What are the dangers and how do pituitary gland disorders manifest themselves? Pituitary disease - pubertal hypothalamic syndrome. Dysfunction of the neurohypophysis

The most common diseases of the pituitary gland include hyperfunction and hypofunction, pituitary dwarfism and prolactinoma.

Less commonly diagnosed are diseases of the pituitary gland, such as Sheehan and Simmonds syndrome.

Also, if there is a failure in the production of pituitary hormones, gigantism, acromegaly, Itsenko-Cushing's disease, pubertal hypothalamic syndrome and other diseases can develop.

Hyperfunction and hypofunction of the pituitary gland

With hyperfunction of the pituitary gland, benign tumor- an adenoma that produces too many hormones. IN normal conditions negative mechanism works feedback - high level Hormones in the blood inhibit the production of releasing hormones in the hypothalamus through the nervous system, which inhibit the production of hormones in the pituitary gland, and the production of hormones in the peripheral glands decreases.

With hyperfunction, hormone-producing cells become autonomous, they no longer obey the signals of the pituitary gland and continue to produce hormones, despite the fact that they no longer act to benefit, but to harm the body.

Hypofunction of the pituitary gland is a decrease in the production of hormones or its complete cessation. This usually occurs when the pituitary gland is destroyed due to brain injury, bleeding of the pituitary gland, or as a result of genetic disorders.

Pituitary prolactinoma: symptoms and treatment

If pituitary prolactinoma affects the cells that produce prolactin, women who are not breastfeeding may experience breast discharge. This is not always full-fledged milk, often just clear liquid. Increased performance prolactin in the blood also leads to disorders menstrual cycle and amenorrhea (similar to physiological amenorrhea in breastfeeding women), in this condition a woman cannot conceive.

It is registered that hyperprolactinemia is found in every 3rd woman suffering from infertility.

Men develop infertility. Also a symptom of a pituitary tumor in the stronger sex is a decrease in sexual desire and weakening potency.

When treating pituitary prolactinoma, drugs are prescribed that block the production of prolactin. If treatment is unsuccessful, the pituitary tumor is removed surgically.

Pituitary diseases gigantism and acromegaly

With adenoma of cells producing somatotropic hormone in children, growth does not stop and so-called gigantism develops. It usually occurs at 9-10 years of age or during puberty. By the age of 15-16 years, female patients reach more than 1.9 meters and male patients - 2 meters while maintaining a relatively proportional physique. Except tall they may be bothered headache, weakness, numbness in the arms and pain in the joints, dry mouth and thirst are the result of the counter-insulin action of growth hormone; almost all women have irregular menstrual cycles; 30% of men develop sexual weakness.

If a disease caused by pituitary hormones develops when growth is already complete, the patient’s individual parts of the body enlarge: nose, feet, palms. With acromegaly, the proportions of the face are distorted and it becomes ugly.

Treatment.Radiation therapy, surgical, medicinal.

Disease of the pituitary gland function: Itsenko-Cushing's disease

Cushing's disease is named after two doctors who described it independently of each other. In 1924, Soviet neurologist Nikolai Mikhailovich Itsenko described a clinic that frolicked in two patients with lesions of the interstitial pituitary region. In 1932, American surgeon Harvey Cushing described clinical syndrome, which he called “pituitary basophilism.” The cause is a benign pituitary tumor that produces large quantities ACTH, which leads to hyperproduction of adrenal hormones.

Symptoms:

Weight increases: fat is deposited on the shoulders, abdomen, face, mammary glands and back. Despite the corpulence of the body, the patients' arms and legs are thin. The face becomes moon-shaped, round, and the cheeks are red.
Pink-purple or purple stripes (striae) appear on the skin.
Observed overgrowth body hair (women grow mustaches and beards).
In women, the menstrual cycle is disrupted and infertility is observed; in men, sexual desire and potency decrease.
Another symptom of this pituitary disease is muscle weakness.
Bone fragility increases (osteoporosis), up to pathological fractures of the spine and ribs.
Increasing.
Insulin sensitivity is impaired and develops.
Decreasing. Manifested by the formation of trophic ulcers, pustular skin lesions, chronic pyelonephritis, and so on.

Treatment. Radiation therapy of the pituitary gland area, medicinal.

