Presentation on Pituitary Disorders

Prepared byTanzina Rahman

Content

Pituitary Gland Sections of Pituitary land Types of Pituitary Tumor Tests, Diagnosis & Treatment of pituitary disorders

Pituitary gland

Located at the base of the brain, just behind the eyes and it sits in a tiny bony space called the sella turcica.

Small, cherry-shaped double structure attached by a stalk to the base of the brain.

Continue… Pituitary gland is connected directly to part of the brain called the hypothalamus.

Hypothalamus releases hormones into tiny blood vessels directly connected to the pituitary gland. These cause the pituitary gland to make its own hormones.

Master Gland

Releases substances which control the basic functions of

Growthmetabolism reproduction

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Anterior lobe

Intermediate lobe and

Posterior lobe

Sections of pituitary gland

PIYUITARY HORMONE & THEIR TARGETS

Hormone Increased level Decreased level

GH Gigantism (child)Acromegaly (adult)

Dwarfism (child)Lethargy, premature aging

ACTH Cushing’s Disease Addison’s Disease

TSH Goiter, increased BMR, HR, BPGraves disease

Decreased BMR, HR, CO, BPCretinism (children)

Prolactin amenorrhea Too little milk

FSH Late puberty, infertility

LH Menstrual cycle disturbance

Amenorrhea, impotence

Anterior Pituitary Disorders

Hormone Increased Decreased

OxytocinPrecipitates childbirth, excess milk

Prolonged childbirth, diminished milk

ADH (vassopressin)

Increased BP, decreased urinary output, edema.

Diabetes insipidus, dilute urine & increased urine output.

Posterior Pituitary Disorders

Pituitary Gland Tumor

Pituitary tumors are abnormal growths that develop in your pituitary gland.

The most frequent type of pituitary disorder is a pituitary gland tumor.

10% of all primary brain tumors are pituitary tumors

Hypersecretion, Hyposecretion, & Tumor mass effects are Problems Caused by Pituitary Tumor.

Disorders of the Pituitary Gland

Benign tumors of the pituitary gland. found due to hormonal imbalances that

affect bodily functions. relatively small when detected. remain confined to the sella turcica. People can develop pituitary adenomas at

any age. Most pituitary adenomas are in the front

part (anterior lobe) of the pituitary gland.

Pituitary Adenoma

Produce too much of hormone

Secretory

Tumor

Do not produce too much hormone

Non-Secreto

ry Tumor

PITUITARY TUMOR TYPES

Secretory Tumors Causes Prolactinoma

Acromegaly and Gigantism

Cushing's disease

Thyroid stimulating hormone (TSH)-secreting tumors

Symptoms

Changes in menstrual cycle Headaches Fatigue and decreased energy Infertility Vision problems Osteoporosis or bone loss Galactorrhea(breast milk production)

Prolactinoma

Diagnosis

Hormone testing Imaging tests

Treatment

Medication Cabergoline(0.5 mg per week) Bromocriptine

Surgery Radiation

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Side Effects

Dizziness Drowsiness nausea, Vomiting Diarrhea or constipation Confusion Depression

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Acromegaly is a rare disease caused by a GH-secreting pituitary adenoma in more than 99% of patients

Symptoms

Acral enlargement Excessive sweating Hypertension, congestive heart failure, arrhythmias Thick and coarse skin, skin tags Goiter Pituitary insufficiency Interrupted menstrual cycle  Deepening of the voice  Fatigue Osteoarthritis or bone loss

 

Acromegaly and Gigantism

Treatment Somatostatin analogs:

OCTREOTIDE LANREOTIDE SIGNIFOR ®LAR

Growth hormone antagonists: PREGVISOMANT

Side effects Slowed heart rat Nausea Vomiting diarrhea stomach pain Dizziness Headache

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Cushing's disease occurs when a pituitary tumor secretes too much ACTH, the hormone that stimulates the adrenal glands.  Too much ACTH causes the adrenal glands to produce excess cortisol.

