The anterior pituitary often is referred to as the "master gland" because, together with the hypothalamus, it orchestrates the complex regulatory functions of many other endocrine glands. The anterior pituitary gland produces six major hormones: (1) prolactin (PRL), (2) growth hormone (GH), (3) adrenocorticotropic hormone (ACTH), (4) luteinizing hormone (LH), (5) follicle-stimulating hormone (FSH), and (6) thyroid-stimulating hormone (TSH) (Table 339-1). Pituitary hormones are secreted in a pulsatile manner, reflecting stimulation by an array of specific hypothalamic releasing factors. Each of these pituitary hormones elicits specific responses in peripheral target tissues. The hormonal products of those peripheral glands, in turn, exert feedback control at the level of the hypothalamus and pituitary to modulate pituitary function (Fig. 339-1). Pituitary tumors cause characteristic hormone-excess syndromes. Hormone deficiency may be inherited or acquired. Fortunately, there are efficacious treatments for the various pituitary hormone-excess and -deficiency syndromes. Nonetheless, these diagnoses are often elusive; this emphasizes the importance of recognizing subtle clinical manifestations and performing the correct laboratory diagnostic tests. For discussion of disorders of the posterior pituitary, or neurohypophysis, see Chap. 340.
Table 339-1 Anterior Pituitary Hormone Expression and Regulation |Favorite Table|Download (.pdf)
Table 339-1 Anterior Pituitary Hormone Expression and Regulation
|Tissue-specific transcription factor||T-Pit||Prop-1, Pit-1||Prop-1, Pit-1||Prop-1, Pit-1, TEF||SF-1, DAX-1|
|Fetal appearance||6 weeks||8 weeks||12 weeks||12 weeks||12 weeks|
|Protein||Polypeptide||Polypeptide||Polypeptide||Glycoprotein α, β subunits||Glycoprotein α, β subunits|
|Amino acids||266 (ACTH 1–39)||191||199||211||210 204|
|Stimulators||CRH, AVP, gp-130 cytokines||GHRH, ghrelin||Estrogen, TRH, VIP||TRH||GnRH, activins, estrogen|
|Inhibitors||Glucocorticoids||Somatostatin, IGF-I||Dopamine||T3, T4, dopamine, somatostatin, glucocorticoids||Sex steroids, inhibin|
|Target gland||Adrenal||Liver, other tissues||Breast, other tissues||Thyroid ||Ovary, testis|
|Trophic effect||Steroid production||IGF-I production, growth induction, insulin antagonism||Milk production||T4 synthesis and secretion||Sex steroid production, follicle growth, germ cell maturation|
|Normal range||ACTH, 4–22 pg/L||<0.5 μg/L*||M < 15; F <20 μg/L||0.1–5 mU/L||M, 5–20 IU/L, F (basal), 5–20 IU/L|
Diagram of pituitary axes. Hypothalamic hormones regulate anterior pituitary trophic hormones that in turn determine target gland secretion. Peripheral hormones feed back to regulate hypothalamic and pituitary hormones. For abbreviations, see text.
The pituitary gland weighs ∼600 mg and is located within the sella turcica ventral to the diaphragma sella; it consists of anatomically and functionally distinct anterior and posterior lobes. The bony sella is contiguous to vascular and neurologic structures, ...