Pituitary gland disease pubertal hypothalamic syndrome

Similar changes, but more mildly expressed, sometimes develop in adolescence and are called pubertal hypothalamic syndrome or pubertal-adolescent dyspituitarism. It often develops against the background of an already existing constitutional one. Other risk factors include diseases, including neuroinfections, physical and mental injuries, sharp decrease familiar physical activity, for example, cessation of systematic sports, chronic and recurring.

Fortunately, we are not talking about a tumor of the pituitary gland, but only about overstimulation of the hypothalamus, which releases large doses of CRH, stimulating the release of ACTH, which increases the production of hormones of the adrenal cortex. Since feedback mechanisms (a decrease in hormone production in response to an increase in their level in the blood) are not destroyed in this case, the changes are not as severe and pronounced as in the disease and Cushing's syndrome.

Treatment. Diet therapy for. If necessary, prescribe diuretics that lower blood pressure and sex hormones that restore the menstrual cycle. Girls are prescribed vitamin therapy for the same purposes depending on the phase of the cycle.

Pituitary dwarfism (deficiency of pituitary hormones)

Pituitary dwarfism is short stature caused by insufficient production of growth hormone in childhood. This disease, associated with disruption of the pituitary gland, is genetic in nature. Defects in genes disrupt the synthesis of growth hormone in the pituitary gland, and, as a rule, this is combined with a deficiency of follicle-stimulating and luteinizing hormones.

The main symptom is growth retardation from 2-4 years, the growth rate does not exceed 4 centimeters per year. The physique of the patients is proportional, however, the proportions are more consistent with those of children. Delayed sexual development is often observed. The genital organs are significantly underdeveloped, but their defects are rare. Secondary sexual characteristics are often absent. The majority of patients have completely preserved intelligence.

The diagnosis is made based on low levels of growth hormone in the blood.

Treatment. Patients are injected with artificial somatotropin, which stimulates their growth. It is better to start it no later than 5-7 years, then there is hope to “hold out” the patient to normal height. In order to avoid errors in diagnosis (short stature may be due to other reasons, such as lack of nutrition), an observation period of 6-12 months is required. During this time, complex restorative therapy is prescribed, good nutrition, A and D, drugs and phosphorus. If against this background there is no sufficient improvement physical development, then start taking growth hormone.

Adequate nutrition, restorative therapy with vitamins and biostimulants, as well as zinc preparations are also important. Lifelong monitoring by an endocrinologist is carried out.

Postpartum pituitary infarction (Sheehan syndrome)

Sheehan syndrome was described in 1937 by N. L. Sheehan. Develops after heavy bleeding during childbirth or during an abortion. During pregnancy, the pituitary gland increases in size and fills with blood; when it bleeds, necrosis and cell destruction begin in it. If more than 90% of the pituitary gland is destroyed, the body develops total glandular deficiency. internal secretion, caused by the fact that they no longer receive stimulating signals from the pituitary gland. With this disease of the pituitary gland, weakness, lethargy, dizziness, and loss of appetite appear. Problems with milk production may occur.

Particularly dangerous is a drop in pressure as a result of adrenal insufficiency. It can lead to death. Tests show low levels of all hormones.

Treatment. Replacement therapy. Artificial analogues of hormones are introduced. Treatment continues for life.

Pituitary disease Simmonds syndrome

Simmonds syndrome was described in 1974 by the German doctor M. Simmonds. This is also pituitary insufficiency, but does not develop in postpartum period, but from injuries, infections (sepsis, encephalitis, syphilis) or vascular disorders(spasm, collapse).

The clinical picture of a combination of hypothyroidism, adrenal insufficiency and hypogonadism, however, early stages it is possible that only one of them is deficient endocrine glands.

One of the first symptoms of this pituitary disease is quick loss weight. Weakness, lethargy, apathy, loss of appetite, dry skin and mucous membranes, dry and brittle hair, hair loss, swelling of the face, constipation develop, the heart rate decreases, then menstruation in women and potency in men disappear, then blood pressure begins to decrease, which can lead to vascular collapse and death.

The diagnosis is made based on a combination of characteristic complaints with low level hormones in the blood.

