Pituitary pathology
- ANATO-PHYSIOLOGICAL REMINDERS ON THE PITUITARY GLAND
The pituitary gland and the hypothalamus
- The pituitary gland and hypothalamus are small, nut-shaped glands located at the base of the brain. The Hy is located in the sella turcica and the Ho just above it.
- Between these two glands there are nerve fibers and vessels which constitute the pituitary stalk and allow communication between these two organs.
Pituitary pathology
Pituitary pathology
Pituitary hormones:
Anterior pituitary: FSH LH, ACTH, TSH, GH, prolactin,
Posterior pituitary: ADH (arginine vasopressin)
Pituitary pathology
- Hyperfunction syndromes:
- Acromegaly:
Acromegaly (adult) is a hypersecretion of growth hormone (GH) most often corresponding to a pituitary adenoma.
Its treatment is most often surgical from the outset.
In children (gigantism) or adolescents: acromegalo-gigantism will be noted due to the absence of fusion of the epiphyses.
1-Clinical signs:
- Dysmorphic syndrome
- Organomegaly: tongue, vocal cords, heart, thyroid, liver, spleen, colon
- Functional signs: sweating, muscle fatigue, paresthesia, arthralgia, headaches
- Signs of complication: HBP, heart rhythm disorders
2- radiological signs:
- Signs of general GH involvement:
- Skull X-ray – feet – chest – thyroid and heart ultrasound
- Signs of the tumor: pituitary MRI (micro or macro adenoma).
3- complications of acromegaly:
- Tumor extension: optic compression, headaches, intracranial hypertension
- HTA due to hypervolemia
- Heart disease: increased cardiac output, myocardial hypertrophy then congestive heart failure with dilation and drop in cardiac output (cause of death).
- Type 2 or type 1 diabetes with its vascular complications
- Colonic polyps (colonoscopy).
4- treatment:
- Treatment often has an imperfect result due to the late diagnosis of acromegaly and the presence of an invasive tumor.
- In most cases :
Primary surgery
In case of non-cure or recurrence: pituitary radiotherapy
While waiting for its action under somatostatin analogue
- Hyperprolactinemia:
Prolactin stimulates the formation of milk in the breasts
- Signs of hyperprolactinemia:
- Prevalence: 1 to 1.5%
- In women: menstrual disorders, infertility, galactorrhea 10%
- In men: libido disorder, infertility, gynecomastia.
- Anterior pituitary insufficiency:
- Deficiency of all or several hormones (pan hypopituitarism)
- Either by surgical destruction or radiotherapy of the gland
- Either by a tumor compressing the gland and preventing normal secretion
- Clinical signs:
- Thyroid hormone deficiency (TSH): signs of hypothyroidism
- Growth hormone deficiency: growth arrest in children
Asthenia, weight gain in adults
- Gonadotropic deficiency (FSH LH): signs of hypogonadism
Man: impotence, hair removal, gynecomastia
Female: amenorrhea, hot flashes)
- Corticotropic deficiency: signs of adrenal insufficiency without melanoderma (pallor ++).
In summary, often: pallor and hypotension.
Description type: Global anterior pituitary insufficiency in adults
- Evocative aspect:
- Pale, alabaster-colored face, with a youthful, inexpressive face
- Thin, atrophic , dry skin
- Low facial hair, axillary hollows and sexual regions
- Fine brittle hair
- Causes of pituitary insufficiency:
- Tumor causes and infiltrations of the pituitary gland: adenoma and tumors of the hypothalamic-pituitary region.
- Other causes:
- SHEEHAN syndrome
- Hemochromatosis
- Intrasellar arachnoidocele (partial deficiency).
- Pituitary apoplexy
- Midline syndrome (pituitary insufficiency, cleft palate, brain malformation in children)
- Genetic deficiency due to anomaly in the development gene of certain anterior pituitary cells (familial deficiency).
- Treatment :
- Substitution of the deficient target hormone:
- Levothyrox L thyroxine
- Hydrocortisone
- Androgens or HRT
- Growth hormone in children and now in adults.
- Clinical monitoring (general condition, blood pressure, weight) and biological monitoring (regular hormone tests).
- Pathology of the posterior pituitary gland:
Pituitary pathology
Pituitary pathology
- Diabetes insipidus: symptoms.
- Rapid dehydration
- Profuse diuresis up to 30 l/24h
- Collapsed urine osmolarity: 50 mosmol/l.
- Intra and extracellular hyperosmolarity.
- Severe hypernatremia.
- The treatment:
The aim is to provide ADH or a synthetic analogue exogenously to enable effective antidiuresis.
A synthetic analogue of lysine vasopressin, DDAVP or desmopressin (MINIRIN) is available, administered by nasal spray 2x/day due to its long duration of action.
MINIRIN is used in cases of central diabetes, known as pitressosensitive diabetes, as oposide substitution therapy.
- Consequences of pituitary pathologies on the oral mucosa.
- Acromegaly:
1- Macroglossia.
Macroglossia is an increase in the volume of the tongue.
Macroglossia is a major oral symptom alongside loss of dental articulation and prognathism.
2- Consequences
The tongue, by its increase in volume, can cause:
– an increase in the width of the mandible by the forces it exerts,
- spacing of teeth (creation of interdental diastemas),
- a labial version of the teeth (especially the mandibular teeth),
- problems with swallowing, speech,
- aesthetic problems
2-Labial hypertrophy: The lips are often full, everted, especially the lower lip .
3-Gingivostomatitis: They are common in acromegaly, favored by mouth breathing, macroglossia and local irritants. It is therefore necessary to ensure regular monitoring in order to maintain correct hygiene.
DENTAL TREATMENT:
- Prosthetic rehabilitation in patients with acromegaly
Pituitary pathology
Sensitive teeth react to hot, cold or sweet.
Sensitive teeth react to hot, cold or sweet.
Ceramic crowns perfectly imitate the appearance of natural teeth.
Regular dental care reduces the risk of serious problems.
Impacted teeth can cause pain and require intervention.
Antiseptic mouthwashes help reduce plaque.
Fractured teeth can be repaired with modern techniques.
A balanced diet promotes healthy teeth and gums.