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The Pituitary Gland

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This tutorial is designed as a single presentation, but if you wish to review a particular section, click one of the links below... Location & anatomy of the pituitary and hypothalamus Posterior pituitary hormones Anterior pituitary hormones Control of the anterior pituitary

Clinical significance

Location of the Pituitary Gland


The pituitary gland controls the functions of many of the other endocrine glands.

It is about the size of a pea !.

Click on the pituitary gland to continue..

Location of the Pituitary Gland

This is the pituitary gland!

Lets now look at the anatomy of the pituitary gland and its relationship to the hypothalamus and surrounding tissues

Location of the pituitary and hypothalamus


The hypothalamus is located at the base of the brain in the posterior part of the forebrain (diencephalon).
Optic chiasm Anterior pituitary

Hypothalamus
Mamillary body
Pituitary stalk

The pituitary is located at the base of the brain within a bony cavity called the sella turcica.

Posterior pituitary

Sella turcica

Location of the pituitary and hypothalamus

Hypothalamus
Mamillary body
Pituitary stalk

The pituitary gland itself consists of two main parts: the anterior lobe (adenohypophysis)

Optic chiasm Anterior pituitary

Posterior pituitary

the posterior lobe (neurohypophysis)

Sella turcica

Anatomy of the hypothalamus and pituitary gland


The hypothalamus is the integration centre for many physiological processes in the body
Hypothalamus

Infundibulum

Neurosecretory neurones

Anterior pituitary

Posterior pituitary

Anatomy of the hypothalamus and pituitary gland


The hypothalamus is the integration centre for many physiological processes in the body. It is made up of nervous tissue and contains specialised neurones arranged in groups called nuclei. These include the preoptic, the supraoptic and the paraventricular nuclei.
Paraventricular nucleus

Supraoptic nucleus Preoptic nucleus

Hypothalamus

Infundibulum

Neurosecretory neurones

Anterior pituitary

Posterior pituitary

Anatomy of the hypothalamus and pituitary gland


The hypothalamus is the integration centre for many physiological processes in the body. It is made up of nervous tissue and contains groups of specialised neurones called nuclei. These include the preoptic, the supraoptic and the paraventricular nuclei. These nuclei have axons, which terminate in the posterior lobe of the pituitary.
Paraventricular nucleus

Supraoptic nucleus Preoptic nucleus

Hypothalamus

Infundibulum

Neurosecretory neurones

nerve axons

Anterior pituitary

Posterior pituitary

Anatomy of the hypothalamus and pituitary gland


Paraventricular nucleus

The anterior lobe is larger than the posterior lobe and has three parts: the pars tuberalis, which forms a sleeve round the pituitary stalk the pars distalis (the major part) the pars intermedia, which adjoins the posterior lobe

Supraoptic nucleus Preoptic nucleus

Hypothalamus

Neurosecretory neurones

Infundibulum

Anterior pituitary
Posterior pituitary

To understand and remember how the pituitary gland works, it is important to understand how the pituitary is formed during development.

Development of the pituitary gland

The two lobes of the pituitary develop from different embryological tissues.
Anterior lobe Posterior lobe

The POSTERIOR pituitary is neural tissue derived from primitive ectoderm. It develops as a downgrowth from the hypothalamus. The ANTERIOR pituitary consists of epithelial tissue and develops upwards as an outgrowth from the roof of the mouth.

Development of the pituitary gland


1. Outgrowths of tissue begin to appear from the hypothalamus and the roof of the mouth Infundibulum growing down from the hypothalamus Outgrowth of epithelial cells growing up from the roof of the mouth 3. The immature anterior pituitary lobe separates from the roof of the mouth

Immature anterior pituitary gland roof of mouth

4. The anterior and posterior pituitary lobes mature and the bony sella turcica forms 2. The two outgrowths of tissue start to fuse together

anterior lobe sella turcica

posterior lobe

Connections between the hypothalamus and the anterior pituitary gland

In this photograph you can see the lower part of the hypothalamus connected to the pituitary gland by the pituitary stalk or infundibulum.

Hypothalamus

Pituitary stalk

Pituitary

Connections between the hypothalamus and the anterior pituitary gland

In this photograph you can see the lower part of the hypothalamus connected to the anterior pituitary by the pituitary stalk or infundibulum.

