Hypothalamic and pituitary

disorders
 Our objectives

List hormones synthesized by the anterior pituitary and those

stored in the posterior pituitary gland.

Peripheral effects of increased and decreased pituitary gland Hormones.

List the laboratory tests used to assess pituitary function.

 introduction

 The pituitary gland is the "master gland"

of the body, It’s consisted of
anterior and posterior lobes.

 Anterior pituitary hormone secretion is

under the control of hormones produced
in the hypothalamus and transport it by
hypothalamic pituitary portal system
Hormones synthesized by the anterior pituitary and
those stored in the posterior pituitary gland
 Effect of Hormones that Released by the
Hypothalamus on the Anterior Pituitary

Hypothalamic Hormone Effect on the Anterior Pituitary gland

Gonadotropin-releasing hormone Stimulate leutenizing Hormone (LH) secretion
GnRH &
Stimulate Follicular stimulating Hormone (FSH) secretion

Corticotropin-releasing hormone Stimulate Adrenocorticotropic hormone

CRH (ACTH) secretion
Thyrotropin-releasing hormone Stimulate thyroid stimulating hormone (TSH) secretion
TRH
Prolactin-releasing hormone Stimulate Prolctin secretion
PRH
Growth hormone–releasing hormone Stimulate growth hormone (GH) secretion
GHRH
 Effect of Hormones that Released by the
Hypothalamus and stored in the posterior Pituitary

Hormone Effect on the Body

Anti-diuretic hormone Stimulate water reabsorption by renal
ADH collecting ducts

Oxytocin Milk ejection , utrine contraction

These hormones are released from the hypothalamus

but stored in the posterior pituitary
Function of hormones that synthesized by
the anterior pituitary gland
 Effect of Hyper pitutarism

Hypothalamic Hormone Effect in case of :

Excess Deficient
Growth hormone
(GH) Acromegaly failure to grow
& Gigantism

Prolctin Galactorrhea failure to lactate

decreased libido
In men
Leutenizing Hormone decrease libido
(LH) impotence ,loss of muscular
& primary ovarian failure Mass.
Follicular stimulating Hormone
In women
(FSH)
2ry amenorrhea, infertility
and vaginal atrophy

Adrenocorticotropic hormone Cushing syndrome secondary chronic adrenal failure.

(ACTH)

Thyroid stimulating hormone hyperthyroidism secondary hypothyroidism

(TSH)
 Effects of (increased or decreased) in release
of pituitary gland hormones

Hypopituitarism

Hypopituitarism is the decreased secretion of one or more of

Hormones that normally produced by the pituitary gland.

 If there is decreased secretion of one specific pituitary hormone,

the condition is known as selective hypopituitarism.

If there is decreased secretion of most or all pituitary hormones,

the condition is known as pan hypopituitarism
 Hypopituitarism

 Etiology of Hypopituitarism
It can be result from
1. Tumer : Pitutary Adenoma, other primary CNS tumors
2. Infarction : Sheehan’s syndrome
3. Injury : severe head trauma
4. Iatrogenic; surgery, radiotherapy
5. Infectious ; TB, syphilis ,
6. Idiopathic
  1- Growth hormone

Growth Hormone (GH) is a peptide hormone that stimulates growth

GH is a stress hormone that raises the concentration of glucose and free fatty acids
GH stimulates the production of insulin – like growth factor -1, (IGF-1).
IGF-1 is a hormone that mediates the effects of GH and helps promote normal bone
and tissue growth and development.
Unlike GH, level of IGF-1 is stable in the blood throughout the day.
 IGF-1 is a a useful indicator of the average GH levels and it is often used to help
evaluate GH deficiency or GH excess
  Growth hormone Deficiency

Etiology:
Non functioning pituitary tumor that destroys anterior
pituitary gland.
 Congenital defect of pituitary gland
 defect in GHRH

Effects & presentations:

A) In children: (pituitary dwarfism)
-failure to grow, short stature,
mild obesity, and delayed puberty.