CUSHING’S DISEASE: 

Treatment:

Surgery Radiation Medication -Pasireotide -Cyproheptadine -ketoconazole

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A TSH-secreting pituitary tumor produces too much thyroid-stimulating hormone, which then causes the thyroid gland to make too much thyroid hormone.  This leads to hyp.erthyroidism.

Symptoms  Fast heartbeat Irregular menstrual cycle Headaches Visual disturbances Difficulty sleeping More frequent bowel movements Inability to tolerate heat Excessive sweating Fatigue Weight loss Shakiness Nervousness

THYROTROPIN (TSH)-secreting tumors

Treatment

Transsphenoidal microsurgery through the nasal sinuses.

Somatostatin analogue is an effective medication to reduce TSH levels, which in turn lowers thyroid hormone levels.

Radiation therapy. Radiation therapy will destroy the remaining tumor, but the process is slow.

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Non-functioning adenomas: some tumors of the pituitary do not secret too many

hormones Instead, they cause health problems because of their size and location.

It cause headaches and vision problems.

It includes- Craniopharyingiomas and Rathke's cleft cysts

Non-Secretory Tumors Causes

These masses on or near the pituitary gland are non-cancerous growths, but they may be mistaken for a pituitary tumor on an MRI scan.

Do not arise from the hormone-producing cells of the pituitary gland.

Craniopharyngiomas are most common during childhood, but can also be found and cause problems in older adults.

Craniopharyingiomas and Rathke's cleft cysts

Growth failure in children Delayed puberty in children Reduced or loss of sex drive Constipation Nausea Frequent urination Excessive thirst Obesity Headaches Menstrual irregularities/loss of menstrual cycle Milk discharge from breasts Fatigue Dry skin Low blood pressure Visual disturbances Confusion

Symptoms of craniopharyngiomas and Rathke's cleft cysts are similar:

Treatment TeamRadiation oncologist Medical oncologist An endocrinologist A neurosurgeon A Neuro oncologist A specialist nurse

Tests, Diagnosis & Treatment of Pituitary Disorders

Tests and diagnosis

Doctor will use one or more tests to find out

Pituitary adenoma depends on the presenting symptoms

A list of the common tests, procedures, and scans that doctors can use to find out

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Factors Influencing Diagnostic Test

Doctor may consider these factors when choosing a diagnostic test:

• Age and medical condition• Type of tumor suspected• Signs and symptoms• Previous test results

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  Diagnosis of a Pituitary Tumor

(adenoma)

Blood and Urine tests Vision Testing Endocrine Diagnostics Brain Imaging

- Magnetic Resonance Imaging (MRI) scans-Computed Tomography (CT) scan

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Blood and Urine tests

A blood test may be recommended to measure the amounts of certain hormones in the blood.

If Cushing's disease is suspected, samples of saliva may be collected as well as one or more 24-hour urine samples.

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Macro adenoma on magnetic resonance

imaging.

Macro adenoma (arrow) on computed tomography

Brain Imaging:

Magnetic resonance imaging (MRI) scan:

MRI scans use radio waves and strong magnets to create detailed pictures of the inside of the body.

The energy from the radio waves is absorbed and then released in a pattern formed by the type of tissue and by certain diseases.

The CT scan uses x-rays to create detailed cross-sectional images of part of the body.

CT scans can find a pituitary adenoma if it is large enough, but MRI scans are used much more often to look at the brain and pituitary gland.

Computed tomography (CT) scan:

Surgery1. Endoscopic Transnasal Transsphenoidal

Approach: -remove the tumor through nose and sinuses

without an external incision.

2. Ranial Transapproach (craniotomy): -Tumor is removed through the upper part of your

skull by way of an incision in your scalp.

Treatment of Pituitary Disorders

Radiation therapy

1. External beam radiation: -delivers radiation in small increments over a

period of time.

2. Gamma Knife stereotactic radio surgery: -focuses radiation beams precisely on the

tumor without an incision.

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