A network of blood capillaries in the hypothalamus drain into larger portal blood vessels, which link the hypothalamus to the anterior pituitary.

Portal blood vessels

Connections between the hypothalamus and the anterior pituitary gland

In this photograph you can see the lower part of the hypothalamus connected to the anterior pituitary by the pituitary stalk or infundibulum.

neurones

A network of blood capillaries in the hypothalamus drain into larger portal blood vessels, which link the hypothalamus to the anterior pituitary.

Portal blood vessels

Some of the neurones in the hypothalamus terminate close to the blood capillaries in the hypothalamus, but there is NO direct neural connection between the hypothalamus and the anterior pituitary gland.

You have now seen: 1. The anatomical structure of the pituitary gland 2. Its spatial and anatomical relationship with the hypothalamus

3. How each pituitary lobe develops embryologically

Lets now look at the posterior pituitary gland in more detail.

Posterior Pituitary Hormones

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Control of the posterior pituitary gland


Hypothalamus

The posterior pituitary secretes 2 important hormones : Anti-diuretic hormone (ADH), also called vasopressin

Infundibulum

Axons of hypothalamichypophyseal tract

Oxytocin

Posterior pituitary

ADH
Anterior Anterior pituitary pituitary

kidney

pituitary vein

Oxytocin

breast and uterus

Control of the posterior pituitary gland


Supraoptic nucleus Paraventricular Hypothalamus nucleus

Both hormones are peptides, which are synthesised in the cell bodies of neurones in the paraventricular and supraoptic nuclei of the hypothalamus.

Infundibulum

Axons of hypothalamichypophyseal tract

ADH
Anterior Anterior pituitary pituitary

pituitary vein

Oxytocin

Control of the posterior pituitary gland


Supraoptic nucleus Paraventricular Hypothalamus nucleus

The hormones travel from the hypothalamus to the posterior pituitary via axons in the pituitary stalk. This neuronal connection is called the hypothalamichypophyseal tract.

Infundibulum

Axons of hypothalamichypophyseal tract

ADH
Anterior Anterior pituitary pituitary

pituitary vein

Oxytocin

Control of the posterior pituitary gland


Supraoptic nucleus Paraventricular Hypothalamus nucleus

Infundibulum

Axons of hypothalamichypophyseal tract

The hormones are stored in the axon terminals in the posterior pituitary and can be secreted into the bloodstream when nerve impulses travel down the neurones

ADH
Anterior Anterior pituitary pituitary

pituitary vein

Oxytocin

What are the actions of the posterior pituitary hormones?

Anti-diuretic hormone (ADH) (vasopressin)


ADH secretion is stimulated by low blood pressure ADH increases water reabsorption in the kidney and so modulates blood pressure A deficiency in ADH causes diabetes insipidus (polyuria, hypotension)

External stimulus e.g. low blood pressure

Posterior pituitary

ADH

Oxytocin
Oxytocin secretion is stimulated by stretching of the cervix during birth and suckling of the baby at the breast Oxytocin stimulates uterine contractions during labour and the milk ejection reflex after birth

External stimulus e.g. stretching of cervix or suckling

Posterior pituitary

A deficiency of oxytocin causes a failure to progress in labour and difficulty with breast feeding

Oxytocin

Now lets look at the anterior pituitary gland:

1. The cellular structure of the anterior pituitary gland.

2. What hormones does it secrete?

3. What are the effects of these hormones?

Anterior Pituitary Hormones

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Cellular structure of the anterior pituitary gland


The anterior pituitary is composed of groups of epithelial cells surrounded by wide capillaries called GH sinusoids. Different populations of cells produce different hormones.
For example:

GH
sinusoid

GH
ANTERIOR PITUITARY

Somatotrophs produce growth hormone (GH)

GH

The anterior pituitary is composed of groups of epithelial cells surrounded by wide capillaries called sinusoids. Different populations of cells produce different hormones. PRL

PRL

PRL

sinusoid

ANTERIOR PITUITARY PRL

Lactotrophs produce prolactin (PRL)

The anterior pituitary is composed of groups of epithelial cells surrounded by wide capillaries called TSH sinusoids. Different populations of cells produce different hormones.

