PITUITARY DISEASE
Ed Friedlander, M.D., Pathologist
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Especially if you're looking for information on a disease with a name that you know, here are a couple of great places for you to go right now and use Medline, which will allow you to find every relevant current scientific publication. You owe it to yourself to learn to use this invaluable internet resource. Not only will you find some information immediately, but you'll have references to journal articles that you can obtain by interlibrary loan, plus the names of the world's foremost experts and their institutions.

Alternative (complementary) medicine has made real progress since my generally-unfavorable 1983 review. If you are interested in complementary medicine, then I would urge you to visit my new Alternative Medicine page. If you are looking for something on complementary medicine, please go first to the American Association of Naturopathic Physicians. And for your enjoyment... here are some of my old pathology exams for medical school undergraduates.

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Some nice cases

Normal pituitary

WebPath Photo

Normal pituitary

WebPath Photo

Pituitary gland
Pars intermedia
KCUMB Team

{14945} anterior (A) and posterior (B) pituitary
{02294} anterior pituitary, histology; curious stain, don't worry about the colors
{14948} posterior pituitary, histology (arrow: Herring body)

Normal anterior pituitary

WebPath Photo

Normal posterior pituitary

WebPath Photo

OBJECTIVES;

KCUMB Students
"Big Robbins" -- Endocrine
Lectures follow Textbook

QUIZBANK

INTRODUCTION

LABS TO LOOK FOR PITUITARY INSUFFICIENCY

LABS TO LOOK FOR PITUITARY HORMONE OVERPRODUCTION

ANTERIOR LOBE ADENOMAS (Am. Fam. Phys. 88: 319, 2013; curious five-tier WHO classification Cancer 78: 502, 1996; tumorigenesis J. Clin. Inv. 112: 1603, 2003)

{15683} pituitary adenoma, gross
{15682} pituitary adenoma with hemorrhage
{49422} pituitary adenoma, gross
{49612} pituitary adenoma, gross
{09214} pituitary adenoma, histology (this was a prolactinoma; you couldn't tell)
{24821} pituitary acidophilic adenoma, Orange G stain (acromegaly)
{09215} pituitary adenoma, histology
{15679} pituitary adenoma, histology
{05026} pituitary adenoma, x-ray
{00344} pituitary adenoma, x-ray

Pituitary adenoma
Pittsburgh Pathology Cases

Pituitary adenoma
Pittsburgh Pathology Cases

Pituitary microadenoma

WebPath Photo

Pituitary adenoma

WebPath Photo

{49419} giant and her sisters
{16101} acromegaly
{25668} acromegaly (which twin has it?)
{49421} acromegaly, hand (compared with normal)

      Excess growth hormone before puberty produces excessively tall stature. In the past, these people typically were crippled by nerve, muscle, and joint problems, acquired acromegalic features as they got older, and died young of complications of their diabetes.

        A giant is defined to be a human over seven feet tall (you may hear 200 cm instead).

Gheorge Muresan
George Muresan

        * Andre "the Giant" Rousimoff, the famous wrestler, had acromegaly; he was 7'4" tall and weighed 520 lb when he died at age 46. Several movie villains have been played by acromegalics. My favorite is Richard Kiel as "Jaws" from "Moonraker". Acromegalic Rondo Hatton (here or here, from the 1940's B-movies, "could have played Frankenstein without make-up". Dalip Singh evidently has gigantism-acromegaly; he remains very physically fit.

        The lab workup of acromegaly is straightforward. Your screening test is a spot blood insulin-like growth factor I (IGF-I). If this is normal, acromegaly is unlikely. Next, attempt suppression of the hGH levels to <1 microgram/L by administering 75 grams of glucose orally (yuck). If this fails, your patient probably has acromegaly.

Jaws
Jaws

{09367} Cushingism
{09368} Cushingism
{09369} Cushingism
{09370} Cushingism
{16110} Cushingism
{16111} Cushingism
{49427} Cushingism
{25669} Cushingism, before and after treatment

Pituitary adenoma
Pittsburgh Illustrated Case

PANHYPOPITUITARISM (NEJM 330: 1651, 1994)

PITUITARY DWARFISM

    Failure to produce normal amounts of growth hormone in childhood results in miniature, well-proportioned people. Causes range from "idiopathic" to various genetic syndromes to other causes of hypopituitarism.

      Around 50% of "idiopathic dwarves" are breech or transverse deliveries, and the damage to the hypothalamic-pituitary axis may occur when their little skulls get crunched: Lancet 338: 480, 1991

      After traumatic brain injury, there is often considerable loss of growth hormone (Arch. Phys. Med. 86: 463, 2005). New studies of professional and elite amateur boxers show that growth hormone and ACTH are often impaired -- watch this one (Ann. Int. Med. 148: 827, 2008.)

CRANIOPHARYNGIOMA ("adamantinoma", "ameloblastoma", both named for tooth enamel)

{15685} craniopharyngioma, gross
{15686} craniopharyngioma, gross
{15687} craniopharyngioma, histology
{15688} craniopharyngioma, histology

Craniopharyngioma

KU Collection

Craniopharyngioma
Notice the benign squamous pearl
KU Collection

Craniopharyngioma

WebPath Photo

DIABETES INSIPIDUS (Am. Fam. Phys. 55: 2146, 1997; Arch. Int. Med. 157: 1293, 1997).

