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Disorders of pituitary gland

The document discusses disorders of the pituitary gland, including gigantism, acromegaly, Cushing's disease, and acromegalic gigantism. Gigantism occurs when excess growth hormone is produced in childhood, leading to abnormal growth and heights over 7 feet. Acromegaly occurs when excess growth hormone is produced in adulthood, causing enlarged hands, feet, and face. Cushing's disease is caused by excess cortisol production due to a pituitary tumor secreting ACTH. It results in central obesity, purple stretch marks, and a rounded "moon face."

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TOPIC DISORDERS OF PITUITARY GLAND PRESENTED BY OM VERMA ASST.PROFESSOR RELIANCE INSTITUTE OF NURSING
DISORDERS OF PITUITARY GLAND
The pituitary is the "master control gland" - it makes hormones that affect growth and the functions of other glands in the body. With pituitary disorders, you often have too much or too little of one of your hormones. Injuries can cause pituitary disorders, but the most common cause is a pituitary tumor. ACCORDING TO LUCLMANN
Pituitary disorders it is a defend as anMost pituitary adenomas are known as non- functional adenomas and do not produce excessive amounts of hormones, while others can result in hormone overproduction, causing serious endocrine problems, such as acromegaly (GH excess), Cushing's syndrome (ACTH excess) or prolactinoma (prolactin excess). ACCORDING TO LEWIS
Causes of Disorder of PituitaryGland Mainly of 2 reasons: • Hyperactivity • Hypoactivity
DISORDERS OF PITUITARYGLAND Parts involved Hyperactivity Hypoactivity Anterior Pituitary 1. Gigantism 2. Acromegaly 3. Acromegalic gigantism 4. Cushing’s disease 1. Dwarfism 2. Acromicria 3. Simmond’s disease Posterior Pituitary Syndrome of inappropriate hypersecretion of ADH (SIADH) Diabetes insipidus Anterior and Posterior Pituitary ……. Dystrophia adiposogenitalis
HYPERACTIVITY IN PITUITARY GLAND
ANTERIOR PITUITARY Gigantism Acromegaly Acromegalic gigantism Cushing’s disease
GIGANTISM Pituitary disorder characterized by: • Excess growth of body • Average height is approximately 7 – 8 feet
Gigantism is a rare condition that causes abnormal growth in children. This change is most notable in terms of height, but girth is affected as well. It occurs when your child's pituitary gland makes too much growth hormone, which is also known as somatotropin.
CAUSES OF GIGANTISM • Hypersecretion of GH in childhood or in pre – adult • Tumor of acidophilic cells of Anterior pituitary
Carney complex is an inherited condition that causes noncancerous tumors on connective tissue, cancerous or noncancerous endocrine tumors, and spots of darker skin. Multiple endocrine neoplasia type 1 (MEN1) is an inherited disorder that causes tumors in the pituitary gland, pancreas, or parathyroid glands. Neurofibromatosis is an inherited disorder that causes tumors in the nervous system.
Continued… SIGNS AND SYMPTOMS • Huge stature : 7 or 8 feet height • Hyperglycemia , develop glycosuria , pituitary diabetes mellitus • Headache due to tumor of pituitary
Continued… • Visual disturbances • Gigantism ends in hypopituitarism (burning of cells of anterior pituitary )
very large hands and feet thick toes and fingers a prominent jaw and forehead coarse facial features excessive sweating severe or recurrent headaches weakness insomnia and other sleep disorders delayed puberty in both boys and girls irregular menstrual periods in girls deafness
GIGANTISM DIAGNOSTIC TEST HISTORY TAKING PHYSICAL EXAMINATION BLOOD TEST If your child’s doctor suspects gigantism, they may recommend a blood test to measure levels of growth hormones and insulin-like growth factor 1 (IGF-1), which is a hormone produced by the liver.
MRI SCAN of the pituitary gland. Doctors use this scan to find the tumor and see its size and position. ORAL GLUCOSE TOLERANCE TEST, The doctor also may recommend an oral glucose tolerance test. During an oral glucose tolerance test, your child will drink a special beverage containing glucose, a type of sugar. Blood samples will be taken before and after your child drinks the beverage.
In a normal body, growth hormone levels will drop after eating or drinking glucose. If your child’s levels remain the same, it means their body is producing too much growth hormone. If the blood tests indicate gigantism, child will needed.