Treatment. A diet containing sufficient amounts of proteins, fats, vitamins and hormone replacement therapy, which continues for life.

Disease associated with dysfunction of the pituitary gland: diabetes insipidus

Translated from Greek, “diabetes” means “to pass through.” In diabetes mellitus, the cause of the disease is a violation of the production of the hormone insulin.

Diabetes insipidus is a completely different disease, although it is also endocrine. It is associated with insufficient production of the hormone vasopressin by the pituitary gland, which retains fluid in the body.

In the absence of the hormone, the fluid literally begins to pass through: the patient drinks a lot (up to 5-6 liters per day), and he produces the same amount of urine.

The cause of this disease of the pituitary gland may be congenital disorders of vasopressin synthesis or damage to the pituitary gland by tumors, injuries, or infections. Sometimes the level of vasopressin in the blood is normal, but they are insensitive to it.

If fluid intake is limited, the patient may develop symptoms of central nervous system damage. nervous system: decreased blood pressure, lethargy, irritability, poor coordination of movements, elevated temperature bodies. If fluid loss is not stopped, coma may develop.

An artificial analogue of vasopressin is used for treatment. If the reason diabetes insipidus in renal insensitivity, a special class of diuretics is used that can restore sensitivity.

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Pituitary most important gland internal secretion in human body. It consists of two sections: the anterior - adenohypophysis, and the posterior - neurohypophysis. Its functioning is regulated by liberins and statins - the hypothalamus.

What is the pituitary gland

The following pituitary glands can be distinguished: regulation of the functioning of the pituitary-dependent endocrine glands, as well as the development and growth of the body, control over the functioning individual organs, production and release of melanins.

Adenohypophysis hormones are divided into three families according to the chemical nature of the molecules, the principle of synthesis and biological effects:

proopiomelanocortin derivatives – adrenocorticotropic hormone (ACTH), melanocyte-stimulating hormone (MSH), β-lipotropin
hormones-proteins – somatotropin (GH), prolactin
glycoprotein hormones – follitropin (FSH), luteotropin (LH), thyrotropin (TSH)

Biological effects of adenohypophysis hormones

ACTH can accelerate metabolic processes in the cells of the adrenal cortex and stimulate the formation of glucocorticoids. It also acts on adipose tissue– causes the breakdown of fats and their release into the blood. With stress and increased body temperature, the concentration of ACTH in the blood increases.

MSH affects the skin by enhancing melanin synthesis and sebaceous glands, stimulating the release of pheromones.

The main function of β-lipotropin is that it is a substrate for the formation of endorphins and enkephalins - “pleasure hormones”.

HGH controls human growth. After the onset of puberty, its action slows down. It regulates metabolism by acting on the liver, where insulin-like growth factors are formed. In an adult, GH during stress triggers adaptation reactions - promotes release into the blood fatty acids, which are an energy substrate, and enhances the production of lymphocytes.

Prolactin has a main effect on the reproductive organs:

V male body– accelerates the growth of seminal vesicles and prostate gland
V female body acts together with LH and progesterones - causes the formation corpus luteum, inhibits the development of a new follicle, promotes the growth of mammary glands, after childbirth stimulates the synthesis of milk components

There is also an assumption that prolactin triggers growth processes in the fetus and is involved in the regulation of metabolism.

Gonadotropic hormones (FSH, LH) at the 4th month intrauterine development take an active part in the differentiation of the external genitalia. Under their influence, the production of hormones in the gonads and adrenal glands increases. In adults, gonadotropins control the functioning of the gonads.

Biological effects of neurohypophysis hormones

Vasopressin (antidiuretic hormone - ADH) and oxytocin are synthesized by the hypothalamus and are transported in an inactive form to the neurohypophysis. There they are activated and enter the blood. ADH manages water-salt metabolism– reduces daily diuresis. Under the influence of oxytocin, labor begins - the hormone causes contraction of uterine myocytes, regulates milk secretion, and also has a number of effects at the level of the nervous system: in stressful situations, it triggers a passive avoidance reaction, promotes the transition to a state of drowsiness and sleep, and shapes parental behavior. Together with vasopressin it has an anti-pain effect.