TSH
ANTERIOR PITUITARY

sinusoid

TSH

TSH Thyrotrophs produce thyroid-stimulating hormone (TSH)

The anterior pituitary is composed of groups of epithelial cells surrounded by wide capillaries called sinusoids. Different populations of cells produce different hormones.

MSH ACTH

MSH
sinusoid

ANTERIOR PITUITARY ACTH ACTH

MSH Corticotrophs produce both adrenocorticotrophic hormone (ACTH) and melanocyte-stimulating hormone (MSH)

The anterior pituitary is composed of groups of epithelial cells surrounded by wide capillaries called sinusoids. LH Different populations of cells produce different hormones. FSH

FSH

sinusoid

LH FSH

ANTERIOR PITUITARY

Gonadotrophs produce luteinising hormone (LH) and follicle-stimulating hormone (FSH)

The following screens give a brief summary of what the anterior pituitary hormones do. Each hormone may be dealt with in more detail in other presentations.

Anterior pituitary hormones - Growth Hormone

1. Growth Hormone (GH) regulates growth in the muscles and bones and opposes the action of insulin
Somatotrophs in the anterior pituitary gland secrete GH

GH

1. Growth Hormone (GH) regulates growth in the muscles and bones and opposes the action of insulin
Somatotrophs in the anterior pituitary gland secrete GH Many body cells (chondrocytes, fat cells, muscle, but mainly the liver) respond to GH by secreting insulin-like growth factor (IGF)
IGF

GH

1. Growth Hormone (GH) regulates growth in the muscles and bones and opposes the action of insulin
Somatotrophs in the anterior pituitary gland secrete GH Many body cells (chondrocytes, fat cells, muscle, but mainly the liver) respond to GH by secreting insulin-like growth factor (IGF)
IGF

GH

Therefore, GH acts indirectly via IGF to regulate body growth Growth and cellular differentiation in bone, muscle and adipose cells

Anterior pituitary hormones - LH and FSH


2. Luteinising Hormone (LH) and Follicle Stimulating Hormone (FSH) control both the ovaries and testes
Gonadotrophs in the anterior pituitary gland secrete LH and FSH
LH FSH

2. Luteinising Hormone (LH) and Follicle Stimulating Hormone (FSH) control both the ovaries and testes
Gonadotrophs in the anterior pituitary gland secrete LH and FSH
LH In the female, LH and FSH stimulate the ovary. FSH

inhibin

ovary

oestrogen

progesterone

2. Luteinising Hormone (LH) and Follicle Stimulating Hormone (FSH) control both the ovaries and testes
Gonadotrophs in the anterior pituitary gland secrete LH and FSH
LH In the female, LH and FSH stimulate the ovary. FSH

inhibin The ovarian steroid hormones (oestradiol and progesterone) have effects on many other parts of the body (bone, brain, vascular tissue etc.), secondary sexual characteristics and behaviour.

ovary

oestrogen

progesterone

Effects on bone, brain, vascular tissue etc., behaviour

2. Luteinising Hormone (LH) and Follicle Stimulating Hormone (FSH) control both the ovaries and testes
Gonadotrophs in the anterior pituitary gland secrete LH and FSH LH In the male, LH and FSH stimulate the Leydig cells and the Sertoli cells in the testis, respectively, to secrete testosterone and inhibin
testosterone

FSH

inhibin

testis

2. Luteinising Hormone (LH) and Follicle Stimulating Hormone (FSH) control both the ovaries and testes
Gonadotrophs in the anterior pituitary gland secrete LH and FSH LH In the male, LH and FSH stimulate the Leydig cells and the Sertoli cells in the testis, respectively, to secrete testosterone and inhibin
testosterone

FSH

inhibin

testis

Spermatogenesis, secondary sexual characteristics and behaviour

Anterior pituitary hormones - Prolactin


3. Prolactin (PRL) initiates lactation and promotes the growth of the mammary glands, ovaries and testes

Lactotrophs in the anterior pituitary gland secrete PRL

PRL

3. Prolactin (PRL) initiates lactation and promotes the growth of the mammary glands, ovaries and testes

Lactotrophs in the anterior pituitary gland secrete PRL

PRL

Prolactin acts directly on the breast to stimulate milk production.