Medical management Treatments for gigantism aim to stop or slow your child’s production of growth hormones. Medication In some cases, surgery may not be an option. For example, if there’s a high risk of injury to a critical blood vessel or nerve. Your child’s doctor may recommend medication if surgery is not an option. This treatment is meant to either shrink the tumor or stop the production of excess growth hormone.
doctor may use the drugs octreotide or lanreotide to prevent the growth hormone’s release. These drugs mimic another hormone that stops growth hormone production. They’re usually given as an injection about once a month. Bromocriptine and cabergoline are drugs that can be used to lower growth hormone levels. These are typically given in pill form. They may be used with octreotide. Octreotide is a synthetic hormone that, when injected, can also lower the levels of growth hormones and IGF-
Gamma knife radiosurgery Gamma knife radiosurgery is an option if your child’s doctor believes that a traditional surgery isn’t possible. The “gamma knife” is a collection of highly focused radiation beams. These beams don’t harm the surrounding tissue, but they’re able to deliver a powerful dose of radiation at the point where they combine and hit the tumor. This dose is enough to destroy the tumor
Gamma knife treatment takes months to years to be fully effective and to return the levels of growth hormone to normal. It’s performed on an outpatient basis under general anesthetic. However, since the radiation in this type of surgery has been linked to obesity, learning disabilities, and emotional issues in children, it’s usually used only when other treatment options don’t work.
Surgery Removing the tumor is the preferred treatment for gigantism if it’s the underlying cause. The surgeon will reach the tumor by making an incision in your child’s nose. Microscopes or small cameras may be used to help the surgeon see the tumor in the gland. In most cases, your child should be able to return home from the hospital the day after the surgery.
ACROMEGALY Anterior pituitary disorder characterized by: • Enlargement, thickening, and broadening of bones • Particularly extremities of the body
Acromegaly is a hormonal disorder that develops when pituitary gland produces too much growth hormone during adulthood. When this happens, your bones increase in size, including those of your hands, feet and face. Acromegaly usually affects middle- aged adults
Continued… CAUSES OF ACROMEGALY • Hypersecretion of GH after fusion of epiphysis with shaft of bone • Adenomatous tumor of anterior pituitary involving the acidophilic cells.
Continued... SIGNS AND SYMPTOMS Striking features are protrusion of : • Supraorbital ridges • Broadening of nose • Thickening of lips • Thickening and wrinkles formation on forehead • Lower jaw (prognathism) Face with these features called as acromegalic or guerilla face
Continued… Signs and symptoms • Kyphosis : enlargement of hands and feet with bowing spine • Scalp is thickened and thrown into folds • Overgrowth of body hair • Visceral organs are enlarged
Continued… Signs and symptoms • Thyroid , parathyroid and adrenal glands shows hyperactivity • Hyperglycemia and glucosuria • Hypertension • Headache • Visual disturbance – Bitemporal hemianopia
Con… Common symptoms of acromegaly are: enlarged bones in the face, feet, and hands excessive hair growth in women an enlarged jaw or tongue a prominent brow excessive growth spurts, which are more common in people who’ve had abnormal growth before adolescence weight gain swollen and painful joints that limit movement
Con…. spaces between the teeth splayed fingers and toes a hoarse, deep voice fatigue headaches an inability to sleep muscle weakness profuse sweating body odor enlarged sebaceous glands, which are glands that produce oils in the skin thickened skin skin tags, which are noncancerous growths
DIAGNOSING ACROMEGALY BLOOD TESTS Blood tests can determine if you have too much GH, but these aren’t always accurate because GH levels fluctuate throughout the day. Instead, your doctor may order a glucose tolerance test. This test requires you to drink 75 to 100 grams of glucose and then have your GH levels tested. If your body is secreting normal levels of GH, excess glucose will cause your body to suppress your GH levels. People who have acromegaly will still show high GH levels.
INSULIN-LIKE GROWTH FACTOR 1 (IGF-1) Doctors may also test for a protein called insulin-like growth factor 1 (IGF-1). Levels of IGF-1 can show if there is abnormal growth in the body. IGF-1 testing can also be used to monitor the progress of other hormone treatments.
IMAGING STUDIES X-rays and MRI scans may be ordered to check for excess bone growth if your doctor suspects you have acromegaly. Your doctor will also perform a physical exam, and they may order a sonogram to check the size of internal organ After you’re diagnosed with acromegaly, your doctor can use MRI and CT scans to help them find the pituitary tumor and determine its size. If they don’t find a tumor on the pituitary gland, your doctor will look for tumors in the chest, abdomen, or pelvis that may be causing excess GH production.