Hypofunction of the pituitary gland

ACTH deficiency causes adrenal dysfunction, the most dangerous being a decrease in cortisol production. Symptoms such as weakness, decreased blood pressure, depression, frequent nausea and vomiting.

People with GH experience dwarfism. The height of men is no more than 1 m, the height of women is no more than 90 cm. The internal organs of patients are small and have proportions characteristic of child's body, “senile” skin is thin, dry, very sensitive to microdamage.

Often, deficiency of GH and TSH is combined. If the decrease in thyroid hormone levels is caused by a drop in TSH concentration, then the symptoms will be similar to those of the disease thyroid gland, but less pronounced.

The most common dysfunction of ADH is nephrogenic diabetes insipidus - Parhon's disease. This condition is distinguished by the fact that the body has a very high daily diuresis - up to 30 l / day. (norm – 2-2.5 l). Extreme polyuria is associated with the inability to regulate the state of the cells of the distal nephron and collecting ducts by ADH.

A lack of FSH and LH in men and women leads to reproductive dysfunction, in particular to. Lack of prolactin is diagnosed extremely rarely; in women it leads to the disappearance of lactation.

Oxytocin deficiency leads to the development depressive state and sleep disorders.

Hyperfunction of the pituitary gland

GH hyperfunction is associated with the appearance of a tumor formation in the adenohypophysis or ectopic synthesis of the hormone by a pancreatic tumor. Increased production of GH during prepuberty causes gigantism. The body proportions remain normal.

A pathological increase in GH levels in adulthood has following symptoms: increase intracranial pressure, deterioration of vision, initially an increase in the performance of the heart, lungs, kidneys, and then a sharp failure. At severe stages of the disease, the proportions of the body and face change - cartilage tissue grows strongly in the area of the feet, hands, ears, nose; increases lower jaw and rollers brow ridges; the tongue does not fit in the mouth.

Causes of pituitary gland diseases

The most common cause of pituitary hyperfunction is the formation of adenomas. The concentration of the hormone produced by tumor cells increases, while the concentration of other hormones decreases due to compression of the remaining part of the organ. Vessels may also be pinched, neighboring nerves and other parts of the brain. Most patients complain of blurred vision and headaches.

Insufficiency of pituitary hormones can develop as a result of injury, impaired blood supply, strangulation by a tumor, dysregulation of the hypothalamus, or under the influence of certain medications. There is also a congenital defect in the development of the gland.

Approximately 30% of women after difficult childbirth, accompanied by large loss of blood, suffer from hypofunction of the adenohypophysis, which is caused by ischemic necrosis of brain tissue.

The causes of dysregulation of kidney function by vasopressin may be: congenital features, in which hormone receptors are not activated, acquired disorders - taking drugs containing lithium cations, or tetracycline antibiotics - receptor blockers. The sensitivity of kidney cells to ADH changes under certain conditions of the body - hypokalemia, hypercalcemia.

Diagnosis of pituitary diseases

If you suspect a dysfunction of the pituitary gland, you should visit an endocrinologist. Based on the patient's medical history and complaints, he will prescribe. Most in a simple way identifying a pituitary adenoma is X-ray. Determination of the concentration of hormones in the blood, a tomogram or magnetic resonance imaging is also indicated. With increased diuresis, a study of vasopressin levels is necessary.

If inflammation of the pituitary gland is suspected, a spinal cord puncture is performed.

Chapter 2. Pathological physiology pituitary gland

§ 323. Complete failure of the pituitary gland functions

Hypophysectomy. The consequences of hypophysectomy depend on the type and age of the animal. The resulting disorders are associated mainly with loss of function of the adenohypophysis. Common signs hypophysectomy is growth retardation (Fig. 83), impaired reproductive function, atrophy of the thyroid and gonads and adrenal cortex, asthenia, cachexia, polyuria. Fish, reptiles and amphibians lose the ability to adapt their color to the surrounding background. Metabolism and utilization of the main components of food are disrupted. Animals are insulin sensitive and resistant to the hyperglycemic effects of adrenaline. Sensitivity to environmental factors increases and sensitivity to infection decreases.

Panhypopituitarism. In humans, complete failure of pituitary gland function is detected when 95% of its tissue is destroyed. This disease is called panhypopituitarism, or Simmonds disease (Fig. 84). It can occur after an infection, trauma to the base of the skull, as a result of thrombosis or embolism of the cavernous sinus and other causes.

