, primary hypothyroidism, and
    drug ingestion
    Pituitay Insufficiency

    73
    Pituitay Insufficiency

    > Panhypopituitarism 
    classic manifestation of
    pituitary adenomas;
    Hypogonadism c/ GnRH 
    screened FSH/LH to
    exclude primary gonadal
    failure
    > TSH or ACTH deficiency is
    relatively unusual

    74
    Replacement therapy for hypopituitarism

    Axis Usual replacement therapy


    Adrenal Hydrocortisone 15-40 mg/day
    Thyroid Thyroxine 100 – 150 umg/day
    Gonadal
    Male Testosterone IM / patch
    Female Cyclical oestrogen/progesterone orally/ patch
    Fertility hCG + FSH
    Growth Recombinant human GH
    Thirst Desmopressin (DDAVP) 10-20ug-spray 1-3
    x/day
    Carbamazepine and thiazide use rarely in mild
    DI nephrogenic
    Breast
    75 Dopamine agonist replacement inhibition
    (bromocriptine 2.5-15 mg/day)
    76

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