MANAGEMENT OF ACROMEGALY Treatment for acromegaly is based on your age and overall health. The goals of treatment are to: bring GH production levels back to normal relieve pressure around any growing pituitary tumors maintain normal pituitary function treat any hormone deficiencies and improve the symptoms of acromegaly Several types of treatments may be needed.
MEDICATION Medication is another treatment option that’s often used if surgery isn’t successful in reducing GH levels, and it can also be used to shrink large tumors before surgery. These types of medications are used to regulate or block GH production: somatostatin analogs GH receptor antagonists dopamine agonists
RADIATION Radiation may be used to destroy large tumors or sections of tumor left after surgery or when medications alone aren’t effective. Radiation can slowly help to lower GH levels when used along with medication. A dramatic decrease in GH levels using this type of treatment may take several years, with radiation administered in multiple four- to six-week sessions. Radiation can impair your fertility. In rare cases, it can lead to vision loss, brain injury, or secondary tumors.
COMPLICATIONS If it’s left untreated, acromegaly can cause serious health problems. It can even become life-threatening. Some common complications include: vision loss a compression of the spinal cord uterine fibroids in women, which are benign tumors of the uterus a reduced release of pituitary hormones, which is called hypopituitarism carpal tunnel syndrome
sleep apnea, which is characterized by sporadic breathing during sleep precancerous growths, or polyps, on the lining of the colon goiter, which is a thyroid gland enlargement that causes swelling of the neck type 2 diabetes arthritis heart disease, especially an enlarged heart high blood pressure, or hypertension
Acromegalic Gigantism Rare disorder Due to hypersecretion of GH in children,before fusion of epiphysis with the shaft of bone results in Gigantism If hyersecretion of GH is continued after the fusion of epiphysis the symptoms of Acromegaly also appear
CUSHING’S DISEASE • Rare disease characterized by obesity
Cushing's disease is a serious condition of an excess of the steroid hormone cortisol in the blood level caused by a pituitary tumor secreting adrenocorticotropic hormone (ACTH). ACTH is a hormone produced by the normal pituitary gland. ACCORDING TO LEWIS
Cushing disease is a condition in which the pituitary gland releases too much adrenocorticotropic hormone (ACTH). The pituitary gland is an organ of the endocrine system. ACCORDING TO LUCKMANS
ETIOLOGY • Hypersecretion of glucocorticoids mainly cortisol • Either pituitary origin or adrenal origin Cushing’s disease Cushing’s syndrome
Continued… Pituitary origin • Increased secretion of ACTH leads to hyperplasia of adrenal cortex therefore, hypersecretion of glucocorticoids takes place • ACTH is increased by • Tumor in pituitary cells ( basophilic cells) • Malignant tumor of nonendocrine origin like cancer of lungs or abdominal viscera • Hypothalamic disorder causing hypersecretion of corticotropin releasing hormone
Cushing’s syndrome is caused by an excess of the hormone cortisol. adrenal glands produce cortisol. It helps with a number of body’s functions, including: regulating blood pressure and the cardiovascular system reducing the immune system’s inflammatory response converting carbohydrates, fats, and proteins into energy balancing the effects of insulin responding to stress
body may produce high levels of cortisol for a variety of reasons, including: high stress levels, including stress related to an acute illness, surgery, injury, or pregnancy, especially in the final trimester athletic training malnutrition alcoholism depression, panic disorders, or high levels of emotional stress
CORTICOSTEROIDS The most common cause of Cushing’s syndrome is the use of corticosteroid medications, such as prednisone, in high doses for a long period. Healthcare providers can prescribe these to treat inflammatory diseases, such as lupus, or to prevent rejection of a transplanted organ. High doses of injectable steroids for treatment of back pain can also cause Cushing’s syndrome. However, lower dose steroids in the form of inhalants, such as those used for asthma, or creams, such as those prescribed for eczema, usually aren’t enough to cause the condition.
