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OK, you live. Yeah. OK. Welcome back, everyone to your and ask me collaborative. I would like you to present our today. We have section two session, one of our series and now now handover to Paul who will be introducing our speaker for today. Hi. Yeah, thank you. Thank you for joining this evening. So for the first time, this year, we're running the series on me, which means we have a live audience from all over the world and we've also decided to rejig the structure of the talk slightly. So we're working up anatomically from the spinal cord and the brainstem integrating clinical cases into ejection and individual sessions to enhance your learning. In our opening series of talks, we cover the spinal cord brainstem cranial nerves and visual system and now to open our second section. It's my pleasure to introduce Mr John Han, a neurosurgical trainee and senior clinical research fellow at the National Hospital who will cover the pituitary gland and its disorders and I'll hand over to him now. Cool. Um Thanks guys. Thank you for having me and I think for the next kind of 45 to 15 minutes, we'll look at the pituitary gland its disorders. Um, and I apo I'm in a, I'm in an office so people might be coming in and out. So if you can't hear me or if there's an interruption system just flag it in the chat. Um, this talk is targeted at like medical students and early stage junior doctors. But if, um, the audience is significantly different, then we can try and readjust a little bit. So, um hopefully you can see my slides and this is kind of an overview of what we'll we'll cover. So we'll look at first some basics about the gland itself, how we image it and then a few cases which are relevant to osk. So there's different kind of terms for the hypophysis or pituitary gland, which obviously always relate to some pretty cool Latin words, there was a little bit of spiel on this, but in the interest of time cos we've got about 60 slides to cover. I'm gonna skip through the, the small talk. So, um it'd be good. I'll, I'll, I'll open up the chat as well. What does the gland do? Happy for people to shout out or pop a, a message in the chat? So obviously, there, there's a, there's a clue on the, on the slide on the right where it's part of the H pa the hypothalamic pituitary adrenal axis or the endocrine system. Um But what, what, what is the pu gonna do? Anyone? Cool. So the aim is to basically disseminate through your bloodstream, um hormones to exact particular effects in different organs. And I think it's quite important that when thinking about the gland and then the disorders that relate to the gland and also how to assess it, you need to know what hormones are produced um by the pituitary gland. And there are quite a few and um they, they, they stimulate um the, the, the atrophic hormones essentially to stimulate other um organ systems and parts of the body. And I've got a list here on the left as an example of some of the uh the endocrine um hormones that are produced. Uh And this is a schematic of the gland and it's broken down into a few parts. And not only do we need to understand what the gland does but knowing where it is also impacts patients and drives some presentations of conditions and the region it's in is quite a busy region. So it's important to know the different aspects in close proximity. So, if we first split the gland, the pituitary gland into two, two halves, two loaves, the adenohypophysis is at the front, the an anterior pituitary gland and that produces its own hormones and secretes them all in the anterior pituitary gland. And it's made up of the past U brelis intermedia and the distalis, the posterior pituitary, the neurohypophysis receives hormones via the stalk um and, and secretes them. Um and you know, sometimes it's called the pars nervosa. Those are the two distinct lobes or halves of the pituitary gland. It's also important to be aware that the gland kind of hangs off a stalk from the hypothalamus, um which is involved in delivering some hormones. Um It contains an important venous plexus and is important in the posterior pituitary function. So this is a quite important schematic just to be aware of. And if you want to go into some more detail about the gland itself, um I initially, when um studies were or the gland was studied cells were defined based on how they were stained. Um and that's how they derived some of the names, but we've now moved towards naming cells or classifying cells according to the specific hormone that they produce because we see in some disorders, those cell populations grow and result in particular conditions. Um So for example, like a a Cushing's disease would have a corticotrophic ad adenoma um when you analyze a tumor. So it's, it's important just to have a, a general understanding of how function kind of directs diagnoses and therefore management and understanding of the gland. So these are the five anterior lobe um hormones and the commonest is growth hormone in terms of the cell population, and then the rest are pretty much evenly distributed. So this is, this is quite an important question and I'm gonna put this out to the chats if, if I if, if we removed your pituitary gland. Um, lack of which hormone would probably kill you first. Mm. Mm. Now, I can't see the chat. So I don't know if there, if anyone wants to contribute un unmute your mic or throw up a comment in the chat, you need to pick one anterior lobe. We'll go anterior first, one anterior pituitary hormone. Which one is the most important acutely for sustaining life? Cortisol? Yeah. Great. And why is that? It's important stress response. Yeah. And your body uses that all the time. So it helps with like uh tone of vessels, electronic heart rates. And that's why um an Addisonian crisis is so such an emergency because with, with a, with a, with a lack of um cortisol, you become vasoplegic, you become um bradycardic and there are other whole host of other issues, um er, that patients face and it, you know, it is, it is an emergency. So if, um, what if there was, if you think about the whole gland, now, what would be the second, um, second hormone that would kill you first if you lacked it? It's a poorly worded question. So we'll talk about it and we'll talk about it in a bit, but that's great. So, so good that we've identified cortisol. And um your hand reference to the Sella Turcica basically cos it looks like a Turkish saddle which it does. Um, and the Sellar this region will often be referred to as the Sellar region. So just be mindful of the, the MENC. So this, this is a um this is an important slide anatomically. One second. OK. Sorry about that. Um This is an important slide a anatomically. And um it's, it's because it tells us what are the things that can get affected by tumors or lesions but also the structures at risk when we try and intervene to treat pituitary gland, um pituitary diseases. Um So, so is anyone able to name any of the structures on here? So if I and I can't see the chat, but it would be good to make this a bit more interactive. So, so this is the pituitary gland, we can all agree on that. We're looking coronally. So front to back. So the pituitary gland is is here. Can anyone identify this structure? So you have to unmute your mic cos I can't see the chat chiasm chiasm? Perfect. And that's you can see it's right above the gland. Um Is it unable to identify this structure here?