endocrinology - university of sheffield...lecture outline 1.review the anatomy of the hypothalamus...
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ENDOCRINOLOGY“Pituitary hormone regulation
and presentation of pituitary disease”
Richard Ross
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Lecture outline
1.Review the anatomy of the hypothalamus and pituitary
2.Describe the regulation of pituitary hormones
3.Describe presentation of pituitary disease
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Pituitary Anatomy
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Pituitary
Pituitary Anatomy
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Pituitary
Pituitary Coronal Section
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The anterior pituitary has no arterial blood supply but receives blood through a portal venous circulation from the hypothalamus
Anatomy: Portal Circulation
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Discovery of hypothalamic hormones
One Million pig & 50 tons of sheep
hypothalami
Two humans
TRH 1969
GnRH 1971
SMS 1973
CRH 1981
GHRH 1982
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Pituitary – thyroid axis
TRH
TSHT4 & T3
-
-Hypothalamus
Pituitary
Thyroid
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SPERMTESTOSTERONE
PITUITARY
HYPOTHALAMUS
TESTOSTERONE+
FSHLH
SHBG
GnRH
Pituitary Gonadal Axis
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HPA Axis
Hypothalamus
Pituitary
Adrenal
ACTHCortisol
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GH / IGF-I AXIS
GHRH
GHIGF-I
+
-Hypothalamus
Pituitary
Liver
SMS-
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- ve
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SUMMARYRegulation of pituitary hormones
Hypothalamus
• GHRH & SMS• GnRH• CRH• TRH• Dopamine
Pituitary
• GH• LH & FSH• ACTH• TSH• Prolactin
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Presentation of pituitary disease
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Diseases of the pituitary
• Benign pituitary adenoma• Craniopharygioma• Trauma• Apoplexy / Sheehans• Sarcoid / TB
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Large pituitary tumour
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Craniopharygioma
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Tumours cause:1. Pressure on local structure e.g. optic nerves
– Bitemporal hemianopia
2. Pressure on normal pituitary– hypopituitarism
3. Functioning tumour – Prolactinoma– Acromegaly– Cushing’s disease
Presentation: 3 vital points
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1. Pressure on local structures
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Measuring the visual fields with a red pin
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Bitemporal hemianopia
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Functioning Pituitary Tumour
• Prolactinoma• Acromegaly and Gigantism• Cushing’s Disease
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Prolactin microadenoma
Tumour
Carotid
Pituitarystalk
OpticChiasm
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Galactorrhoea in a prolactinoma
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Prolactinomas
• More common in women• Present with galactorrhoea / amenorrhoea
/ infertility• Loss of libido• Visual field defect
• Treatment dopamine agonist eg Cabergoline or bromocriptine.
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Harvey Cushing
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Causes of Cushing’s syndrome
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Patients with a pituitary tumour:1.Is it pressing on optic chiasm2.Are they hypopituitary3.Do they have a functioning tumour
Summary