Milk production breast

3. Prolactin (PRL) initiates lactation and promotes the growth of the mammary glands, ovaries and testes

Lactotrophs in the anterior pituitary gland secrete PRL

PRL

Prolactin acts directly on the breast to stimulate milk production.

Milk production breast

Growth of mammary glands, ovaries and testes

Anterior pituitary hormones - Thyroid-stimulating hormone


4. Thyroid-stimulating hormone (TSH) regulates the thyroid gland

Thyrotrophs in the anterior pituitary gland secrete TSH TSH

4. Thyroid-stimulating hormone (TSH) regulates the thyroid gland


Thyrotrophs in the anterior pituitary gland secrete TSH TSH TSH acts on the thyroid gland to stimulate the release of thyroid hormones (Thyroxine, T4, Tri-iodothyronine, T3.
parathyroids

thyroid

Thyroid hormones

Anterior pituitary hormones - Thyroid-stimulating hormone


4. Thyroid-stimulating hormone (TSH) regulates the thyroid gland
Thyrotrophs in the anterior pituitary gland secrete TSH TSH

4. Thyroid-stimulating hormone (TSH) regulates the thyroid gland


Thyrotrophs in the anterior pituitary gland secrete TSH TSH TSH acts on the thyroid gland to stimulate the release of thyroid hormones (Thyroxine, T4, Tri-iodothyronine, T3, and Calcitonin) as well as changes to the thyroid gland

parathyroids

thyroid

Thyroid hormones

4. Thyroid-stimulating hormone (TSH) regulates the thyroid gland


Thyrotrophs in the anterior pituitary gland secrete TSH TSH TSH acts on the thyroid gland to stimulate the release of thyroid hormones (Thyroxine, T4, Tri-iodothyronine, T3.
parathyroids

thyroid

The thyroid hormones play an important role in controlling control carbohydrate and fat metabolism, and basal metabolic rate.

Thyroid hormones Metabolism, heat production, growth.

Anterior pituitary hormones - Adrenocorticotrophic hormone


5. Adrenocorticotrophic hormone (ACTH) controls hormone secretion from the adrenal cortex
Corticotrophs in the anterior pituitary gland secrete ACTH
ACTH

5. Adrenocorticotrophic hormone (ACTH) controls hormone secretion from the adrenal cortex
Corticotrophs in the anterior pituitary gland secrete ACTH
ACTH acts on the adrenal cortex to stimulate the release of glucocorticoids (mainly cortisol) and adrenal androgens (mainly androstenedione and dehydroepiandrosterone (DHEA)) ACTH

adrenal cortex

Adrenal cortex hormones

5. Adrenocorticotrophic hormone (ACTH) controls hormone secretion from the adrenal cortex
Corticotrophs in the anterior pituitary gland secrete ACTH
ACTH acts on the adrenal cortex to stimulate the release of glucocorticoids (mainly cortisol) and adrenal androgens (mainly androstenedione and dehydroepiandrosterone (DHEA))
Cortisol controls the metabolism of carbohydrates, fats and proteins, inflammatory and immune responses, and responses to stress

ACTH

adrenal cortex

Adrenal cortex hormones

Metabolism, immune system, stress responses, testosterone and oestrogen

Anterior pituitary hormones - Melanocyte-stimulating hormone


6. Melanocyte Stimulating Hormone (MSH) stimulates melanocytes in the skin
Corticotrophs in the anterior pituitary gland also secrete MSH MSH

6. Melanocyte Stimulating Hormone (MSH) stimulates melanocytes in the skin


Corticotrophs in the anterior pituitary gland secrete MSH MSH MSH acts on melanocytes in the epidermis of the skin to stimulate the secretion of melanin

melanocytes in the skin

Melanin

6. Melanocyte Stimulating Hormone (MSH) stimulates melanocytes in the skin


Corticotrophs in the anterior pituitary gland secrete MSH MSH MSH acts on melanocytes in the epidermis of the skin to stimulate the secretion of melanin

melanocytes in the skin

Melanin controls pigmentation in the skin

Melanin

Skin pigmentation

Summary of hormones secreted by the anterior pituitary gland


So the anterior pituitary secretes at least 7 important hormones:
Growth Hormone (GH) regulates growth in muscles and bones and opposes the action of insulin Prolactin initiates lactation and promotes the growth of the mammary glands, ovaries and testes Luteinising Hormone (LH) and Follicle Stimulating Hormone (FSH) Thyroid Stimulating Hormone (TSH) regulates the thyroid gland Adrenocorticotrophic Hormone (ACTH) controls hormone secretion from the adrenal cortex Melanocyte Stimulating Hormone (MSH) stimulates melanocytes in the skin

control both the ovaries and the testes

Essentials in Biomedical Science


Control of the Anterior Pituitary

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Kings College London Date last modified: 26/09/2001 Stuart Milligan Victoria Pocock

But what controls the differential secretion of the anterior pituitary gland hormones?