The changes that occur (in the form of cachexia, muscle adynamia and asthenia) are determined primarily by the absence of growth hormone and corticosteroid deficiency.

§ 324. Hyperfunction of the anterior pituitary gland

Somatotropic hormone (growth hormone, STH). Excessive secretion of this hormone is most often observed with eosinophilic pituitary adenoma. Increased formation of growth hormone leads to disruption of the metabolism of proteins, carbohydrates and fats.

Protein metabolism disorders. Increased growth indicates activation of protein synthesis or inhibition of their destruction. Indeed, the administration of GH to animals causes nitrogen retention in the body, a positive nitrogen balance and a decrease in protein breakdown. At the same time, an increase in the inclusion of various amino acids in tissue proteins and a decrease in the ratio residual nitrogen to protein. Increased protein synthesis is obviously associated with an increase in the permeability of cell membranes to amino acids and an increase in RNA synthesis. At the same time, the activity of some proteolytic enzymes is inhibited.
The anabolic effect of GH is determined by two factors:
1. Availability of insulin. Against the background of experimental diabetes in animals and diabetes mellitus in humans, GH usually does not enhance protein synthesis. Obviously, this is due to the fact that insulin activates carbohydrate metabolism and stimulates protein synthesis.
2. Glucocorticoid concentration. Small doses contribute to the implementation of the anabolic effect of GH, and large doses, on the contrary, inhibit the anabolic effect of GH and retard growth. In patients with eosinophilic pituitary adenoma, glucocorticoid production is often increased. It is possible that this is one of the compensatory processes aimed at limiting the effect of excess amounts of growth hormone.
Disturbance of carbohydrate metabolism. With acromegaly, a disorder of carbohydrate metabolism is often detected, which in its extreme form manifests itself in the form of diabetes mellitus; the mechanism of these disorders is complex and includes the participation of the following factors: a) GH activates the release of glucose from the liver by activating the secretion of glucagon by the alpha cells of the pancreatic islets, which enhances glycogenolysis; b) in the pancreas, growth hormone stimulates the production of insulin, which enhances the utilization of glucose by tissues, however, at the level of tissue cells, growth hormone, together with glucocorticoids, acts as an insulin antagonist, i.e., it inhibits the absorption of glucose. The mechanism of inhibition is associated with activation of the inhibitory activity of the β-lipoprotein fraction of blood serum, which inhibits the hexokinase reaction, which is a trigger in carbohydrate metabolism; c) STH activates liver insulinase, which breaks down insulin. The end result of the influence on carbohydrate metabolism depends on all these factors.
Stimulation of the insular apparatus by GH and its stimulation due to hyperglycemia due to inhibition of glucose utilization can lead to depletion of beta cells of the islets of Langerhans of the pancreas, and if they are functionally inferior, to the development of diabetes mellitus.
Violation fat metabolism. HGH activates lipolysis of adipose tissue, which leads to an increase in free, non-esterified fatty acids in the blood, their accumulation in the liver and oxidation. Increased oxidation is expressed, in particular, in increased formation of ketone bodies. This catabolic effect occurs in the presence of small concentrations of glucocorticoids. An increase in their number inhibits the mobilization of fat and its oxidation by growth hormone. Obviously, it is this factor that plays a role in the pathogenesis of obesity in Itsenko-Cushing syndrome.

Adrenocorticotropic hormone (ACTH). Excessively formed ACTH exerts its effect in two ways: a) through the adrenal glands, b) through the extra-adrenal pathway. In the adrenal glands, it stimulates the zona fasciculata and, to a lesser extent, the zona reticularis, enhancing the formation of mainly cortisol and corticosterone, the expression of which is hypercortisolism. The extra-adrenal effect of ACTH on some metabolic processes differs from its effect on these same processes through increased cortisol secretion. This is revealed in relation to the influence on protein metabolism. By enhancing the formation of cortisol, ACTH thereby increases protein catabolism. However, under conditions of increased protein breakdown, ACTH can enhance anabolic processes, i.e., exhibit a so-called normalizing effect.

