Pituitary Gland

The pituitary (also known as the hypophysis) is found at the base of the brain, about 1cm in
diameter, lying beneath the third ventricle in a bony cavity (sella turcica) in the base of the skull.
It has a complex structure. This diagram of the pituitary shows its main features.

The anterior and posterior parts of the pituitary have different embryological origins.
The posterior part of the pituitary has its embryological origins in nervous tissue. It is formed
from a downgrowth of the diencephalon that forms the floor of the third ventricle.
The anterior part is derived from an upgrowth from the oral ectoderm of the primitive oral
cavity called Rathke's pouch.
Along the posterior part of the the anterior lobe there is a narrow region called the pars
intermedia, which also has its embryological origin in Rathke's pounch. The pars intermedia is
poorly developed in humans. The glandular epithelial part of the pituitary is also called the
adenohypophysis - (anterior pituitary, pars intermedia and pars tuberalis).
These different origins are reflected in the histological structure of the anterior and posterior
parts of the pituitary.

Anterior Pituitary
You should also be able to see two types of chromophils (cells which take up stain)
calledacidophils and basophils.
Acidophils and basophils are divided into different classes of cells which have different
secretory products and target organs. The subtypes of acidophils and basophils, are described in
the table below. These cannot be distinguished by H&E or other histological stains, but can be
stained specifically by immunohistochemical techniques.
The anterior pituitary secretes five different types of hormone. See the table below.
The capillaries in this gland are fenestrated, to enable passage of hormones from the secretory
cells into the bloodstream.
Glandular Disorders and diseases
The anterior pituitary also contains one type of chromophobe (cells which stain only weakly)
These are resting/degranulated chromophils.
Type of
chromophil

Class

Secretory Product

Target Organ
General, but a major target is the

Somatotrophs (about
50%)

growth hormone (GH,

also known as
somatotrophin, STH)

Mammotrophs (about

Acidophil

20%)

prolactin (PRL)

(Adrenocorticotrophic
hormone,) also
known as
corticotrophin.

20%)

Thyrotrophs (about
Basophil

5%)

plates. Promotes growth (together

with insulin like growth factors)
Milk producting tissue (alveolar

ACTH

Corticotrophs (about

chondrocytes in epiphyseal growth

Melanocytestimulating hormone
(MSH)

cells) in the breast

Trophic (trophic - from the greek to nourish)- general action promote growth and secretory
activity in other endocrine glands.
ACTH target is the corticosteroid
cells of the adrenal cortex.
MSH target is the melanocytes.
TSH target is the follicular

TSH (thyroid

epithelial cells of the thyroid.

stimulating hormone),

FSH target is the follicular cells of

also known as

the ovaries, to promote growth of

thyrotrophin

follicles, or the sertoli cells of the

testes to promote
spermatogenesis.
LH target is developing follicles promotes ovulation, or the Leydig
cells of the testes - where it
promotes secretion of adrogenens,

gonadotrophins: FSH
(follicle stimulating
Gonadotrophs (about

hormone) and LH

5%)

(Lutenising hormone).

aiding spermatogenesis.
Three of these trophic hormones
(TSH, FSH and LH) are
glycoproteins, so they can be
stained up by the technique PAS.

Posterior Pituitary.
The posterior pituitary looks very different to the anterior pituitary (see adjacent image). It
contains non-myelinated axons which are the neurosecretory cells. The cell bodies of these cells
are located in the hypothalamus.
It only secretes two hormones:
Antidiuretic hormone (ADH) which acts on the kidney, and oxytocin, which acts on the uterus.
Quiz 3:
The SA node triggers a wave of contraction that spreads over the myocardium of both atria, emptying
the atria and completing ventricular filling (atrial systole 0.1 s). When the electrical impulse reaches the
AV node it is slowed down, delaying atrioventricular transmission. This allows the atria to finish
emptying into the ventricles before the ventricles begin to contract. The AV node triggers its own
electrical impulse, which quickly spreads to the ventricular muscle via the AV bundle, the bundle
branches and Purkinje fibres. This results in a wave of contraction which sweeps upwards from the apex
of the heart and across the walls of both ventricles pumping the blood into the pulmonary artery and the
aorta.
The main components of the cardiac conduction system are the SA node, AV node, bundle of His, bundle
branches, and Purkinje fibers. The SA node (anatomical pacemaker) starts the sequence by causing the
atrial muscles to contract. From there, the signal travels to the AV node, through the bundle of His, down
the bundle branches, and through the Purkinje fibers, causing the ventricles to contract.
Quiz 4

Quiz 5;
Regions and landmarks in the fetal skull
particular importance for obstetric care because they may form the so-called presenting part of the
fetus that is, the part leading the way down the birth canal.

