PITUITARY GLAND o Dr Manahil Ghandour ANTERIOR PITUITARY

PITUITARY GLAND o Dr. Manahil Ghandour

ANTERIOR PITUITARY GLAND: CRUCIAL FOR ; o o o NORMAL GROWTH. SEXUAL MATURATION. ENDOCRINE FUNCTIONS.

ANTERIOR PITUITARY SECRETES : o GH, o PROLACTIN, o ACTH, o FSH, LH o TSH.

GROWTH HORMONE

ANTERIOR PITUITARY o. GROWTH HORMONE DEFICIENCY

ANTERIOR PITUITARY GH deficiency can occur ; o Isolated or, o in conjunction with deficiency of one or more of other hormones

ANTERIOR PITUITARY; GH DEF CAUSES OF GH DEF: o 1 -DISEASES OF THE PITUITARY GLAND ( I ) Aplasia, ( ii ) Hypoplasia, ( iii) Familial Pan hypopituitarism. ( iv) Tumours: Craniopharyngioma , Adenoma (iiv) Infarction due to ; Trauma Infection Head irradiation.

ANTERIOR PITUITARY; GH DEF 2 - DISORDERS OF THE HYPOTHALAMUS (GRF DEF) 3 - DISORDERS OF GH RESPONSIVENESS (high GH+ low SOMATOMEDIN)

ANTERIOR PITUITARY; GH o 1. 2. 3. DEF NEONATAL PERIOD: NEONATAL HYPOGLYCEMIC SEIZIURES PROLONGED NEONATAL JAUNDICE IN MALES : MICROPENIS AND UNDECENDED TESTES

ANTERIOR PITUITARY; GH DEF GROWTH FAILURE IS OFTEN APARENT AT THE END OF THE FIRST YEAR. IF HEIGHT IS >3 SD BELOW MEAN FOR AGE, THE FOLLOWING SCREENING TESTS CAN BE PERFORMED AFTER DETAILED HISTORY AND PHYSICAL EXAM for the Diff Diag of Short Stature ; -

ANTERIOR PITUITARY; GH DEF TREATMENT o GROWTH HORMONE THERAPY

GIGANTISM o - - GROWTH HORMONE EXCESS. Onset ; - at puberty but can be early. GIGANTISM ; - Ht >97 th percentile with rapid linear growth. ttt ; - Surgery if adenoma. -GH receptor antagonist.

PROLACTIN

PROLACTIN EXCESS o o o Cause : - prolactin secreting adenoma. M: F = 1: 2. CF : SS of increase ICP. Gynecomastia. SS of hypopitutarism

ACTH

ACTH EXCESS : -

CUSHING SYNDROME o DUE TO : (i) PITUITARY OVER PRODUCTION OF ACTH. (age above 7 yrs). (ii) IATROGENIC CUSHING SYNDROME RESULTS FROM SUPRAPHYSIOLOGIC QUANTITIES OF ACTH.

CUSHING SYNDROME o CUSHIG SYNDROME IS GENERALY THE RESULT OF ADRENAL HYPERPLASIA CAUSED BY INCREASED SECRETION OF ACTH.

CUSHING SYNDROME -; CLINICAL FEATURES

CLINICAL FEATURES 1. 2. 3. 4. 5. 6. 7. CENTRAL OBESITY MOON FACIES HIRSUTISM FACIAL FLUSHING STRIAE HYPERTENSION MUSCULAR WEAKNESS

CLINICAL FEATURES 8. 9. 10. 11. 12. 13. 14. BACKPAIN BUFFALO HUMP PSYCHOLOGICAL DISTURBANCES ACNE EASY BRUISING POOR WOUND HEALING GLYCOSURIA

CLINICAL FEATURES SIGNS TO RAISE SUSPICION: o RAPID WT GAIN o GROWTH ARREST o MOOD CHANGE o FACIES LAB: INCREASED PLASMA ACTH o

ACTH DEF : -

ADRENAL INSUFFICIENCY o o CAN BE SECONDARY TO HYPOPITUITARISM AND ACTH DEFICIENCY OR DUE TO PRIMARY ADRENAL DISORDER. PRIMARY ADRENAL INSUFFICIENCY IS TERMED ( ADDISON DISEASE(

ACTH DEF : o 1. 2. 3. CAUSES OF SECONDARY ADR INSUFFICIENCY : HYPOPITUITARISM HYPOTHALAMIC TUMOURS IRRADIATION OF THE CNS

ACTH DEF : o 1. 2. 3. 4. 5. 6. CLINICAL FEATURES: ANOREXIA APATHY AND CONFUSION DEHYDRATION FATIGUE HYPERKALEMIA, HYPONATREMIA HYPOGLYCEMIA

ACTH DEF : 7. 8. 9. 10. 11. HYPOVOLEMIA POSTURAL HYPOTENSION SALT CRAVING WEAKNESS NAUSEA AND VOMITING IN ACUTE INSUFFICIENCY (ADR CRISIS) ALSO MAY HAVE ABD PAIN AND FEVER.

o o o o BRADYCARDIA DIMINISHED PULSE PRESSURE RADIOLOGY: ENLARGED CARDIAC SILHOUETTE ECG: LOW VOLTAGE & PROLONGED CONDUCTION TIME GFR IMPAIRED CONJUGATION AND EXCRETION OF DRUGS AND BILIRUBIN IS IMPAIRED ANEMIA NOT RESPONDING TO IRON THERAPY MARKED DELAY IN CNS DEVELOPMENT ( FIRST 2 -3 YEARS OF LIFE)

TSH

TSH EXCESS o o o CF : NERVOUSNESS, PALPITATION, INCREASED APETITE AND MUSCLE WEAKNESS. MARKED WT LOSS? EXOPTHALMOS, LID-LAG etc BEHAVIOR ABNORMALITIES, DECLINING SCHOOL PERFORMANCE AND EMOTIONAL INSTABILITY.

TSH DEF ; PITUITARY (TSH) DEFICIENCY ; o o o o CLASSIC FACIES BECOME MORE EVIDENT WITH AGE ( ACCUMULATION OF MYXEDEMA): Protruding tongue, hoarse cry CONISTIPATION LETHARGY HYPOTHERMIA PALLOR POTBELLY HYPOTONIA UMBILICAL HERNIA

TSH DEF ; NEWBORN SCREENING FOR CONGENITAL HYPOTHYROIDISM: 1 -TSH level 2 -T 4 level o

FSH, LH

-; FSH and LH o In the ovaries: FSH follicular maturation & oestrogen production LH triggers ovulation & maintains progesterone production.

-; FSH and LH o In the testis: FSH acts on Sertoli-Leydig cells to initiate spermatogenesis LH acts on the Leydig cells to stimulate testosterone production

POSTIRIOR PITUITARY; -

DIABETES ISIPIDUS

DIABETES ISIPIDUS A RARE DISEASE CHARACTERIZED BY; = POLYURIA. = POLYDYPSIA DUE TO DEFICINCY OF ( ADH ). o THERE IS AN X-LINKED TYPE CAUSED BY UNRESPONSIVENESS OF THE KIDNEYS TO AVP (NEPHROGENIC TYPE) o

o o o LAB: URINE SP GRAVITY 1. 001 - 1. 005 COMPLICATIONS: IN VERY YOUNG CHILDREN, HYPERPYREXIA, HYPERNATREMIA. TRT: DESSMOPRESSIN INTRANASALY