ACTH affects fat metabolism in the following way: adding it directly to adipose tissue stimulates its lipolytic activity (fat breakdown) and thereby the mobilization of fat with the formation of free higher non-esterified fatty acids. However, by enhancing the formation of cortisol, ACTH has the following effects:

inhibits fat mobilization;
activates gluconeogenesis and thereby promotes fat formation;
inhibits the action of growth hormone, which activates fat oxidation.

Obviously, the final result depends on the ratio of adrenal and extra-adrenal action.

Thyroid-stimulating hormone (TSH). Excessive secretion of TSH stimulates the function of the thyroid gland, which leads to increased formation of thyroid hormones, the development of hyperthyroidism and thyrotoxicosis. In addition, TSH increases the content of acidic mucopolysaccharides in the skin, muscles and retro-orbital fiber of both intact and thyroidectomized animals. The so-called exophthalmic factor, which causes bulging eyes (exophthalmos) in thyrotoxicosis, is associated with TSH. Therefore, in conditions that increase TSH secretion (thyroidectomy or suppression of thyroid activity), the degree of exophthalmos increases. At the same time, TSH is not identical to the exophthalmic factor, since exophthalmos can be observed without hyperthyroidism.

Gonadotropic hormones (GTG). The secretion of GTH (FSH, LH, or otherwise GSIC, and luteotropic hormone - LTG) is closely related to the function of the hypothalamus. The hypothalamus secretes mediators that, going down to the pituitary gland, stimulate the formation of FSH and LH (GSIC). The formation of luteotropic hormone (LTH) is inhibited. Damage to the median eminence, like hypophysectomy, leads to a decrease in GTH secretion and to atrophy of the gonads. On the contrary, damage to the posterior formations of the hypothalamus causes increased secretion of GTH and in childhood leads to premature puberty. Previously, a certain role in the pathogenesis of this disease was attributed to the pineal gland, since it was believed that in physiological conditions it inhibits the secretion of GTH until a certain age. Premature inhibition of the function of this gland - hypopinealism - supposedly disinhibited the secretion of GTH and led to early puberty. Now importance is attached to tumors of the hypothalamus in general, which somehow stimulate the secretion of GTH by the pituitary gland. The secretion of THG also increases with the primary loss of endocrine activity of the gonads, but this does not lead to an increase in the production of sex hormones.

Excessive formation of LTG was noted in patients suffering from breast cancer, in whom therapeutic purpose The pituitary stalk was transected. This leads to galactorrhea. Under certain conditions, excessive secretion of LTG in the postpartum period becomes one of the factors in the development of obesity. This hormone activates the formation of fat from carbohydrates and thereby promotes its deposition.

§ 325. Hypofunction of the anterior pituitary gland

Somatotropic hormone. Insufficiency of growth hormone leads to the development of pituitary dwarfism, or dwarfism. As a result of insufficient formation of growth hormone, the following are observed:

a decrease in the intensity of protein synthesis, which leads to a delay and cessation of bone growth and development, internal organs, muscles; protein synthesis disorder connective tissue leads to loss of elasticity and development of sagging;
a decrease in the inhibitory effect of growth hormone on glucose uptake and the predominance of the insulin effect, which is expressed in the development of hypoglycemia;
loss of fat-mobilizing effect and a tendency to obesity.

Typically, pituitary dwarfism is accompanied by sexual underdevelopment, which is associated with insufficient formation of GTH, and, consequently, with insufficient formation of sex hormones. Hence, dwarfs have childish facial features, which, along with sagging skin, gives them the appearance of an “old-looking youth.” A decrease in the intensity of protein synthesis also underlies some insufficiency in the synthesis of hormones of the adrenal cortex and thyroid gland. This reduces the endurance of such patients in relation to unfavorable factors.

Adrenocorticotropic hormone. Insufficient formation of ACTH leads to secondary partial adrenal insufficiency. The glucocorticoid function is mainly affected. Mineralocorticoid function remains virtually unchanged, since the mechanisms of its regulation are different. The difference from primary hypofunction of the adrenal cortex is a less pronounced pigmentation disorder. This is due to the fact that when ACTH secretion decreases, the formation of the associated melanophore factor simultaneously decreases. With primary inhibition of the function of the adrenal cortex, the formation of ACTH and melanophore hormone increases through a feedback mechanism.