TUMORS Several kinds of tumors can also lead to a higher production of cortisol. Some of these include: Pituitary gland tumors. The pituitary gland releases too much adrenocorticotropic hormone (ACTH), which stimulates cortisol production in the adrenal glands. This is called Cushing’s disease. Ectopic tumors. These are tumors outside of the pituitary that produce ACTH. They usually occur in the lung, pancreas, thyroid, or thymus gland. Adrenal gland abnormality or tumor. An adrenal abnormality or tumor can lead to irregular patterns of cortisol production, which can cause Cushing’s syndrome. Familial Cushing’s syndrome. Although Cushing’s syndrome isn’t typically inherited, it’s possible to have an inherited tendency to develop tumors of the endocrine glands
SIGNS AND SYMPTOMS 1. Disproportionate distribution of body fat results: • MOON FACE : Fat accumulation and retention of water and salt • Torso : Fat accumulation in chest and abdomen but slim legs and arms • BUFFALO HUMP : Fat deposit on the back of neck and shoulder • Pot belly : Fat accumulation in upper abdomen
Continued… 2.PURPLE STRIAE : Reddish purple stripes on abdomen due to mainly three reasons:  Stretching of abdominal wall by excess subcutaneous fat  Rupture of subdermal tissues due to stretching  Deficiency of collagen fibres due to protein depletion
Continued… 3. Thinning of extremities 4. Thinning of skin and subcutaneous tissues 5. Darkening of skin on neck (aconthosis) 6. Pigmentation of skin 7. Facial redness (facial plethora) 8. Weakening of muscle
Continued… 9. Facial hair growth ( Hirsutism ) 10. Bone resorption leads to osteoporosis 11.Hyperglycemia due to gluconeogeneis leads adrenal diabetes and glycosuria 12. Hypertension 13.Immunosuppression resulting in susceptibility for infection 14. Poor healing
LABORATORY TESTS, INCLUDING: 24-HOUR URINARY FREE CORTISOL TEST: For this test, you’ll be asked to collect your urine over a 24- hour period. The levels of cortisol will then be tested. Salivary cortisol measurement: In people without Cushing’s syndrome, cortisol levels drop in the evening. This test measures the level of cortisol in a saliva sample that’s been collected late at night to see if cortisol levels are too high. LOW-DOSE DEXAMETHASONE SUPPRESSION TEST: For this test, you’ll be given a dose of dexamethasone late in the evening. Your blood will be tested for cortisol levels in the morning. Normally, dexamethasone causes cortisol levels to drop. If you have Cushing’s syndrome, this won’t occur.
DIAGNOSING THE CAUSE OF CUSHING’S SYNDROME After you receive the diagnosis of Cushing’s syndrome, your healthcare provider must still determine the cause of the excess cortisol production. Tests to help determine the cause may include: BLOOD ADRENOCORTICOTROPIN HORMONE (ACTH) TEST: Levels of ACTH in the blood are measured. Low levels of ADTH and high levels of cortisol could indicate the presence of a tumor on the adrenal glands. CORTICOTROPIN-RELEASING HORMONE (CRH) STIMULATION TEST: In this test, a shot of CRH is given. This will raise levels of ACTH and cortisol in people with pituitary tumors.
HIGH-DOSE DEXAMETHASONE SUPPRESSION TEST: This is the same as the low-dose test, except that a higher dose of dexamethasone is used. If cortisol levels drop, you may have a pituitary tumor. If they don’t you may have an ectopic tumor. PETROSAL SINUS SAMPLING: Blood is drawn from a vein near the pituitary and also from a vein far away from the pituitary. A shot of CRH is given. High levels of ACTH in the blood near the pituitary can indicate a pituitary tumor. Similar levels from both samples indicate an ectopic tumor. IMAGING STUDIES: These can include things like CT and MRI scans. They’re used to visualize the adrenal and pituitary glands to look for tumors.
CUSHING’S SYNDROME TREATMENT The overall goal of Cushing’s syndrome treatment is to lower the levels of cortisol in your body. This can be accomplished in several ways. The treatment that you receive will depend on what’s causing your condition. Your healthcare provider may prescribe a medication to help manage cortisol levels. Some medications decrease cortisol production in the adrenal glands or decrease ACTH production in the pituitary gland. Other medications block the effect of cortisol on your tissues.
Examples include: ketoconazole (Nizoral) mitotane (Lysodren) metyrapone (Metopirone) pasireotide (Signifor) mifepristone (Korlym, Mifeprex) in individuals with type 2 diabetes or glucose intolerance
Disorders of PituitaryGland Parts involved Hyperactivity Hypoactivity Anterior Pituitary 1. Gigantism 2. Acromegaly 3. Acromegalic gigantism 4. Cushing’s disease 1. Dwarfism 2. Acromicria 3. Simmond’s disease Posterior Pituitary Syndrome of inappropriate hypersecretion of ADH (SIADH) Diabetes insipidus Anterior and Posterior Pituitary ……. Dystrophia adiposogenitalis
Hypoactivity in Anterior Pituitary
DWARFISM • Pituitary disorder in children characterized by stunted growth
Dwarfism is short stature that results from a genetic or medical condition. Dwarfism is generally defined as an adult height of 4 feet 10 inches (147 centimeters) or less. The average adult height among people with dwarfism is 4 feet (122 cm).