The following screens will show:

1. How the hypothalamus controls the anterior pituitary gland

2. The importance of negative feedback control of the hypothalamic-pituitary axis.

Hypothalamic control of the anterior pituitary hormones


We have already seen that many neurones terminate in the base of the hypothalamus in close association with the portal blood vessels.

Hypothalamus
These hypothalamic neurones release neurosecretory hormones into the portal blood vessels
portal blood vessels

hypothalamic neurones

NEUROSECRETORY HORMONES

The hypothalamic hormones control the release of anterior pituitary hormones

Anterior pituitary

Hypothalamic control of the anterior pituitary hormones

Let us look at how the hypothalamic hormones control the release of anterior pituitary hormones using thyroid stimulating hormone (TSH) as an example..

In the cold, specific neurones in the hypothalamus secrete the neurosecretory hormone Thyrotrophin Releasing Hormone (TRH)

Only certain neurones in the hypothalamus can secrete TRH. Other hypothalamic neurones secrete different neurosecretory hormones under different conditions.

+
Low temperature Hypothalamus hypothalamic neurones

TRH
Anterior pituitary

+
Low temperature Hypothalamus hypothalamic neurones

Increased body temperature

TRH
TSH
thyrotrophs

Anterior pituitary
Thyroid hormones Thyroid

TRH stimulates the thyrotrophs in the anterior pituitary to secrete thyroid stimulating hormone (TSH)

TSH then stimulates the thyroid to release thyroid hormones, which subsequently cause an increase in body temperature

Hypothalamic hormones that control the anterior pituitary


The hypothalamus secretes several hormones that control the secretion of anterior pituitary hormones:
Growth Hormone Releasing Hormone (GHRH) Somatostatin

GH

Hypothalamic hormones that control the anterior pituitary


The hypothalamus secretes several hormones that control the secretion of anterior pituitary hormones:
Growth Hormone Releasing Hormone (GHRH) Somatostatin

Corticotrophin Releasing Hormone (CRH)

ACTH

Hypothalamic hormones that control the anterior pituitary


The hypothalamus secretes several hormones that control the secretion of anterior pituitary hormones:
Growth Hormone Releasing Hormone (GHRH) Somatostatin

Corticotrophin Releasing Hormone (CRH)


Gonadotrophin Releasing Hormone (GnRH)

LH FSH

Hypothalamic hormones that control the anterior pituitary


The hypothalamus secretes several hormones that control the secretion of anterior pituitary hormones:
Growth Hormone Releasing Hormone (GHRH) Somatostatin

Corticotrophin Releasing Hormone (CRH)


Gonadotrophin Releasing Hormone (GnRH)

Thyrotrophin Releasing Hormone (TRH)

TSH

Hypothalamic hormones that control the anterior pituitary


The hypothalamus secretes several hormones that control the secretion of anterior pituitary hormones:
Growth Hormone Releasing Hormone (GHRH) Somatostatin

Corticotrophin Releasing Hormone (CRH)


Gonadotrophin Releasing Hormone (GnRH)

Thyrotrophin Releasing Hormone (TRH)


Dopamine
Prolactin Releasing Factors (PRF),

PRL

one of which is TRH

The hypothalamic hormones are the primary hormones controlling the secretion of the anterior pituitary hormones. However, many other factors feed into the control of the hypothalamic-pituitary axis.. Lets look at some of these ..

Specific stimuli

We have already seen that specific stimuli (e.g. cold in the case of TSH) feed into the hypothalamic control system

Hypothalamus

Pituitary

Circadian changes Specific stimuli

In addition, many hormones show daily rhythms.

Hypothalamus

Pituitary
GH levels

Note that GH is released in pulses during the hours of sleep.