The vertex is the area midway between the anterior fontanel, the two parietal bones and the
posterior fontanel. A vertex presentation occurs when this part of the fetal skull is leading the way. This
is the normal and the safest presentation for a vaginal delivery.

The brow is the area of skull which extends from the anterior fontanel to the upper border of
the eye. A brow presentation is a significant risk for the mother and the baby.

The face extends from the upper ridge of the eye to the nose and chin (lower jaw). A face
presentation is also a significant risk for the mother and baby.

The occiput is the area between the base of the skull and the posterior fontanel. It is unusual
and very risky for the occiput to be the presenting part.
Quiz 6:

Adaptations of the Malpighian body (Made up of cup-shaped Bowmans capsule and the glomerulus) for
its functions:
The efferent arteriole is narrower than the afferent arteriole allowing a pressure system to develop
which is essential for filtration.
The small size of the slit pores between the podocytes ensures that the blood corpuscles and large
plasma proteins do not pass through into the capsular space.(filtration)
The Bowmans capsule is cup-shaped allowing more close contact with the blood capillaries of the
glomerulus for filtration.
A single layer of endothelial cells of the capillary wall and a single layer of podocytes of the Bowmans
capsule form a thin surface for filtration.
Large surface area of the capillary network of the glomerulus increases the efficiency of filtration.
(many capillaries increase the surface area for reabsorption and excretion).
Pores on endothelium of the capillaries allow for a passageway of substances during filtration.
Adaptations of the renal tubule for its functions:
It is long and convoluted allowing sufficient time for re-absorption of useful substances. (also
increasing surface area)
The second capillary network allows for the re-absorption of useful substances and for excretion of
waste substances into the tubules.
The cells of the tubules are richly supplied with mitochondria providing energy for active re-absorption
to take place.
The cells of the tubule have micro-villi to increase the surface area for excretion and re-absorption.
The sodium pump ensures that the medulla always has a high concentration of salts ensuring that
large amounts of water can be absorbed from the distal tubule and the collecting tubule by
osmosis.(rephrase to include difference in water potential/water potential gradient)
Quiz 7:
The right lung, which is heavier than the left, is also shorter (the right dome of the
diaphragm being higher) and wider (the heart bulging more to the left). The right lung is
divided into upper, middle, and lower lobes by oblique and horizontal fissures, whereas the left
lung has usually only upper and lower lobes, separated by an oblique fissure.
Right lung has three lobes, whereas left lung has only two.

 Right lung is shorter and wider, whereas the left lung is narrower and more oblong.
Anterior border of the left lung is marked by a deep cardiac notch, while that of the right
lung is straight. Therefore, left lung is much smaller than right lung (heart occupies space on the
left side).
Due to the compression of the liver, the volume of the right lung is higher than that of the
left lung. Hence, the right lung is heavier than left lung.
The base of the right lung is more concave, while the base of left lung is less concave.
At the hilums of both lungs, the right lung possesses two bronchi and the left lung
possesses only one bronchus.
Quiz 8

Tracheal Stenosis: This is where the trachea is narrower than it should be. This makes the
work of breathing much harder, and even with simple chest infections (e.g. bronchiolitis) a child
can become very unwell.
Tracheomalacia: Tracheomalacia refers to the trachea being softer than normal, and so
when the child breathes out or coughs the calibre of the trachea gets smaller. The picture is of a
CT of the chest showing an abnormal D or kidney shape to the trachea, as it collapses a bit.
Normally the trachea is round.
Tracheo-oesophageal fistula: A fistula is an abnormal connection between two organs. In a
tracheo-oesophageal fistula, there is a connection between the oesophagus (gullet) and trachea
(windpipe). There are different types, as shown in the diagram. The abnormal connection can be
separated by an operation, but even afterwards the trachea is abnormal.
Congenital lobar emphysema: This is a problem where a portion of one lung forms
abnormally so it is permanently overinflated and too large. It then compresses other parts of the
lungs in the chest. It is usually removed by an operation, although the timing of when this is best
done varies from child to child. Your childs doctors will be able to advise what is best for your
child.
Congenital Pulmonary Adenomatoid Malformation (CPAM): This abnormality is a problem
with the formation of lung tissue itself. Part of the lung grows as a solid collection of cysts and

solid tissue. This usually needs removal. It is quite common for the problem not to present itself
until the child is much older, or even into adulthood.
Quiz 9:

Tetralogy of Fallot (ToF)

Total anomalous pulmonary venous connection

Hypoplastic left heart syndrome (HLHS)

Transposition of the great arteries (d-TGA)

Truncus arteriosus (Persistent)

Tricuspid atresia

Interrupted aortic arch

Pulmonary atresia (PA)

Pulmonary stenosis (critical)

Eisenmenger syndrome (reversal of shunt due to pulmonary hypertension) .

Patent ductus arteriosus may cause cyanosis in late stage[1]

Quiz 10:

Clinical significance[edit]
When CSF pressure is elevated, cerebral blood flow may be constricted. When disorders of CSF
flow occur, they may therefore affect not only CSF movement but also craniospinal compliance and
the intracranial blood flow, with subsequent neuronal and glial vulnerabilities.[23] The venous system
is also important in this equation. Infants and patients shunted as small children may have
particularly unexpected relationships between pressure and ventricular size, possibly due in part to
venous pressure dynamics. This may have significant treatment implications, but the underlying
pathophysiology needs to be further explored.
CSF connections with the lymphatic system have been demonstrated in
several mammalian systems. Preliminary data suggest that these CSF-lymph connections form
around the time that the CSF secretory capacity of the choroid plexus is developing (in utero). There
may be some relationship between CSF disorders, including hydrocephalus and impaired CSF
lymphatic transport.[23]

Hydrocephalus[edit]
Hydrocephalus can be caused by impaired cerebro-spinal fluid (CSF) flow, re-absorption, or
excessive production of CSF. Hydrocephalus can be colloquially termed as "water on the brain" and
is of medical importance. Hydrocephalus is an abnormal accumulation of cerebrospinal fluid (CSF) in

the ventricles, or cavities, of the brain, which may cause increased intracranial pressure (ICP) inside
the skull. It may lead to enlargement of the cranium if hydrocephalus occurs during development. It
is most often accompanied by mental disability, sometimes by convulsive episodes and also tunnel
vision. Hydrocephalus may become fatal if it is not corrected quickly. It is more common in infants,
and in older adults.[24]

Lumbar puncture[edit]

Vials containing human cerebrospinal fluid.

Main article: Lumbar puncture

CSF can be tested for the diagnosis of a variety of neurological diseases, usually obtained by a
procedure called lumbar puncture.[25]
Lumbar puncture is carried out under sterile conditions by inserting a needle into the subarachnoid
space, usually between the third and fourth lumbar vertebrae. CSF is extracted through the needle,
and tested. Cells in the fluid are counted, as are the levels of protein and glucose. These parameters
alone may be extremely beneficial in the diagnosis of subarachnoid hemorrhage and central nervous
systeminfections (such as meningitis). Moreover, a CSF culture examination may yield
the microorganism that has caused the infection. By using more sophisticated methods, such as the
detection of the oligoclonal bands, an ongoing inflammatory condition (for example, multiple
sclerosis) can be recognized. A beta-2 transferrin assay is highly specific and sensitive for the
detection for, e.g., CSF leakage.[26]
Lumbar puncture can also be performed to measure the intracranial pressure, which might be
increased in certain types ofhydrocephalus. However a lumbar puncture should never be performed
if increased intracranial pressure is suspected due to certain situations such as a tumour, because it
can lead to brain herniation and ultimately death.[26]
About one third of people experience a headache after lumbar puncture.[26]

Baricity[edit]
This fluid has an importance in anesthesiology. Baricity refers to the density of a substance
compared to the density of human cerebrospinal fluid. Baricity is used in anesthesia to determine the
manner in which a particular drug will spread in the intrathecal space.

Alzheimer's disease[edit]
A 2010 study showed analysis of CSF for three protein biomarkers that can indicate the presence
of Alzheimer's disease. The three biomarkers are CSF amyloid beta 1-42, total CSF tau protein and
P-Tau181P. In the study, the biomarker test showed good sensitivity, identifying 90% of persons with
Alzheimer's disease, but poor specificity, as 36% of control subjects were positive for the
biomarkers. The researchers suggested the low specificity may be explained by developing but not
yet symptomatic disease in controls.[27][28]