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Hi, my name is Amelia. Um And today I'm doing your lecture on disorders of the pituitary gland. So basically, we're gonna cover the endocrine tylus, I guess. So, summarize the pathology pathophysiology, um the function of endocrine glands and also the structure as well. And then this is the lecture timeline. So you've got hypopituitarism, pituitary tumors and disorders of vasopressin. So to start with hypopituitarism, so these are basically everything that you need to know in terms of which hormone corresponds to each hypothalamic factor. So you should know that the pituitary is divided into anterior and posterior and basically just the structure. So from the hypothalamus, you got the hypothalamic hypophyseal tract. Um And then the anterior pituitary from that basically. And then um you've also got the hypothalamus direct to the posterior pituitary via the stalk. So for the anterior pituitary hypothalamic releasing or inhibitory factors for dopamine. Um basically, this is what they correspond to essentially. So we've called dopamine GSPL C HR HSG H GNR FS H TRH TSH. So the main thing about this lecture is basically what happens when the system fails. Um So we mentioned again that these are everything that comes with the anterior pituitary, but what do they do? So, growth hormone, this is responsible for growth. So, if you're not getting enough, this is gonna do something bad to this system. Prolactin is necessary for milk production. LH and FS H are responsible for estrogen progesterone testosterone. So, sex hormones, TSH, this is your thyroid. So anything related to thyroid is gonna go a bit um wonky and then ACTH cortisol. So you should know primary and secondary disease and the causes of these as well. So, primary disease is a problem with the actual gland itself. So that's gonna be the thyroid gland, the adrenal gland, the gonadal glands. Um and this can be for a variety of different reasons. So I put like the main ones that you should know. Um So the thyroid, you're probably thinking more autoimmune destruction. So that could be hashimoto's graves. Um TB and then for the adrenal gland, it's more so autoimmune destruction, uh or trauma. And again, the gonads, you're thinking destruction of testes or the ovaries. So that can be mumps for the testes. That's probably the most likely one, or ovaries would be something like chemo um in terms of secondary disease, then this is due to external factors. Um So the slides will be available later. You don't need to screenshot them at the moment. Ok. Sorry. One sec. Ok. So secondary factors, uh secondary disease is due to external factors. Um So no signals from the hypothalamus or anterior pituitary. So it's not necessarily something to do with the glands themselves. And that's the important thing to take away from that. So we go one by one through each of these then. So first of all, looking at the gonads. So we've got primary hypogonadism and secondary hypogonadism. So with primary, again, there's a problem with the gland itself. So you're looking at low testosterone, low estrogen because the gland itself can't produce it. And as a result, you've got negative feedback. So your LH should rise and, well, first of all, your GN should rise because your hypothalamus is detecting this low LH FS H. So the anterior pituitary produces more GNRH and that therefore makes LH and FS H rise. Um But again, there's still a problem with the um gonads. So there's still gonna be low testosterone, but that's a key hallmark in primary hypogonadism is high, LH and FSH with secondary, there's a problem with the anterior pituitary itself. So it can't produce the GNRH. And as a result, the LH FS H is low and the testosterone is also low. Then um it's kind of very similar thing with thyroid as well. So with primary hypothyroidism, you've still got that negative feedback. So, um there's an issue with the gland itself and therefore there's gonna be low um T three or T four. And as a result, that's gonna negatively feed back to the hypothalamus. It's gonna produce more trh. And that's gonna lead to more TSH being released. And that's why you've got a higher TSH, um, secondary hypothyroidism problem with the hypothalamus. So low TSH, it can't, it can't produce it at all. Um, or it can't produce it in enough amounts and then low t three, low T four as a result. Um, we don't measure trh. So that's why I haven't put low trh anywhere here, but it would also be high. And then we've got primary hypoadrenal adrenalism and secondary hypoadrenalism. Exactly the same thing. So th this problem with the adrenal gland, it can't make cortisol as a result. Um, hypothalamus gonna produce more C Rh and that's gonna lead to an increase in ACTH and then with secondary ACTH is low. Um because there's a problem with the gland itself and therefore cortisol is also low. Um The main thing to take away from this is that cortisol itself is regulated by ACTH, but aldosterone isn't. So aldosterone is regulated through the renin angiotensin system. And so aldosterone can be normal, but cortisol would be low basically in primary or secondary hypoadrenalism. So our first cases here, it, so it's a 35 year old woman visiting her GP. After feeling increasingly fatigued over the past nine months, she has also gained weight despite no major changes in her diet or exercise. And she mentions feeling unusually cold. She lays up a lot with her family complaining that the house is too warm and she's noticed her periods have become infrequent and unpredictable with her last one occurring around six months ago when she was asked about her personal life, she admits that her interest and intimacy has declined significantly and she's recently struggled with her vision while driving. She noticed that she has trouble seeing cars approaching from either side at junctions and at work, she also finds it harder to focus small tasks now seem overwhelming and she wonders if she's burnt out, but she admits that even time off hasn't helped, she seems slightly pale. She has a resting heart rate of 52 and her skin feels quite dry, particularly on her elbows and knees. And we've got five different kind of diagnoses. Um So we're gonna go through some content and come back to this basically. No, no, we're not. Ok. Which of the five would it be? It would be a pituitary adenoma. But I do think we're gonna come back to that. Um OK. So in terms of panhypopituitarism, this is total loss of anterior posterior pituitary function. So there's different presentations you can get and this is kind of what it links to. So fatigue, you're thinking C Rh deficiency, weight gain, poor appetite, cold intolerance is more TSH. Um And then anything related to kind of sex or anything like that. So, reduced libido, um secondary amenorrhea, erectile dysfunction, reduced pubic hair, that's all FS H LH and then depression, low mood GH um you're also thinking short stature in Children, but only Children. So if it's an adult, it's not likely to be related to GH deficiency. But if it's a child, then it is and then in inability to breastfeed is prolactin and then causes of hypopituitarism. So there's acquired and congenital, um acquired just means things that you can get. These are a lot, lot, lot more common congenital things that you're born with. So this is very rare. Um Again, congenital, you're thinking short stature and also hypoplastic or an underdeveloped anterior pituitary on an Mr MRI. Um So if we're acquired, there's quite a few different reasons. Um I try and learn at least three but tumors, radiation infection, trauma, inflammation, pituitary, apoplexy and peripartum infarction. We are gonna go through a few of these. Um And then congenital um is gonna be a mutation of the transcription factor genes prop one that's needed for the development of anterior pituitary and you will.