Thyroid-stimulating hormone. Decreased TSH production causes a secondary decrease in thyroid function. In contrast to primary hypofunction of the thyroid gland, administration of TSH can restore its function.

Gonadotropic hormones. With insufficient formation of TG, various disorders arise, the picture of which depends on how this insufficiency is combined with the loss of secretion of other hormones of the adenohypophysis. With uncomplicated GTH deficiency, hypogonadism develops, which includes eunuchoidism, delayed puberty and in boys, cryptorchidism (delayed descent of the testicles into the scrotum).

The secretion of THG is inhibited by a feedback mechanism by sex hormones, and estrogens are more powerful inhibitors than androgens. Under physiological conditions, the gonads of men produce a small amount of estrogens. In pathology, this formation of estrogen can increase, which leads to suppression of the formation of GTH and thereby the development of hypogonadism.

When the ventromedial nuclei of the infundibulo-tuberal part of the hypothalamus are damaged with secondary involvement of the pituitary gland, mainly in the form of insufficient secretion of THG, the so-called adipose-genital dystrophy develops. It manifests itself in the form of hypogenitalism and obesity with predominant fat deposition in the lower abdomen, pelvis and upper thighs. Insufficient secretion of THG causes delayed puberty. The pathogenesis of obesity is complex. It plays a role:

insufficient formation in the pituitary gland (or release) of fat-mobilizing polypeptides or those fragments of the growth hormone and ACTH molecules that activate the mobilization of fat from fat depots, increase the content of fatty acids in the blood and stimulate their oxidation;
damage to the trophic centers of the hypothalamus, which reduces the activating effect of the sympathetic nervous system on the mobilization of fat from fat depots;
increased formation or activity of insulin, which stimulates the conversion of carbohydrates to fats.

§ 326. Disorders of the posterior lobe of the pituitary gland

The hormones of the posterior lobe of the pituitary gland - vasopressin (also known as antidiuretic hormone - ADH) and oxytocin are formed in the supraoptic and paraventricular nuclei of the anterior hypothalamus, from where they enter the posterior lobe.

Excessive secretion of ADH. An increase in ADH secretion leads to a decrease in diuresis. It increases with painful stimuli and can cause reflex anuria. ADH secretion also increases with emotional excitement, administration of nicotine and acetylcholine. Increased secretion of ADH is a link in the reflex regulation of water metabolism. An increase in the concentration of ADH in the blood is not always associated only with an increase in its formation and may be a consequence of insufficient inactivation of ADH in the body, for example, in the liver with cirrhosis, or with toxicosis of pregnancy.

ADH deficiency. It leads to the development of diabetes insipidus, characterized by polyuria and, as a result, polydipsia. In sharply expressed cases daily diuresis can exceed 40 liters. ADH deficiency is caused mainly by its insufficient formation in the supraoptic nuclei of the hypothalamus due to their degeneration and degeneration of the supraoptic-pituitary tract. In experiments, damage to these nuclei in cats and monkeys gives a similar picture. A certain role in the occurrence of ADH deficiency is played by increased inactivation of ADH in tissues or loss of the kidneys’ ability to respond to ADH. In the latter case, the concentration of ADH in the blood may be increased. Full picture Diabetes insipidus develops only when normal function adrenal cortex and thyroid gland, since cortisol and thyroxine stimulate diuresis. Therefore, polyuria does not develop in adrenalectomized animals, and in thyroidectomized animals it is weakly expressed. Polyuria does not develop after hypophysectomy, because in this case the secretion of ACTH and TSH disappears, leading to hypofunction of the corresponding glands.

Diseases of the pituitary gland can cause disruptions in the functioning of the entire body. This happens because it is here that biologically active substances known as hormones are produced, with the help of which the hypothalamus, one of the parts of the brain, controls the processes occurring in the body.

The main task of hormones is to regulate the activity of all internal organs and systems of a person: they actively participate in metabolism, growth and development of the body, influence the formation of the skeleton, and deliver nutrients to cells. The work of the nervous, cardiovascular, digestive systems, reproductive function of the body.