B) In adults:
-No syndrome, a tendency to hypoglycemia
muscle weakness, lethargy and obesity
 Laboratory investigation of
 Growth hormone Deficiency

insulin like Growth Factor -1 (IGF-1 ) is decreased

*GH level is decreased
*GHRH is low
GH secretion varies throughout the days so plasma GH is not a reliable
indicator.
IGF-1 is usually measured for initial diagnosis.
  Increased Growth hormone Secretion

Etiology:

Growth hormone secreting adenoma.

Effects & presentations:

A) Gigantism:
the growth hormone is increased before the
closure of epiphysis
The giant ordinarily has hyperglycemia, and in
10 % of giants, diabetes mellitus eventually develops.
B) Acromegaly:
In this condition the growth hormone is increased
after the closure of epiphysis
 Laboratory investigation of
 increased Growth hormone Secretion

1.GH levels:
 elevated GH
 elevated insulin like Growth Factor -1 (IGF-1 )

2. GH level during glucose tolerance test

-Higher blood glucose level usually causes suppression of plasma GH

 75g of glucose is given orally, and serum GH is measured after 60 min.

- Normally : suppression of plasma GH to (< 0.3 µg/L) during the test

- In Acromegaly : plasma GH doesn’t suppress.

  2- Prolactin

Prolactin : is a hormone produced by the anterior portion of the

pituitary gland
Normally present in low amounts in men and non-pregnant
women, prolactin's primary role is to promote lactation
The prolactin level is usually high throughout pregnancy and just
after childbirth
 Regulation of Prolactin level

Prolactin is regulated by Hypothalamus through tow ways :

 Reduction of Prolactin level

Through Secretion of Dopamine ( Prolactin Inhibiting Factor)

Which will inhibit releasing of prolactin from pitutary gland

 Increase of Prolactin level

Through Secretion of Thyro tropine Relasing Hormone (TRH)

Which will increase releasing of prolactin from pitutary gland
Regulation of Prolactin level
  Hyper Prolactenemia

It is the presence of abnormally high levels of prolactin in the blood

The most common cause is pituitary tumor (prolactinoma )

Others:
 Physiological : Pregnancy & Lactating
 Hypo Thyroidism :  TRH   Prolactin
 Some drugs
Antipsychotic drugs ( Dopamine Antagonist )  Dopamine   Prolactin
 Hyper Prolactenemia
 Laboratory investigation of
 Hyper Prolactenemia

Normal level of prolactin:

Women who are not pregnant 4 - 25 ng/ml
Women who are pregnant 34 to 386 ng/ml
Males 3 - 15 ng/ml
Children 3.2 – 20 ng/ml

Lab Finiding in Prolactenemia :

serum prolactin level above 200 ng/ml
Decrease (FSH) and (LH) due to –ve feed back inhibition to GnRH
  3- Adrenocorticotropic hormone ( ACTH )

ACTH is a polypeptide tropic hormone produced and

secreted by the anterior pituitary gland
Its principal effects are increased production and
release of cortisol by the cortex of the adrenal gland
 Deficiency of ACTH is a sign of secondary adrenal
insufficiency (suppressed production of ACTH due to
an impairment of the pituitary gland or hypothalamus )

When a pituitary tumor causes elevated level of ACTH

Cushing's disease will result
 3- Effect of ( ACTH ) in zones of Adrenal Cortex
  increased (ACTH) Secretion

Cushing’s disaese
Is a condition in which the pituitary gland releases too much
Adreno Cortico Tropic hormone (ACTH) which stimulate adrenal glands to
release more cortisol

Etiology:
1.Tumor ( pitutary Adenoma )
2.excess growth (hyperplasia) of the pituitary gland
3.excess production of (corticotropin releasing hormone) from hypothalamus
 Laboratory investigation of

Cushing’s Disease & Cushing’s syndrome

Disease Cortisol ACTH

 Cushing’s Disease
High High
Pituitary tumor making ACTH

 Cushing’s Syndrome
Adrenal tumor High Low

Ectopic ACTH High High

(made by a tumor outside the pituitary)
 Laboratory investigation of
Cushing’s Disease & Cushing’s syndrome

Dexamethasone suppression test :

Dexamethasone
is cortisol analogue

 has 10 to 20 times of the metabolic potency of cortisol,

 cause negative feedback action on the pituitary ACTH

not interfere with plasma cortisol and urinary steroid measurements.

