CSIM2.

26 Pituitary function
Pituitary tumours
Pathology
1. pituitary adenoma
a. functional tumours
b. non-functional
2. craniopharyngioma
3. tumours around the pituitary
4. secondary tumours
a. metastases

Local effects
1. Hypopituitarism
2. Chiasmal compression
a. Neuro-opthalmic dysfunction
b. Loss of visual acuity
c. Visual field defects
Bitemporal hemianopia
3. CN palsy
4. Obstructive hydrocephalus

Anterior pituitary
Thyroid
Adrenal

Pituitary
hormone
TSH
ACTH

Gonadal

FH, LSH

GH

GH

System

System
Thyroid
Adrena
l
Gonada
l
GH

Hormo
ne
TSH

Target
Hormone
T4, T3

ACTH

Cortisol

FH, LSH
GH

Target
Hormone
T4, T3
Cortisol
Testosterone,
E2
IGF-1

Testosterone,
E2
IGF-1

Insufficiency
Primary
Secondary
TSH, FT4/T3
TSH, FT4/T3
ACTH, cortisol
ACTH, cortisol
LH/FSH, Testo/E2
LH/FSH,
Testo/E2
Doesnt apply

Excess

Insufficient

Thyrotoxicosis
Cushings Disease
Reproductive Dysf(x)
Acromegaly

A. Prolactin Excess Hyperprolactinaemia

Causes

Clinical Features

1. drug induced
a. dopamine antagonists
b. antidepressants
c. opiates
2. functional pituitary tumour
a. microadenoma
b. macroadenoma
3. non-functioning tumour
a. disruption of hypophyseal-portal
tract

1. hypogonadism
a. secondary ammenorrhoea
b. sub-fertility
c. loss of libido
2. galactorrhoea (milk when not lactating)

Funtional Pituitary Tumour

Management
1. Dopamine agonist; Bromocriptine, cabergoline
2. Tumour control; Prolactin, tumour size, hypogonadism (testosterone)

B. Growth Hormone Excess

GH secreting pituitary tumour

Clinical features

Soft tissue overgrowth: Hand, feet, face, linear growth if pre-pubertal

Headache
Sweating
HPT
Hyperglycaemia
OA

Posterior
System

Pituitary
hormone

Kidney/Arteri
oles

AVP

Uterus

Oxytoxin

Target
Hormone

Insufficiency
Primary
Secondary

Diabetes Insipidus
1.
2.
3.
4.
5.

Coordinated physiology of AVP and thirst

Maintenance of plasma Na+
Balancing water input & output (AVP, thirst)
Defect in AVP production or action
Polyuria with dilute urine. 3 types: hypothalamic AVP deficiency (absolute vs relative),
nephrogenic (renal AVP resistance), and dipsogenic (excess fluid intake)

Hypothalamic DI
Acquired

1. tumour
a. craniopharyngioma
b. germ cell tumour
2. trauma
3. vascular
4. inflammatory
a. hypophysitis
b. LCH & sarcoid
5. idiopathic
a. autoimmune

Congenital/genetic
1. developmental
a. SOD
2. autosomal dominant
3. autosomal recessive
4. syndromic
a. Wolframs syndrome

Key points to remember:

1. Diabetes Insipidus: There is a low level of ADH produced
- Low Level of ADH equals excessive urinary output
2. SIADH: There is a high level of ADH produced
- High Level of ADH equals low urinary output