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Anterior Pituitary


In hypopituitarism hormone are affected in the following order: GH, FSH and LH, prolactin (PrL), TSH, and ACTH.  (MCQ)


Causes are from 3 levels

  1. Hypothalamus: Kallmann’s syndrome , tumor, inflammation, infection (eg meningitis, TB), ischemia.
  2. Pituitary stalk: Trauma, craniopharyngioma, meningioma.
  3. Pituitary: Tumour, irradiation, inflammation, infiltration (hemochromatosis, amyloidosis, metastatic ca), ischemia (pituitary apoplexy, Sheehan's syndrome). 

Pituitary apoplexy occur in pregnancy, DM, HT, Sickle cell anemia. (AIIMS May 12) It does not occur in. hyperthyroidism. (Ref. Hari-18th ed., Pg- 2879)

Features are due to

  1. â hormones                    
  2. Mass effect
  1. ↓ Hormone:
    1. GH deficiency
    2. Gonadotrophin deficiency (FSH; LH) oligomenorrhea or amenorrhea
    3. Thyroid deficiency: As for hypothyroidism.
    4. Corticotrophin deficiency: As for adrenal insufficiency. (MCQ: No hyper pigmentation as ACTH is reduced)
    5. Prolactin deficiency: failure of lactation. 

Extra Edge:

  1. DI is not a feature of hypopituitarism i.e. transection of pituitary stalk does not lead to diabetes insipidus)
  2. Insulin is a pancreatic hormone and is not under the control of pituitary.
  3. Transection of the pituitary stalk would therefore in no way affect glucose level and will not lead to diabetes mellitus.
  1. Mass effect: eg pituitary tumour , causing mass effect, (Headache, Bitemporal hemianopia)
    1. Tests:
      1. Insulin tolerance test: In this I v insulin is given to induce hypoglycemia causing stress to cortisol and Increase GH secretion.
    2. Treatment involves hormone replacement and treatment of underlying cause.
      1. Hydrocortisone for secondary adrenal failure.
      2. Thyroxine if hypothyroid.
      3. Hypogonadism (for symptoms and to prevent osteoporosis).

Extra Edge:

  1. Sheehan’s syndrome is post-partum infarction of the pituitary, leading to hypopituitarism.
  2. Treatment consists of hormone replacement therapy including Glucocorticoids, thyroid hormone, sex steroids, growth hormone, vasopressin, etc.
  3. Thus multiple hormones must be replaced, but cortisol replacement is most important & should be the first to be replaced.
  4. Steroids are given before thyroxine, otherwise thyroxine may precipitate an adrenal crisis. 

Pituitary Tumours

  1. Pituitary tumours (almost always benign adenomas) account for 10% of intracranial tumours. They may be divided by size: a microadenoma is a tumour< 1cm, and a macroadenoma is > 1cm.
  2. Symptoms are caused by local pressure, hormone hyper secretion, or hypopituitarism
  3. Features of local pressure (Especially if size is more than 10 mm)
    1. Headache,
    2. visual field defects (bilateral temporal hemianopia, due to compression of the optic chiasm),
    3. palsy of cranial nerves III,IV, VI (pressure or invasion of the cavernous sinus).
    4. Diabetes insipidus (DI)  more likely from hypothalamic disease); disturbance of hypothalamic
    5. centres sleep, and appetite; erosion through floor of sella leading to CSF rhinorrhea.
  4. Treatment
    1. In hypopituitarism start hormone replacement as needed. Ensure steroids are given before thyroxine, as thyroxine may precipitate an adrenal crisis.
    2. Surgery: pituitary surgery is trans-sphenoidal
    3. Radiotherapy: Post-op if complete removal of the tumour has not been possible.


  1. It does not secrete any hormone.
  2. Bimodal age of presentation – childhood and above 60 years.
  3. Commonest childhood intracranial tumour
  4. Most common cause of hypopituitarism in children
  5. Benign pituitary tumor derived from Rathke's pouch remnants
  6. Located above the sella turcica i.e. supra sellar mass.
  7. Extends into sella turcica and destroys the gland. Can also damage the pituitary stalk, causing raised prolactin.
  8. Cystic tumor with hemorrhage and calcification.
  9. Commonly causes bitemporal hemianopia
  10. Over 50% present in childhood with growth failure;
  11. Adults may present with amenorrhoea, libido, hypothalamic symptoms (eg central diabetes insipidus, hyperphagia, sleep disturbance) or tumour mass effect.

Tests: CT/MRI (calcification in 50%, may also be seen on skull XR).

Treatment: Surgery ±post-op radiation.

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