Disorders of pituitary gland

1. Pituitary gland Saddam Ansari Tbilisi State Medical University

2. Disorders of Pituitary Gland

3. Causes of Disorder of Pituitary Gland Mainly of 2 reasons: Hyperactivity Hypoactivity

4. Disorders of Pituitary Gland Parts involved Hyperactivity Hypoactivity Anterior Pituitary Gigantism Acromegaly Acromegalic gigantism Cushing’s disease Dwarfism Acromicria Simmond’s disease Posterior Pituitary Syndrome of inappropriate hypersecretion of ADH (SIADH) Diabetes insipidus Anterior and Posterior Pituitary ……. Dystrophia adiposogenitalis

5. Disorders of Pituitary Gland Parts involved Hyperactivity Hypoactivity Anterior Pituitary Gigantism Acromegaly Acromegalic gigantism Cushing’s disease Dwarfism Acromicria Simmond’s disease Posterior Pituitary Syndrome of inappropriate hypersecretion of ADH (SIADH) Diabetes insipidus Anterior and Posterior Pituitary ……. Dystrophia adiposogenitalis

6. Gigantism Pituitary disorder characterized by: Excess growth of body Average height is approximately 7 – 8 feet

7. Continued… Causes of Gigantism Hypersecretion of GH in childhood or in pre – adult Tumor of acidophilic cells of Anterior pituitary

8. Continued… Signs and Symptoms Huge stature : 7 or 8 feet height Hyperglycemia , develop glycosuria , pituitary diabetes mellitus Headache due to tumor of pituitary

9. Continued… Visual disturbances Gigantism ends in hypopituitarism (burning of cells of anterior pituitary )

10. Disorders of Pituitary Gland Parts involved Hyperactivity Hypoactivity Anterior Pituitary Gigantism Acromegaly Acromegalic gigantism Cushing’s disease Dwarfism Acromicria Simmond’s disease Posterior Pituitary Syndrome of inappropriate hypersecretion of ADH (SIADH) Diabetes insipidus Anterior and Posterior Pituitary ……. Dystrophia adiposogenitalis

11. Acromegaly Anterior pituitary disorder characterized by: Enlargement, thickening, and broadening of bones Particularly extremities of the body

12. Continued… Causes of Acromegaly Hypersecretion of GH after fusion of epiphysis with shaft of bone Adenomatous tumor of anterior pituitary involving the acidophilic cells.

13. Continued... Signs and symptoms Striking features are protrusion of : Supraorbital ridges Broadening of nose Thickening of lips Thickening and wrinkles formation on forehead Lower jaw ( prognathism ) Face with these features called as acromegalic or guerilla face

14. Continued… Signs and symptoms Kyphosis : enlargement of hands and feet with bowing spine Scalp is thickened and thrown into folds Overgrowth of body hair Visceral organs are enlarged

15. Continued… Signs and symptoms Thyroid , parathyroid and adrenal glands shows hyperactivity Hyperglycemia and glucosuria Hypertension Headache Visual disturbance – Bitemporal hemianopia

16. Disorders of Pituitary Gland Parts involved Hyperactivity Hypoactivity Anterior Pituitary Gigantism Acromegaly Acromegalic gigantism Cushing’s disease Dwarfism Acromicria Simmond’s disease Posterior Pituitary Syndrome of inappropriate hypersecretion of ADH (SIADH) Diabetes insipidus Anterior and Posterior Pituitary ……. Dystrophia adiposogenitalis

17. Acromegalic Gigantism Rare disorder Due to hypersecretion of GH in children,before fusion of epiphysis with the shaft of bone results in Gigantism If hyersecretion of GH is continued after the fusion of epiphysis the symptoms of Acromegaly also appear

18. Disorders of Pituitary Gland Parts involved Hyperactivity Hypoactivity Anterior Pituitary Gigantism Acromegaly Acromegalic gigantism Cushing’s disease Dwarfism Acromicria Simmond’s disease Posterior Pituitary Syndrome of inappropriate hypersecretion of ADH (SIADH) Diabetes insipidus Anterior and Posterior Pituitary ……. Dystrophia adiposogenitalis

19. Cushing’s Disease Rare disease characterized by obesity

20. Continued… Cause Hypersecretion of glucocorticoids mainly cortisol Either pituitary origin or adrenal origin Cushing’s Cushing’s disease syndrome

21. Continued… Pituitary origin Increased secretion of ACTH leads to hyperplasia of adrenal cortex therefore, hypersecretion of glucocorticoids takes place ACTH is increased by Tumor in pituitary cells ( basophilic cells) Malignant tumor of nonendocrine origin like cancer of lungs or abdominal viscera Hypothalamic disorder causing hypersecretion of corticotropin releasing hormone

