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BY: Minyahil A. Woldu, Clinical Pharmacist (MSc.) Pituitary Gland Disorders 26 November 2014


Objectives To discuss the epidemiology, clinical manifestations, approach to diagnosis and management of pituitary diseases To discuss the mechanism of action, adverse effects and clinical use of drugs for pituitary diseases 11/26/2014


PITUITARY GLAND (THE HYPOPHYSIS) The pituitary is located at the base of the brain, in a small depression of the sphenoid bone (sella turcica). Purpose: control the activity of many other endocrine glands. “ Master gland” Has two lobes, the anterior & posterior lobes. 11/26/2014


PITUITARY HORMONES Anterior Lobe GH: growth hormone ACTH: adrenocorticotropic hormone TSH: thyroid-stimulating hormone PRL: prolactin FSH: follicle-stimulating hormone LH: luteinizing hormone MSH: melanocyte stimulating hormone Posterior Lobe ADH: anti-diuretic hormone (vasopressin) OT: oxytocin 11/26/2014


ANATOMY Anterior lobe ( adenohypophysis ): glandular tissue, accounts for 75% of total weight. Hormones in this lobe are controlled by regulating hormones from the hypothalmus (stimulate or inhibit) Posterior ( neurohypophysis ) : nerve tissue & contains axons that originate in the hypothalmus . Therefore this lobe does not produce hormones but stores those produced by the neurosecretory cells in the hypothalmus . Release of hormones is triggered by receptors in the hypothalmus . 11/26/2014


TERMS Trophic hormones : hormones that control the secretion of hormones by other glands. Example: TSH stimulates the thyroid to secrete hormones. Effector hormones : produce an effect directly when secreted. Example ADH stimulates kidneys 11/26/2014


ANTERIOR PITUITARY DISORDERS 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, BP Graves disease Decreased BMR, HR, CO, BP Cretinism (children) Prolactin amenorrhea Too little milk FSH Late puberty, infertility LH Menstrual cycle disturbance Amenorrhea, impotence 11/26/2014


POSTERIOR PITUITARY DISORDERS Hormone Increased Decreased Oxytocin Precipitates childbirth, excess milk Prolonged childbirth, diminished milk ADH (vassopressin) Increased BP, decreased urinary output, edema. SIADH ( syndrome of inappropriate antidiuretic hormone ) Diabetes insipidus, dilute urine & increased urine output 11/26/2014

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Disorders occur most often in the anterior pituitary The anterior pituitary hormones regulates growth, metabolic activity and sexual development. Major causes include: tumors , pituitary infarction , genetic disorders . Pathologic consequences of pituitary disorders are 1) hyperpituitarism, 2) hypopituitarism, 3) local compression of brain tissue by expanding tumor 11/26/2014


References Joseph T. DiPiro P, FCCP; Executive Dean and Professor, South Carolina College of Pharmacy, University of South Carolina, Columbia, South Carolina and Medical University of South Carolina, Charleston, South Carolina. Pharmacotherapy A Pathophysiologic Approach. Seventh Edition ed.: McGraw-Hill; 2008. Curtis L. Triplitt CAR, and William L. Isley. PHARMACOTHERAPY A Pathophysiologic Approach. Sixth Edition ed. Joseph T. DiPiro P, FCCPProfessor and Executive Dean, South Carolina College of Pharmacy,University of South Carolina, Columbia, and Medical University of South Carolina, Charleston, editor.: The McGraw-Hill Companies, Inc.; 2005. Lindsey MRGaCC. PHARMACOTHERAPY PRINCIPLES & PRACTICE. MARIE A. CHISHOLM-BURNS P, FCCP, FASHP,BARBARA G.WELLS,PHARMD, FASHP, FCCP, BCPP,TERRY L. SCHWINGHAMMER,PHARMD, FCCP, FASHP,, BCPS PMM, PHARMD, FASHP,JILL M. KOLESAR,PHARMD, BCPS, FCCP,JOHN C. ROTSCHAFER,PHARMD, FCCP,JOSEPH T. DIPIRO,PHARMD, FCCP, editors.: McGraw-Hill 2008 http://www.emc.maricopa.edu/faculty/farabee/BIOBK/BioBookENDOCR.html … 11/26/2014

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