Overview
The
pituitary gland is the master endocrine gland. It produces small quantities of
hormones (thyroids, adrenal glands etc.), that cause the target organ to
release the final active hormone e.g. T3 and T4, Adrenaline, oestrogen and
testosterone. The gland sits within the sella turcica in the body of the
sphenoid bone, and receives hormonal influence from the hypothalamus.
Gross Anatomy
The
pituitary gland is the master endocrine gland of the human body. It produces a
range of hormones from its anterior lobe/adenohypophysis (ACTH, TSH, LH and
FSH, PL, GH) and posterior lobe/neurohypophysis (Oxytocin and Vasopressin/ADH).
The production of these hormones is under the influence of the hypothalamus
that releases small concentrations of hormones into the portal system of the
pituitary. These hormones influence the anterior pituitary. Hormones of the
posterior pituitary are produced by the hypothalamus itself, and
stored/released from the posterior pituitary. It is located within the cranial
cavity, and sits within its own space, known as the sella turcica, meaning
Turkish saddle. The name originates from the appearance of the Turkish saddle,
which had 4 posts at each corner. The Turks were therefore able to ride and
swing their swords simultaneously during battles. The anterior and posterior
clinoid processes of the sphenoid bone reciprocate the four posters of the
saddle. The sella turcica is covered in dura mater in life, and the pituitary
is connected to the hypothalamus above by the pituitary stalk, or infundibulum.
The
pituitary releases a large number of hormones that then pass into the systemic
circulation and reach their target endocrine organs or other tissues where they
exert their effects. The blood supply to the anterior pituitary is through the
paired superior hypophyseal arteries that arise from the medial aspect of the
internal carotid artery. These in turn form the hypophyseal portal veins that
lie in the pituitary stalk/infundibulum, which deliver blood to a second venous
plexus within the anterior pituitary itself. Hormones from this second plexus
are drained into the systemic venous circulation. The posterior lobe is
supplied by the inferior hypophyseal arteries, which arise directly from the
cavernous section of the internal carotid artery. The lobe drains directly into
the systemic venous circulation.
Clinical Anatomy
Prolactinoma- This
is the commonest pituitary tumour, and arises from the anterior pituitary
gland. It causes excess prolactin production causing amenorrhoea, bitemporal
hemianopia (if it compressed the chiasm from beneath), may cause milk
production, and a lack of secondary sexual characteristics in males, headache
and impotence.
Cushing’s disease-This
is an ACTH producing tumour of the anterior pituitary. Symptoms are caused by
excessive cortisol, with central obesity, buffalo hump, purple striae, bone and
muscle wasting etc.
Craniopharyngioma- This
tumour arises from pituitary gland embryonic tissue. Symptoms include
progressive bitemporal hemianopia and headache.
Pituitary apoplexy- This
occurs when the pituitary gland bleeds heavily, or had greatly diminished blood
supply. It commonly follows a tumour. Symptoms include sudden headache, double
vision and sometimes a third nerve palsy (due to the proximity of the cavernous
sinus).
Quick Anatomy
Key Facts
Developmental precursor- Anterior pituitary develops from the upward projecting
Rathke’s pouch
Posterior pituitary from a downward ectodermal
projection from the developing diencephalon
Blood supply-
Anterior pituitary from the superior hypophyseal and portal system, posterior
pituitary from the inferior hypophyseal arteries.
Venous drainage- Petrosal sinuses, then the cavernous sinuses.
Aide-Memoire
Remember the two hormones released
by the posterior pituitary (oxytocin and vasopressin), and the others are
released by the anterior pituitary.
Summary
The pituitary
gland is the master endocrine gland. It is under the influence of the hypothalamus,
and releases small quantities of hormones into the blood stream, which will
reach the target organs.
References
1.
Frank H.Netter MD: Atlas of Human Anatomy, 5th
Edition, Elsevier Saunders, Chapter 1 Head and Neck
2.
Chummy S.Sinnatamby: Last’s Anatomy Regional and
Applied, 12th Edition, Churchill Livingstone Elsevier
3.
Richard L. Drake, A. Wayne Vogl,
Adam. W.M. Mitchell:
Gray’s Anatomy for Students, 2nd Edition, Churchill Livingstone
Elsevier
4.
Elliiot L.Manchell: Gray's Clinical Neuroanatomy: The Anatomic Basis for
Clinical Neuroscience
5.
The Definitive Neurological Surgery Board Review
By Shawn P. Moore,
2005
6.
Human Neuroanatomy
By James R. Augustine,
2008