22. Continued… Signs and symptoms 1. Disproportionate distribution of body fat results: Moon face : Fat accumulation and retention of water and salt Torso : Fat accumulation in chest and abdomen but slim legs and arms Buffalo hump : Fat deposit on the back of neck and shoulder Pot belly : Fat accumulation in upper abdomen

23. Continued… 2. Purple striae : Reddish purple stripes on abdomen due to mainly three reasons: Stretching of abdominal wall by excess subcutaneous fat Rupture of subdermal tissues due to stretching Deficiency of collagen fibres due to protein depletion

24. Continued… 3. Thinning of extremities 4. Thinning of skin and subcutaneous tissues 5. Darkening of skin on neck ( aconthosis ) 6. Pigmentation of skin 7. Facial redness (facial plethora) 8. Weakening of muscle

25. Continued… 9. Facial hair growth ( Hirsutism ) 10. Bone resorption leads to osteoporosis 11. Hyperglycemia due to gluconeogeneis leads adrenal diabetes and glycosuria 12. Hypertension 13. Immunosuppression resulting in susceptibility for infection 14. Poor healing

26. Disorders of Pituitary Gland Parts involved Hyperactivity Hypoactivity Anterior Pituitary Gigantism Acromegaly Acromegalic gigantism Cushing’s disease Dwarfism Acromicria Simmond’s disease Posterior Pituitary Syndrome of inappropriate hypersecretion of ADH (SIADH) Diabetes insipidus Anterior and Posterior Pituitary ……. Dystrophia adiposogenitalis

27. Dwarfism Pituitary disorder in children characterized by stunted growth

28. Cause of Dwarfism Reduction in the GH in infancy or early childhood Occurs because of following reasons: Deficiency of GH releasing hormone from hypothalamus Deficiency of Somatomedin – C Atrophy of acidophilic cells in the adenohypophysis Tumor of chromophobes : nonfunctioning tumor , compresses and destroys the normal cells Panhypopituitarism

29. Signs and Symptoms Stunted skeletal growth Maximum height approximately 3 feet Head becomes slightly larger in relation of body Mental activity is normal without any deformity Reproductive system is not affected due to lack of GH but in Panhypopituitarism puberty is not obtained due to lack of gonadotropic hormone

30. Types of Dwarfism Laron dwarfism Psychogenic dwarfism Dwarfism in dystrophia adiposogenitalis

31. Laron Dwarfism Genetical disorder Called as GH insensitivity Occurs due to presence of abnormal GH secretagogue receptors in liver GHS becomes abnormal due to mutation in genes responsible for receptor Doesn’t depend on amount of GH secretion , hormone can’t stimulate the growth due to abnormal GHS

32. Psychogenic Dwarfism Due to extreme emotional deprivation or stress Deficiency of GH Also called as psychosocial dwarfism or Stress dwarfism

33. Dwarfism in D ystrophia adiposogenitalis Called as Frohlich syndrome Rare childhood disorder Characterized by : Obesity Growth retardation Retarded development of genital organs Associated with tumors of hypothalamus – increased appetite and decrease in gonadotropin hormone

34. Disorders of Pituitary Gland Parts involved Hyperactivity Hypoactivity Anterior Pituitary Gigantism Acromegaly Acromegalic gigantism Cushing’s disease Dwarfism Acromicria Simmond’s disease Posterior Pituitary Syndrome of inappropriate hypersecretion of ADH (SIADH) Diabetes insipidus Anterior and Posterior Pituitary ……. Dystrophia adiposogenitalis

35. Acromicria Rare disease in adults characterized by the atrophy of the extremities of the body

36. Causes of Acromicria Deficiency of GH in adults Secretion of GH decreases in the following conditions: Deficiency of GH releasing hormone Atrophy of acidophilic cells in the anterior pituitary Tumor of chromophobes Panhypopituitarism

37. Signs and Symptoms Atrophy and thinning of extremities ( major symptoms ) Associated with hypothyroidism Hyposecretion of adrenocortical hormone Person becomes lethargic and obese Loss of sexual function

38. Disorders of Pituitary Gland Parts involved Hyperactivity Hypoactivity Anterior Pituitary Gigantism Acromegaly Acromegalic gigantism Cushing’s disease Dwarfism Acromicria Simmond’s disease Posterior Pituitary Syndrome of inappropriate hypersecretion of ADH (SIADH) Diabetes insipidus Anterior and Posterior Pituitary ……. Dystrophia adiposogenitalis