 Laboratory investigation of
Cushing’s Disease & Cushing’s syndrome

Dexamethasone suppression test :

•is used to assess adrenal gland function by measuring how cortisol levels
change in response to an injection of dexamethasone.
Normaly decreased to less than 50%

•Failure of depression of cortisol suggests Cushing’s Syndrome with

either ectopic ACTH secretion’ or adrenal tumor with  cortisol
 Laboratory investigation of
Cushing’s Disease & Cushing’s syndrome

Low dose Dexamethasone suppression test : (usually 1–2 mg)

The normal result is

Decrease in cortisol levels upon administration of low-dose dexamethasone.

In Cushing's disease & Cushing’s Syndrome

there is no change in cortisol on low-dose dexamethasone

 Laboratory investigation of
Cushing’s Disease & Cushing’s syndrome

High dose Dexamethasone suppression test : (usually 8 mg)

In Cushing's disease

inhibition of cortisol level on high-dose dexamethasone

In Cushing’s Syndrome

cortisol levels are remain unchanged

by low- and high-dose of dexamethasone, then other causes of Cushing's
syndrome must be considered and further investigation are needed
  4- Luteinizing and Follicle Stimulating Hormones
(LH & FSH)

Are glycoprotein polypeptide hormones

synthesized and secreted by the
gonadotropic cells of the anterior pituitary
gland,and regulates the
development, growth, pubertal maturation,
and reproductive processes of the body.
FSH and LH work together
in the reproductive system.
 Laboratory investigation of
(LH & FSH)

FSH and LH levels can help to differentiate between

primary ovarian failure (failure of the ovaries themselves) and
secondary ovarian failure (failure of the ovaries due to disorders of either the
pituitary or the hypothalamus).

High levels of FSH and LH are consistent with primary ovarian failure
Low levels of FSH and LH are consistent with secondary ovarian failure due to
a pituitary disorder or hypothalamic problem (GnRH) .

Diasease LH FSH
primary ovarian failure High High
secondary ovarian failure Low Low
  5- Thyroid-Stimulating Hormone
(TSH)

It is a glycoprotein hormone synthesized and

secreted by the anterior pituitary gland,
which regulates the endocrine function
of the thyroid.
TSH stimulates the thyroid gland to release
thyroxine (T4) and triiodothyronine (T3) into
the blood. These thyroid hormones help
control the rate at which the body uses energy
 Laboratory investigation of
 Thyroid-Stimulating Hormone
(TSH)

Why Get Tested? For example

diagnose thyroid disorders when a person has symptoms of

Hypothyroidism or Hyperthyroidism

Newborn screening (is widely recommended)

 Laboratory investigation of
 Thyroid-Stimulating Hormone
(TSH)

Most common disease of Hyperthyroidism : Graves disease

Most common disease of Hypothyroidism : Hashimoto thyroiditis

 Laboratory investigation of
 Thyroid-Stimulating Hormone
(TSH)
Most common disease of Hyperthyroidism :
Graves disease

It is a chronic autoimmune disorder in which the affected person's immune syste

m produces thyroid stimulating immunoglobulins that act like TSH, leading to the
production of excessive amounts of thyroid hormone T4 & T3 .
 In response, TSH level, will be low in the blood

Hormone Level
TSH Low
T4 High
T3 High
 Laboratory investigation of
 Thyroid-Stimulating Hormone
(TSH)
Most common disease of Hypothyroidism :
Hashimoto thyroiditis

Is a chronic Autoimmune condition in which the immune response causes

inflammation and damage to the thyroid.
With Hashimoto thyroiditis, the thyroid low amount of T4 & T3.
 In response, TSH level, will be High in the blood

Hormone Level
TSH High
T4 Low
T3 Low