SYNDROME OF INAPPROPRIATE ADH PRODUCTION

PITUITARY-HYPOTHALAMIC SYNDROMES

{49423} Froehlich's man, age twenty

    KALLMANN'S SYNDROME is a brain malformation with anosmia (no sense of smell) and Froehlich's. The best-known gene is KAL1, which directs neuronal migration; two other loci are known (update J. Clin. Inv. 120: 3668, 2010).

      * Jazz singer/musician "Little Jimmy Scott", who's delighted audiences for over half a century, has Kallmann's, which gave him his distinctive child-like appearance and voice.

      * An autosomal dominant Kallman's: Nat. Genet. 33: 463, 2003.

Jimmy Scott

* PITUITARY NON-DISEASES

{10747} pituitary infarct

FINAL NOTE:

* SLICE OF LIFE REVIEW: ALL GLANDS

{00135} thyroid, normal
{09213} pituitary, normal
{09362} thyroid scan radionucleotide, normal
{11204} adrenal and nerve, normal
{11207} adrenal and nerve, normal
{11210} adrenal and nerve, normal
{11754} thyroid, normal
{11755} thyroid, normal
{11803} thyroid, normal
{12866} sella turcica, normal anatomy
{12903} thyroid gland, normal
{12983} sella turcica, normal
{12986} sella turcica, normal
{12992} sella turcica, normal anatomy
{12995} sella turcica, normal
{12998} sella turcica, normal
{13004} sella turcica, normal
{13007} sella turcica, normal
{13010} sella turcica, normal
{13013} sella turcica, normal
{13016} sella turcica, normal
{13019} sella turcica, normal
{13022} sella turcica, normal
{13025} sella turcica, normal
{13028} sella turcica, norma
{13169} adenoma, pituitary
{14942} hypophysis, normal
{14942} hypophysis, normal
{14943} adenohypophysis (pars distalis), normal
{14943} adenohypophysis (pars distalis), normal
{14944} pituitary (anterior & posterior)
{14945} pituitary (anterior & posterior)
{14946} pituitary trabeculae, normal
{14947} neurohypophysis, normal
{14948} neurohypophysis, normal
{15034} adrenal, normal
{15035} adrenal gland (zones), normal
{15036} adrenal gland (zones), normal
{15037} adrenal gland (cortex), normal
{15038} adrenal gland (cortex), normal
{15039} adrenal gland (cortex), normal
{15040} adrenal gland (cortex), normal
{15041} adrenal gland (cortex, lipid stain)
{15042} adrenal gland (cortex, lipid stain)
{15043} adrenal gland (medulla), normal
{15044} adrenal gland (medulla), normal
{15045} adrenal gland (medulla, chromaffin stain)
{15046} adrenal gland (medulla, chromaffin stain)
{15048} thyroid gland, normal
{15049} thyroid gland, normal
{15050} thyroid inactive, normal
{15051} thyroid gland (follicle cells), normal
{15052} thyroid gland (active follicle cells)
{15053} thyroid gland (inactive follicle cells)
{15054} thyroid gland (parafollicular cells)
{15055} thyroid gland (parafollicular cells)
{15056} parathyroid gland fetal, normal
{15057} parathyroid gland, normal
{15058} parathyroid gland, oxyphil cells
{15059} parathyroid gland, oxyphil cells
{15060} parathyroid gland, oxyphil & chief cells
{15680} adenoma, pituitary with normal tissue
{20695} pituitary gland, both lobes
{20696} pituitary gland, both lobes
{20697} pituitary, pars distalis
{20698} pituitary, pars intermedia
{20699} pituitary, intermedia and * nervosa
{20700} pituitary, pars nervosa
{20701} adrenal gland with layers labeled, #98
{20702} adrenal gland with layers labeled, #98
{20703} adrenal gland with layers labeled, #98
{20704} adrenal gland with layers labeled, #98
{20705} adrenal gland, medulla
{20706} thyroid, normal
{20707} thyroid, normal
{20708} thyroid, normal
{20709} parathyroid, normal
{20711} pineal gland, normal
{20712} pineal gland, normal
{20795} parathyroid
{20796} parathyroid, oxyphil cell
{20797} parathyroid, oxyphil cell
{20970} hypophysis, all three regions
{20971} adenohypophysis, anterior lobe of pit.
{20972} neurohypophysis, posterior lobe pituit.
{20973} pars intermedia, pituitary
{20974} pars intermedia, pituitary
{20975} neurohypophysis, herring body
{20976} adrenal
{20977} adrenal, glomerulosa layer
{20978} adrenal, fasciculata layer
{20979} adrenal, reticularis layer
{20980} adrenal, medulla
{20981} adrenal, fasciculata
{24712} adrenal, normal
{24823} thyroid, normal
{25393} adrenal cortex, normal
{31090} pituitary in sella, normal
{34355} pituitary, normal
{36419} thyroid, normal
{36425} thyroid, normal
{36452} thyroid cytology, normal glandular cells
{36455} thyroid cytology, sheet of normal glandular cells

BIBLIOGRAPHY / FURTHER READING

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