7.7. The patient is diagnosed to have panhypopituitarism. What is panhypopituitarism?

Can
someone have “panhyperpituitarism”? Why? What about hyperpituitarism? Give examples

Panhypopituitarism is the undersecretion of the pituitary hormones.

No, because it is not possible for all of the secretory cells to develop a tumor simultaneously.

It is possible for someone to have panhypopituitarism if all of the production of anterior pituitary
hormones is deficient or decreased,
Hyperpituitarism is a condition where excess hormone production of anterior pituitary gland
happens and is rare in children.
Examples: Gigantism and acromegaly

8. What is a tumour? What is an adenoma? By giving examples, compare and contrast

between
a. adenoma and carcinoma
b. microadenoma and macroadenoma.
c. secretory and non-secretory tumour

Which cells of the pituitary form the benign tumour in Mrs A? Justify your answer.
In Mrs A’s case, her normal nonsecretory cells underwent hyperplasia resulting in pituitary
adenoma.

A tumor is uncontrolled cellular hyperplasia

Adenoma is benign tumor of glandular origin
a.
Adenoma Carcinoma

Slower growth Faster growth

benign malignant
b.

Microadenoma Macroadenoma

Less than 10 mm in size More than 10 mm size

Adenomas are benign tumours, can be surgically removed,

c.
 Secretory tumour Non-secretory tumour

Secretes too much of hormones Doesn’t secrete excess hormones

Such as secretory carcinoma which is Such as pituitary adenoma that does not
subtype of a breast carcinoma generally secrete active hormones or also known as
associated with a favourable prognosis clinically non-functioning pituitary adenomas
and it is mostly macroadenomas.

9. What do you expect to happen (structurally and physiologically) when there is non-secretory
(non-functional) tumour of the pituitary? Justify your answer with reference to Mrs A’s case.
Hint: relate to the blood supply to the secretory cells. Compare this to specific forms of pituitary
tumour (functional tumour). Give specific examples of functional tumour of the pituitary and
describe the effects.

Enlargement of the pituitary gland out of sella turcica and if the tumor grows big enough, it will:
1. Compress the optic chiasm located superior to the pituitary and cause disturbances in
vision. (pale-looking optic disc in Mrs.A)
2. Cause damage to the surrounding glandular tissue by compressing it directly or
compressing blood vessels that supply it, causing it to lose it’s function
Mrs.A has symptoms of Gonadotropins deficiency, TSH deficiency and ACTH
deficiency)
3. Grow laterally into the cavernous sinus and compress divisions of the trigeminal nerve
causing headache (Mrs.A has a severe headache)

Functional tumors secrete excess hormones and therefore cause hyperpituitarism not
hypopituitarism. An example is growth hormone–secreting tumors which causes Acromegaly in
adults (gigantism in children)

10. List the hormone-secreting cells of the anterior pituitary (refer to pre-class Q6). Under
normal circumstances, how are these cells stimulated or inhibited in terms of hormonal
secretion? What happen to these cells in this patient who has non-functional adenoma (Q12)?

Somatotrophs, lactotrophs, gonadotrophs, thyrotrophs, corticotrophs.

-All hormonal secretion of anterior pituitary are stimulated and inhibited by the hypothalamus via
neurosecretory neurones. When a patient has non-functional adenoma, the pituitary gland is
compressed causing it to not be able to regulate normal hormone function,thus causing the
decline of hormonal production.
11. Draw and describe the normal transduction mechanism after receptor activation of each
of the pituitary secretory cell types. Hint: G-protein couple receptor (Gαs, Gαi, Gαq). What
would be the final physiological response of each of these cells? How is transduction
mechanism affected in the secretory cells or this patient? Compressed cells cannot carry out
signal transduction, low stimuli What are the effects?

12. Compare the normal circumstances (Q10) to that of this patient with respect to pituitary
secretion. What would the circulating levels of the pituitary hormones be in the patient? What
would be the physiological effects? Hint: depend on the action of the pituitary hormone.

-Insufficient secretion of secretory hormones due to pituitary adenoma compared to the normal
-there will be lower circulating levels of pituitary hormones in the body
-Low thyroid stimulating hormone > low production of thyroid hormone
Low Adenocorticotrophs > low production of cortisol
Low luteinizing hormone > low testosterone, no ovulation
Low follicles stimulating hormone > low maturation of sperm and ovarian follicles
Low growth hormone > growth retardation
Low prolactin > low lactogenesis and lobuloalveolar growth
Low anti diuretic hormone > decrease water retention, polyuria
Low oxytocin > low contraction of myoephithelium of mammary glands and uterine lining
13. Relate the hormonal effects to the signs and symptoms seen in the patient. For
example:
a. Why were her periods irregular?
Amenorrhea due to low prolactin secretion Due to decrease in LH, no ovulation, no menstrual
cycle