SLEEP 24 hrs

Circadian changes Specific stimuli


The secretion of GnRH seems to be governed by a hypothalamic pulse generator.

Pulse generator Pulses of GnRH

LH levels

Pituitary

24 hour profile of LH levels in a young adult.


Note the pulses of LH marked by arrows.

24 hrs

Circadian changes Specific stimuli Pulses?

Hypothalamus
And a very important control for most the the anterior pituitary hormones is feedback control .

Pituitary

Feedback from peripheral signals (usually negative feedback) e.g. thyroid hormones, gonadal steroids

Lets use TSH as an example for looking at feedback control.

Negative feedback controls of the hypothalamic-pituitary axis

Low temperature

+
Specific external signals, e.g. low temperature, stimulate the secretion of TRH by the hypothalamus.

Hypothalamus

hypothalamic neurones

TRH
TSH
Anterior pituitary
thyrotrophs

TRH stimulates the secretion of TSH by the anterior pituitary.

Negative feedback controls of the hypothalamic-pituitary axis

Low temperature

TSH stimulates the thyroid to release the thyroid hormones, T3 and T4.

+
Hypothalamus hypothalamic neurones

TRH
TSH
T4 T3 Thyroid

Anterior pituitary

thyrotrophs

Negative feedback controls of the hypothalamic-pituitary axis

The thyroid hormones feedback onto the hypothalamus and the anterior pituitary to suppress further TSH production. This is a negative feedback effect.

Hypothalamus

hypothalamic neurones

TRH
TSH
Anterior pituitary
Thyroid

thyrotrophs

T4 T3

Negative feedback controls of the hypothalamic-pituitary axis

So high levels of thyroid hormones suppress TRH and TSH secretion.

Hypothalamus

hypothalamic neurones (TRH)

(TSH)
T4 T3 Thyroid

Anterior pituitary

thyrotrophs

Negative feedback controls of the hypothalamic-pituitary axis

However, when there are low levels of thyroid hormones, TRH and TSH secretion will be high.

Hypothalamus

hypothalamic neurones

TRH
TSH
Anterior pituitary
Thyroid

thyrotrophs

T4 T3

Essentials in Biomedical Science


Clinical significance

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Kings College London Date last modified: 26/09/2001 Stuart Milligan Victoria Pocock

Because the control of the hypothalamicpituitary axis involves a number of steps, problems of under-secretion or oversecretion of hormones can arise from different physiological defects in the control pathway. Using growth hormone (GH) as an example, we will now look now how problems might arise. But first a reminder of the controls of GH...

Control of Growth Hormone

Hypothalamus
GHRH stimulates secretion of GH by the anterior pituitary

hypothalamic neurones Somatostatin


Whereas somatostatin inhibits GH secretion

GHRH

+
somatotrophs

Anterior pituitary

GH
IGFs stimulate growth in bones, muscles and fat
IGF

GH stimulates secretion of insulin-like growth factors (IGF) by the liver.

Liver

Control of GH secretion
But other factors such as sleep, exercise, stress, food intake and blood sugar levels also influence the release of these hormones

Blood glucose

Exercise
Stress

Sleep

Hypothalamus

Food

GHRH

Somatostatin

Pituitary

GH IGF-1

Liver

Given the understanding of the normal control of GH, well now look at how it can go wrong..

Hypersecretion of GH
Hypothalamus
In a few people, the pituitary continues to secrete GH independently of the normal regulatory mechanisms. The levels of GH increase above normal, leading to excess bone growth and organ enlargement.

GHRH

Somatostatin

Pituitary GH

Excess bone growth Organ enlargement


The hypersecretion of GH also causes changes in sugar and lipid metabolism and can cause diabetes.

IGF-1

Liver
Diabetes

Understanding how the system works also gives us an insight into where the control mechanisms can break down Lets look at a growth disorders such as short stature as an example.

What could cause short stature?


Problems can occur in the hypothalamus e.g. defects in GHRH production

Hypothalamus

GHRH

So there is a Problems can occur in the pituitary e.g. defects in complex, or bioactivity GH secretion hierarchical control system and problems Problems can occur in the ability of cellscan occur at any to produce IGF. of the levels
Problems can occur in the target organs e.g. defects in growth response

Somatostatin

Pituitary
GH

Liver
IGF-1

Lets now look at how the function of hypothalamic-pituitary axis be tested...