The lack of pituitary hormones also negatively affects the glands controlled by it: in the absence of appropriate stimulation, they reduce the production biologically active substances and in many cases atrophy. A lack of pituitary hormones can also negatively affect reproductive function, cause atrophy of the thyroid gland, gonads and adrenal cortex, syndrome chronic fatigue, increased urination, extreme exhaustion body.

Affects bad job pituitary gland and the activity of hormones produced by the hypothalamus. For example, with a lack of vasopressin, which regulates the excretion of water by the kidneys, diabetes insipidus develops, a symptom of which is excessive urination.

The most dangerous disease is hypopituitarism, when there is a lack of all pituitary hormones, which not only impairs the functioning of all endocrine glands and organs that are under the control of the pituitary gland, but also leads to severe disorders all metabolisms. The disease may be caused by the destruction of cells of the pituitary gland itself, or the development of the disease may be influenced by malfunctions of the hypothalamus or central nervous system.

If hypopituitarism has congenital pathology, the child’s growth slows down, eunuchoid body proportions are observed. Among the symptoms that characterize the development of the disease, in adults there is a gradual decrease in sexual desire, erasing: the amount of hair in the armpits and on the pubis decreases, the mustache and beard begin to grow more slowly, muscle is replaced by fat.

In men, the testicles and prostate gland become smaller, in women the mammary glands atrophy, and the tissues of the genital organs become thinner. Among the first symptoms of the disease that are worth paying attention to is a deterioration in the sense of smell.

Because they can be influenced different reasons, and the course of the disease depends on which hormones are not produced in the required quantities, treatment is prescribed only after a thorough examination.

Usually this is hormonal therapy aimed at compensating for hormone deficiency, sometimes it may be necessary surgical intervention. If the patient pays attention to suspicious symptoms in time, the disease will be detected in time and treatment will begin. timely treatment, patients may well lead normal image life.

Simmonds-Glinsky disease is a multiglandular hormone deficiency. Also known as anterior pituitary hypothyroidism. The disease occurs as a result of suppression secretory function pituitary gland It is more common in women than men and usually begins between the ages of 30 and 40.

Causes of pituitary gland disease

Primary hypofunction of the pituitary gland is directly related to the destruction of the anterior and/or posterior lobe of the pituitary gland.

pituitary tumors;
metastases of cancer of other organs;
thickening of blood in the pituitary gland, in women who have experienced heavy bleeding during childbirth;
vascular diseases, associated, for example, with diabetes mellitus;
infections (tuberculosis, meningitis);
skull injuries;
systemic diseases(leukemia, lymphoma, sclerosis cerebral arteries, malnutrition);
radiation or neurosurgical procedures;
problems with immune system;
other inflammatory processes.

Secondary hypofunction of the pituitary gland occurs as a result of damage to the hypothalamus, which affects the secretion of hormones. In this case, the pituitary gland is not destroyed, but the release of hormones is difficult.

Symptoms of pituitary disease

Simmonds-Glinsky disease can cause mainly deficiency the following hormones: vasopressin, luteinizing hormone, growth hormone, thyroid-stimulating hormone. Sometimes this can lead to a deficiency of the hormone prolactin, which is associated with necrosis of the pituitary gland after childbirth. The result is a range of different symptoms.

Pituitary tumor...

Often develop very slowly:

increased sensitivity to the cold;
feeling tired, drowsiness, apathy;
pale skin;
hair loss dependent on sex hormones;
in men, hair loss on the face and chest;
increased sensitivity of the patient to stress and trauma;
sometimes visual impairment;
loss of sexual desire;
loss of the menstrual cycle in women;
increased susceptibility to colds or infections.

If the posterior lobe of the pituitary gland is also destroyed, symptoms of diabetes insipidus occur. There is a decrease in the level of sugar, salt and water in the body. The disease can sometimes end in coma.

Treatment includes the administration of pituitary or thyroid hormones, adrenal cortex and sex hormones. Hormone therapy should be carried out under the close supervision of an endocrinologist.

Innings hormonal drugs allows patients to return to normal life, however, complications associated with the disease (for example, growth of a pituitary tumor) lead to death. Taking hormonal drugs continues until the end of the patient's life. In some cases, surgery is required (for example, removal of a pituitary tumor).

A person suffering from this disease should be under constant medical supervision.