CHAPTER 20- PITUITARY

• 1) Releases the following into the median eminance:
• 1- TRH
• 2- CRH
• 3-GnRH
• 4- GHRH
• 5- Dopamine

2) passes through the neurohypophysis on way to adenohypophysis

inhibits prolactin secretion

• 1) neurohypophysis
• 2) ADH-
• 1- supraoptic nucleus
• 2- regulated by osmolar receptors in hypothalamus

• 3) Oxytocin
• 1- paraventricular nuclei in hypothalamus

neurohypophysis doesn't contain cell bodies

• 1) 80% of gland, adenohypophysis
• 2) Releases:
• 1- ACTH
• 2- TSH
• 3- GH
• 4- LH
• 5- FSH
• 6- Prolactin

the anterior pituitary doesn't have its own blood supply, it passes through the neurohypophysis first

pituitary mass compressing optic nerve (CNII) at chiasm

• 1) almost always macroadenomas
• 2) present with mass effect and decreased ACTH, TSH, GH, LH, FSH
• 3) Tx: transsphenoid resection

• 1) suprasellar extension
• 2) massive lateral extension
• 3) dumbbell-shaped tumor

TSH and FSH/LH secreting tumors may respond to bromocriptine

• 1) most common pituitary adenoma
• 2) mostly microadenomas
• 3) most patients do not need surgery. Prolactin is usually >150 in these patients
• 4) Symptoms:
• 1- galactorrhea
• 2- irregular menses
• 3- decreased libido
• 4- infertility
• 5- decreased vision
• 5) Tx: bromocriptine for most, or trassphenoidal resection for failure of medical management
• 1) Macroadenomas-
• 1- resection with hemorrhage
• 2- visual loss
• 3- wants pregnancy
• 4- CSF leak
• 2) Microadenomas- resection if bromocriptine unsafe or ineffective (is OK in pregnancy)

• 1) growth hormone
• 2) Symptoms:
• 1- HTN
• 2- DM
• 3- gigantism
• 3) GH >10 in 90%; usually macroadenomas
• 4) Preoperative octreotide may be helpful (inhibits release of GH)
• 5) can be life threatening secondary to cardiac symptoms (valve dysfunction, cardiomyopathy)
• 6) higher remission rate for microadenomas
• 7) Dx:
• 1- elevated IGF-1
• 2- Growth hormone >5-10
• 8) Tx:
• 1- trassphenoidal resection
• 2- XRT and bromocriptine can be used for primary or secondary therapy

• 1) postpartum trouble lactating- usually first sign
• 2) can also have:
• 1- amenorrhea
• 2- adrenal insufficiency
• 3- hypothyroidism
• 3) due to pituitary ischemia following hemorrhage and hypotensive episode

• 1) calcified cyst, remnant of rathke's pouch
• 2) Most frequently presents with
• 1- endocrine abnormalities
• 2- visual disturbances
• 3- headache
• 4- hydrocephalus
• 3) Tx:
• 1- surgery
• 2- XRT
• 4) Diabetes insipidus is a frequent complication postoperatively

1) check axis; if ok, probably metastases

• 1) occurs after bilateral adrenalectomy
• 2) increased CRH causes pituitary enlargment, resulting in amenorrhea, visual problems (bitemporal hemianopia)
• 3) Also get hyperpigmentation from beta-MSH (melanocyte-stimulating hormone), a peptide byproduct of ACTH
• 4) Tx: steroids

• 1) adrenal gland hemorrhage that occurs after meningococcal sepsis infection
• 2) can lead to adrenal insufficiency