b. Why was the patient getting fatigued easily and why was the power in her muscle not as
strong as before?
Low Acth production results in low cortisol production. This can cause the blood to have low
glucose level due to low gluconeogenesis, resulting in fatigueness.Low glucose results in low
glucose metabolism. Due to decrease in thyroid hormone, low metabolic rate, reduced
production of energy. Low growth hormone results in low production of IGF-1. IGF-1 is required
for the proliferation of myoblasts. Therefore, there is a decrease in muscle mass. Muscle doesnt
get enough energy

c. Why was she feeling cool when the day was warm? Was her friend correct when she
said that the metabolic rate of the patient could be low? Explain the mechanism.
Low production of thyroid stimulating hormone will result in low production of thyroid hormones.
Thyroid hormones are responsible for increasing the metabolic rate of the body, indirectly
causing heat production due to increased oxygen consumption and rates of ATP hydrolysis. In
this patient, due to the low thyroid hormone production, she would experience a lower rate of
metabolism thus causing lesser heat production.

d. What was the reason for the headache? No hormone causing headache
Pituitary adenoma, increased intracranial pressure

e. Why did she feel too lethargic to even move about?

Because low levels of cortisols, low thyroid hormone
f. When she stood up to walk, she noticed that she consistently bumped into objects and
cannot see objects on her sides. Why?
Compression of the optic chiasm causing loss of vision due to bitemporal hemianopia

g. The doctor noted that she looked pale, with a slow pulse and was hypotensive. Why?
Due to under secretion of ADH and prolactin, and underactive adrenal glands. Lack of
sympathetic effect. Low heart rate

14. Construct a table to show the hypothalamic hormones, their chemical nature, their target
cells, their mode of action on the target cell, and their physiological effects. Give conditions
when the hormones could be over secreted or under secreted and discuss the physiological
effects. Does the patient have any problem with hypothalamic hormones? Hint: hypersecretion.
Justify your answer.
Yes she does because of the disruption in the negative feedback loop that regulates both
hypothalamic and pituitary hormones, the hypothalamus will secrete pituitary stimulatory and
inhibitory hormones in an attempt to restore normal levels of pituitary hormones.
Hormone Undersecretion Oversecretion

TRH Hypothyroidism Hyperthyroidism

- Low metabolic rate - Heat intolerance
- Cold intolerance - Excessive sweating
- Bradycardia - Tachycardia
- Muscle wasting

GnRH Low production of FSH Infertility, could be polycystic

- Low maturation of ovarian ovary syndrome
follicles
- Low maturation of sperm

Low production of LH
- Low production of testosterone
- No ovulation
- Low androgen

CRH Addisons disease Cushings syndrome

- Low cortisol - High cortisol

GHRH Dwarfisme Acromegaly in adults

- Growth retardation Gigantism in kids

Dopamine Low inhibition of prolactin production > High inhibition of prolactin

increased production of prolactin production > decreased
production of prolactin
 Somatostatin Problems associated with high levels Somatostatinoma, tumor
of other hormones produces hormones
independently.

15. Construct a table to show the anterior and posterior pituitary hormones, their chemical
nature, their target cells, their mode of action on the target cell, and their physiological effects.

Give conditions when the hormones could be over secreted or under secreted and discuss the
physiological effects. Does the patient have any problem with anterior pituitary and posterior
pituitary hormones? Justify your answer.

Hormone Hyposecretion Hypersecretion

ADH Diabetes Insipidus Syndrome of inappropriate
antidiuretic hormone
secretion (SIADH)
Oxytocin Difficulty in breast-feeding High levels of oxytocin have
and is related to autism, been linked to benign
labour may not come prostatic hyperplasia
naturally
GH Dwarfism Acromegaly in adults
(gigantism in children)
Prolactin Poor milk production Galactorrhea, infertility
FSH Female- low estrogen, Female- menopause
amenorrhea
Male- poor sperm production
LH Infertility, failed puberty infertility and miscarriage in
Female- No ovulation women with the polycystic
Male- low testosterone ovary syndrome
TSH Hypothyroidism Hyperthyroidism
ATCH Addison’s disease Cushing disease

16.The doctor decided to do more tests and requested the endocrine laboratory to assist in
coming out with the final diagnosis. What tests do you think should be done on the patient?
Why?

Hyposecretion : stimulation test for all hormones

- Blood and Urine test : these test check hormone levels in the blood and urine.

- CT scan : X-rays and computer to make images of the body

- Head MRI : make detailed images of organs and structure in the body.
17. List the pituitary hormones that are not directly affected by the pituitary adenoma and
briefly describe their functions.

● ADH-regulate blood volume and osmolarity ECF

● Oxytocin- muscle contraction in reproduction

18. How would you manage the patient?Removal of tumour through transsphenoidal approach,
radiation therapy or medication therapy .
Pituitary hormone displacement