39. Simmond’s Disease Rare pituitary disease Also called as cachexia Occurs mostly in panhypopituitarism

40. Signs and Symptoms Developing senile decay Senile decay is due to deficiency of hormone from target glands of anterior pituitary e.g. thyroid gland, adrenal cortex and the gonads Loss of hair and loss of teeth The skin on face becomes dry and wrinkled. ( most common )

41. Summary….. Parts involved Hyperactivity Hypoactivity Anterior Pituitary Gigantism Acromegaly Acromegalic gigantism Cushing’s disease Dwarfism Acromicria Simmond’s disease Posterior Pituitary Syndrome of inappropriate hypersecretion of ADH (SIADH) Diabetes insipidus Anterior and Posterior Pituitary ……. Dystrophia adiposogenitalis

42. Disorders of Pituitary Gland Parts involved Hyperactivity Hypoactivity Anterior Pituitary Gigantism Acromegaly Acromegalic gigantism Cushing’s disease Dwarfism Acromicria Simmond’s disease Posterior Pituitary Syndrome of inappropriate hypersecretion of ADH (SIADH) Diabetes insipidus Anterior and Posterior Pituitary ……. Dystrophia adiposogenitalis

43. Syndrome of Inappropriate Hypersecretion of Antidiuretic hormone Disease characterized by loss of sodium through urine due to hypersecretion of ADH

44. C auses Due to cerebral tumors, lung tumors and lung cancers because the tumor cells secrete ADH Normal secretion of ADH makes the plasma hypotonic Hypotonic solution inhibits the ADH secretion and restoration of plasma osmolarity takes place But in SIADH ,secretion of ADH from tumor is not inhibited by hypotonic plasma

45. Signs and Symptoms Loss of appetite Weight loss Nausea and vomiting Headache Muscle weakness , spasm and cramps Fatigue Restlessness and irritability In severe conditions patient die because of coma and convulsions

46. Disorders of Pituitary Gland Parts involved Hyperactivity Hypoactivity Anterior Pituitary Gigantism Acromegaly Acromegalic gigantism Cushing’s disease Dwarfism Acromicria Simmond’s disease Posterior Pituitary Syndrome of inappropriate hypersecretion of ADH (SIADH) Diabetes insipidus Anterior and Posterior Pituitary ……. Dystrophia adiposogenitalis

47. Diabetes Insipidus Posterior Pituitary disorder characterized by excess excretion of water through urine

48. Causes Develops due to the deficiency of ADH which occurs in the following conditions: Lesion (injury) or degradation of supraoptic and paraventricular nuclei of hypothalamus Lesion in hypothalamo-hypophyseal tract Atrophy of posterior pituitary Inability of renal tubules to give response to ADH hormone. Called as Nephrogenic diabetic insipidus .

49. Signs and Symptoms 1.Polyuria Excretion of large quantity of dilute urine with increased frequency of voiding is called polyuria Daily output is 4 to 12 liters. Due to absence of ADH ,the epithelial cells of distal convoluted tubule in the nephron and the collecting duct of the kidney becomes impermeable to water

50. Continued… 2.Polydipsia Intake of excess water Because of polyuria ,thirst center in hypothalamus results in intake of large quantity of water

51. Continued… 3.Dehydration In some cases ,the thirst center in the hypothalamus is also affected by the lesion Therefore water intake decreases in these patients and, the loss of water through urine is not compensated

52. Disorders of Pituitary Gland Parts involved Hyperactivity Hypoactivity Anterior Pituitary Gigantism Acromegaly Acromegalic gigantism Cushing’s disease Dwarfism Acromicria Simmond’s disease Posterior Pituitary Syndrome of inappropriate hypersecretion of ADH (SIADH) Diabetes insipidus Anterior and Posterior Pituitary ……. Dystrophia adiposogenitalis

53. Dystrophia Adiposogenitalis Characterized by obesity and hypogonadism affecting mainly adolescent boys Also known as Frohlich syndrome or hypothalamic eunuchism

54. Causes Hypoactivity of both anterior and posterior pituitary Tumor in pituitary gland and hypothalamic regions concerned with food intake and gonadal development Injury or atrophy of pituitary gland Genetic inablility of hypothalamus to secrete luteinizing hormone

55. Symptoms Obesity (common feature) Sexual infantilism (failure to develop secondary sexual characters) Dwarfism occurs if disease starts in growing age Called as infantile or prepubertal type of Frohlich syndrome (in children) and adult type of Frohlich’s syndrome (in adults) Other features are loss of vision and diabetes