CAUSE OF DWARFISM • Reduction in the GH in infancy or early childhood • Occurs because of following reasons: Deficiency of GH releasing hormone from hypothalamus Deficiency of Somatomedin – C Atrophy of acidophilic cells in the adenohypophysis Tumor of chromophobes : nonfunctioning tumor , compresses and destroys the normal cells Panhypopituitarism
Causes of proportionate dwarfism include metabolic and hormonal disorders such as growth hormone deficiency. The most common types of dwarfism, known as skeletal dysplasias, are genetic. Skeletal dysplasias are conditions of abnormal bone growth that cause disproportionate dwarfism.
Dwarfism Genetics Skeletal dysplasia is caused by a genetic mutation. The gene mutation can occur spontaneously or can be inherited.
Signs and Symptoms • Stunted skeletal growth • Maximum height approximately 3 feet • Head becomes slightly larger in relation of body • Mental activity is normal without any deformity • Reproductive system is not affected due to lack of GH but in Panhypopituitarism puberty is not obtained due to lack of gonadotropic hormone
A larger head late development of certain motor skills, such as sitting up or walking breathing problems curvature of the spine bowed legs joint stiffness and arthritis lower back pain or numbness in the legs crowding of teeth
Types of Dwarfism • Laron dwarfism • Psychogenic dwarfism • Dwarfism in dystrophia adiposogenitalis
Laron Dwarfism • Genetical disorder • Called as GH insensitivity • Occurs due to presence of abnormal GH secretagogue receptors in liver • GHS becomes abnormal due to mutation in genes responsible for receptor • Doesn’t depend on amount of GH secretion , hormone can’t stimulate the growth due to abnormal GHS
Psychogenic Dwarfism • Due to extreme emotional deprivation or stress • Deficiency of GH • Also called as psychosocial dwarfism or Stress dwarfism
DWARFISM DIAGNOSTIC TEST Some forms of dwarfism are evident in utero, at birth or during infancy and can be diagnosed through X-rays and a physical exam. A diagnosis of achondroplasia, diastrophic dysplasia, or spondyloepiphyseal dysplasia can be confirmed through genetic testing. In some cases, prenatal testing is done if there is concern for specific conditions.
Dwarfism in Dystrophiaadiposogenitalis • Called as Frohlich syndrome • Rare childhood disorder • Characterized by : oObesity oGrowth retardation oRetarded development of genital organs oAssociated with tumors of hypothalamus – increased appetite and decrease in gonadotropin hormone
Dwarfism Treatments Early diagnosis and treatment can help prevent or lessen some of the problems associated with dwarfism. People with dwarfism related to growth hormone deficiency can be treated with growth hormone. In many cases, people with dwarfism have orthopaedic or medical complications. Treatment of those can include: Insertion of a shunt to drain excess fluid and relieve pressure on the brain
A TRACHEOTOMY to improve breathing through small airways Corrective surgeries for deformities such as cleft palate, club foot, or bowed legs Surgery to remove tonsils or adenoids to improve breathing problems related to large tonsils, small facial structures, and/or a small chest Surgery to widen the spinal canal (the opening through which the spinal cord passes) to relieve spinal cord compression
Other treatment may include: Physical therapy to strengthen muscles and increase joint range of motion Back braces to improve curvature of the spine Placement of draining tubes in the middle ear to help prevent hearing loss due to repeated ear infections Orthodontic treatment to relieve crowding of teeth caused by a small jaw Nutritional guidance and exercise to help prevent obesity, which can aggravate skeletal problems
ACROMICRIA • Rare disease in adults characterized by the atrophy of the extremities of the body
Abnormal smallness of the head and extremities.
Causes ofAcromicria • Deficiency of GH in adults • Secretion of GH decreases in the following conditions: Deficiency of GH releasing hormone Atrophy of acidophilic cells in the anterior pituitary Tumor of chromophobes Panhypopituitarism
Signs and Symptoms • Atrophy and thinning of extremities ( major symptoms ) • Associated with hypothyroidism • Hyposecretion of adrenocortical hormone • Person becomes lethargic and obese • Loss of sexual function
Disorders of PituitaryGland Parts involved Hyperactivity Hypoactivity Anterior Pituitary 1. Gigantism 2. Acromegaly 3. Acromegalic gigantism 4. Cushing’s disease 1. Dwarfism 2. Acromicria 3. Simmond’s disease Posterior Pituitary Syndrome of inappropriate hypersecretion of ADH (SIADH) Diabetes insipidus Anterior and Posterior Pituitary ……. Dystrophia adiposogenitalis