Pituitary Dysfunction PDF

ENDOCRINE PATHOLOGY: PITUITARY DYSFUNCTION Amal Sahyoun, PhD Assistant Professor, College of Dental Medicine [email protected] LEARNING OBJECTIVES Understand the etiologies and pathophysiology of pituitary dysfunction Identify the clinical features and laboratory findings of pituitary dysfunct...

ENDOCRINE PATHOLOGY: PITUITARY DYSFUNCTION Amal Sahyoun, PhD Assistant Professor, College of Dental Medicine [email protected] LEARNING OBJECTIVES Understand the etiologies and pathophysiology of pituitary dysfunction Identify the clinical features and laboratory findings of pituitary dysfunction Identify diagnostic approaches and treatment of pituitary dysfunction Pituitary dysfunction and oral manifestations PITUITARY GLAND -Anatomy: the pituitary gland is located immediately below the hypothalamus at the base of the skull  Connected to the hypothalamus by the pituitary stalk (= infundibulum)  Nested in the Sella turcica of the sphenoid bone  Surrounded by cranial nerves, optic nerve, ICA and cavernous sinus -Anterior pituitary hormone synthesis is regulated by: 1) Hypothalamus (direct) 2) Feedback regulation (indirect) PITUITARY GLAND -Pituitary gland is the “master gland” o Take signals from hypothalamus and send them out to almost all the other endocrine glands o Control other endocrine glands by activating their release of hormones o Divided into two sections: Anterior and Posterior lobes Anterior:  Thyroid stimulating hormone (TSH)  Adrenocorticotropic hormone (ACTH)  Growth hormone (increase growth and protein synthesis)  Prolactin (increase milk production)  Gonadotropin  Luteinizing Hormone (LH) and Follicle stimulating hormones Posterior: Antidiuretic hormone (ADH) and oxytocin PITUITARY GLAND PATHOLOGY - There are two types of pituitary disorders: (1) Hypopituitarism  low levels of pituitary hormones  Compression of the pituitary  Direct destruction (2) Hyperpituitarism  high levels of pituitary hormones  Hyperfunctioning H Y P O P IT UITARIS M https://emedicine.medscape.com/article/922410-overview HYPOPITUITARISM - Hypopituitarism due to:  Compression of the pituitary  Direct destruction - Cells producing hormones: Somatotroph Lactotroph Gonadotroph Thyrotroph Corticotroph Supraoptic nucleus (in Posterior pituitary) - Growth hormone Prolactin FSH and LH TSH ACTH ADH and oxytocin Lost first HYPOPITUITARISM : PITUITARY COMPRESSION - Pituitary macroadenoma o Abnormal tissue > 10 mm o Compress the pituitary  low pituitary hormones o Sits between optic chiasma compressing it  Bitemporal hemianopia: Loss of visual lateral fields o Increase intracranial pressure  Secondary Headache https://www.uclahealth.org/medical-services/surgery/endocrine-surgery/patient-resources/patienteducation/endocrine-surgery-encyclopedia/pituitary-tumor https://en.wikipedia.org/wiki/Bitemporal_hemianopsia REFERENCES  Robbins and Cotran Pathologic Basis of Disease, 9th edition or 10th edition. V Kumar; Elsevier Gary D. Hammer and Stephen J. McPhee Pathophysiology of Disease: An Introduction to Clinical Medicine, 8th edition. McGraw Hill. Goodman & Gilman's: The Pharmacological Basis of Therapeutics, 13e