These tests are often called Challenge tests because they are designed to challenge the normal operation of the system..

Challenge Tests
1. Hypothalamic releasing factors, e.g. TRH and GnRH, are useful to identify specific functional cell types in the anterior pituitary (thyrotrophs and gonadotrophs), but this test cannot be used for diagnosis of hypopituitarism or hyperpituitarism.
Note the rapid FSH response when GnRH is given to normal subjects
And the same dose of GnRH results in similar rapid rises in LH

FSH mU/L 8 6 4

LH U/L GnRH 200 g IV 20 GnRH 200 g IV

10 2

-15

0 20 60 Time (minutes)

90

-15

0 20 60 Time (minutes)

90

Challenge Tests
2. Synthetic drugs can be given to investigate whether the negative feedback control of the anterior pituitary is working properly ( e.g. dexamethasone (suppresses ACTH) and metyrapone (blocks cortisol secretion))
Normal negative feedback control of ACTH by cortisol secreted by the adrenal cortex Dexamethasone suppresses ACTH secretion by the anterior pituitary Metyrapone blocks cortisol secretion from the adrenal cortex

DEX

ACTH
Cortisol Cortisol

ACTH Cortisol

ACTH

Metyrapone
Plasma ACTH = 10 pmol/L Plasma ACTH = 2 pmol/L Plasma ACTH = 37 pmol/L+

Note the reduced level of ACTH due to suppression by dexamethasone

Note the increased level of ACTH due to blockage of cortisol secretion and therefore removal of negative feedback control

Challenge Tests
3. The use of a physiological stimulus, e.g. insulin-induced hypoglycaemia, (insulin tolerance test) can be used to help define defects in the system
For example, in normal patients, insulin-induced hypoglycaemia activates hypothalamic neurones to stimulate pituitary secretion of corticotrophin, GH and prolactin.
5
Plasma Glucose 3 (mmol/L) 1

Normal Insulin 0.15 U/kg

Hypopituitary Insulin 0.15 U/kg

800
Plasma 600 Cortisol (nmol/L) 400

But, in subjects with hypopituitarism, plasma cortisol and and serum GH levels are far below normal levels.

200 20 Serum GH 10 (g/L) <1

range of normal response

30

60

90

120

30

60

90

120

Time (minutes)

Time (minutes)

Understanding the normal control of the hypothalamic-pituitary axis allows the system to be manipulated to achieve different aims

Lets use the control of reproduction by GnRH, LH, FSH and ovarian hormones as an example..

Control of reproduction
Hypothalamus
The basic operation of the hypothalamic-pituitary-gonadal system is shown opposite. GnRH drives FSH production from the pituitary, and FSH stimulates follicle growth. Oestradiol produced by the follicle provides negative feedback.

+
Pituitary

GnRH

Oestradiol

LH FSH

Ovary
Understanding this system allowed forms of contraception to be developed ..

Control of reproduction
Hypothalamus
The negative feedback control of oestrogens was the original basis of the oral contraceptive pill
Oral oestrogens

GnRH

Pituitary LH FSH

High doses of oestrogens act on the hypothalamic-pituitary axis to suppress LH and FSH secretion and so suppress follicle growth and prevent ovulation

Oestradiol

Ovary

But we can also use our understanding to stimulate reproduction

Stimulation of ovarian function


Hypothalamus
In some treatments for infertility, it is necessary to stimulate the ovaries

GnRH Pituitary (pulses) Oestradiol LH FSH


One method is give pulses of GnRH: these will stimulate the pituitary to secrete more LH and FSH.

Ovary
Growth of more follicles

Stimulation of follicular growth


Hypothalamus

GnRH
Pituitary FSH Oestradiol

Or: an alternative is to give FSH to stimulate the ovary directly

Ovary
Growth of more follicles

Stimulation of follicular growth


Hypothalamus
Or another way is to give an antioestrogen (e.g. clomiphene). The anti-oestrogen blocks the negative feedback of oestradiol, so gonadotrophin levels rise!

GnRH

Pituitary LH FSH

Clomiphene Oestradiol
Therefore, clomiphene is often used as a fertility treatment for women to increase the number of follicles growing and ovulating

Ovary
Growth of more follicles

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