The Pituitary Gland: Anatomy and Physiology

By Dr. shaklin
DATE- 09/07/2024

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 INTRODUCTION
• The human body functions best in a state of homeostasis.
• This balance is necessary for energy management and
consumption, temperature control, electrolyte and fluid
levels, and blood pressure regulation to name a few.
• Most of this control is managed by circulating hormones
produced by a variety of endocrine organs, such as the
adrenal glands and the thyroid gland.
• Given their importance for survival, there is a need for
interaction with the central nervous system (CNS).
• This interface is mediated by the pituitary gland

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 Cont.
• No other single organ in the human body is as vital, gram-for-
gram, for survival than the pituitary gland.
• This small structure, situated deep in the skull, protected in its
own vault, and surrounded by critical neurovascular structures,
lies truly at the nexus of brain, metaphorically acting as the
gate-keeper of the blood–brain barrier.
• Understanding the normal anatomy and function of the
pituitary gland is requisite to being able to manage pituitary
dysfunction, such as Cushing’s disease.
• This chapter reviews the anatomy and physiology of the
pituitary gland, its role in homeostasis, and the discoveries that
led to our understanding of this incredible organ.
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 EMBRYOLOGy
• The pituitary gland is essentially two separate structures fused together.
• The adenohypophysis and neurohypophysis are derived embryologically
from different tissues, reflected in the pituitary’s mechanisms of
function.
• Ultimately, the pituitary gland originates from the developing ectoderm.
• An outpouching of the ectoderm that ultimately develops into the
nasopharynx, the stomodeum, migrates dorsally and develops into the
anterior lobe of the pituitary gland.
• In concert, the developing diencephalon, originating from the
neuroectoderm, generates an outpouching from the floor of the
developing third ventricle that ultimately becomes the posterior lobe of
the pituitary gland

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ANATOMy

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• The pituitary gland is situated in the center of the skull at the base of the brain.
• It is housed in the pituitary fossa, a dura-lined space at the top of the sphenoid bone.
• This region of the sphenoid sinus, the sella-turcica named for its resemblance to an
archaic horse saddle is bound anteriorly by the tuberculum sella, inferiorly by the floor of
the sella and posteriorly by the dorsum sella.
• Lateral bony prominences of these structures include the anterior and posterior clinoid
processes.
• The pituitary fossa is bordered laterally by the cavernous sinuses, separated by two
layers of dura.
• There is a layer of dura overlying the sella the diaphragma sella—separating the pituitary
fossa from the intracranial subdural and subarachnoid spaces.
• The pituitary fossa is surrounded by critical neurovascular structures. Each of these
structures can be affected by pituitary and parasellar pathology, explaining the variety of
clinical presentations of pituitary tumors.
• Laterally, within the cavernous sinuses, course the internal carotid arteries, including the
C3, C4, and C5 segments.

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• The pituitary gland can be divided histologically into the pars distalis, pars
tuberalis, pars intermedia, and pars nervosa. Regionally, there is a
distinction between the pars distalis and pars tuberalis, but histologically,
they are similar and function together as the adenohypophysis (anterior
lobe).
• The pars nervosa is the neurohypophysis (posterior lobe) and is an
extension of the hypothalamus. The pars intermedia is histologically
unique but likely a remnant of Rathke’s pouch from embryogenesis.
• Rathke’s cleft separates the pars distalis and the pars intermedia.
• The pars tuberalis is an extension of the adenohypophysis along the
infundibulum, wrapping around the pars nervosa. Often, there is an
extension of the third ventricle with CSF within the infundibular pars
nervosa.
• This is correlative of the infundibular recess as viewed dorsally.
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 Histology
• Histologically, the adenohypophysis can be organized based on
histochemical staining.
• These can be divided into acidophils, basophils, and chromophobes.
• For the common hematoxylin and eosin stains (H&E), acidophils take
up eosin and basophils take up hematoxylin.
• Chromophobes have little histological staining uptake with H&E and
are thought to be degranulated cells that no longer secrete hormones.
• Alternatively, they may represent pituitary stem cells that have yet to
differentiate.
• These cells have an acinar arrangement, supported by an extracellular
collagen matrix.
• This is nicely demonstrated with the reticulin (silver) stain.

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 Hypothalamus
• One cannot study the pituitary gland without recognizing its intimate
relationship with the hypothalamus.
• The very name, hypophysis, is from the Greek meaning “outgrowth from
below,” referring to the hypothalamus just above it.
• The hypothalamus regulates many homeostatic processes among other
functions, such as memory, olfaction, appetite, and emotion.
• Despite being a relatively small structure, the organization of the
hypothalamus is amazingly complex.
• The hypothalamus is bordered anteriorly by the lamina terminalis, posteriorly
by the mammillary bodies, inferiorly by the median eminence/floor of the third
ventricle, and laterally by the internal capsule and basal ganglia.
• Its superior (dorsal) limit is the hypothalamic sulcus, delineating it from the
thalamus.
• Perhaps the best way to orient one’s understanding of hypothalamic anatomy
is based on the axial and sagittal plane anatomy of the third ventricle.
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 Vascular Anatomy
• The gross architecture of pituitary vasculature can be separated
into intrinsic and extrinsic vessels .
• The primary blood supply to the pituitary gland arises from the
internal carotid arteries.
• The superior hypophyseal arteries supply the pituitary
infundibulum and, through the pituitary portal system, supply
the anterior pituitary gland.
• These arteries arise from the supraclinoid carotid and can be
duplicated at times.
• They typically are quite small when compared to the larger
posterior communicating and anterior choroidal arteries. These
arteries also supply the optic chiasm.
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 Surgical Anatomy
• The pituitary gland is most commonly reached surgically via
an endonasal transsphenoidal approach.
• The surrounding anatomy is relevant to the management of
pituitary and para-sellar tumors and cysts.
• These tumors can distort the surrounding structures.
• Hence, a keen understanding of the normal anatomy is critical
for safe surgical resection and avoidance of complications.
• The endonasal approach can be divided into various phases
starting with the nasal cavity phase, followed by the
sphenoidal and sellar phases, culminating with the tumor or
lesional phase

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 Nasal Cavity Anatomy
• The nasal cavity phase includes the nasal
turbinates and nasal septum.
• The posterior nasal bony septum is commonly
resected, carefully sparing the overlying septal
mucosa.
• The bony septum includes the vomer and
perpendicular plate of the ethmoid with small
components from the palatal bone and
sphenoid bone.
• The vomer and ethmoid contributions 16
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 PHYSIOLOGY
• The pituitary gland is known as the “master gland,” owing to its
governance over a multitude of target organs.
• This unique gland relies on a set of signal feedback loops to
appropriately regulate each of the hormone systems.
• The function of the pituitary gland can be divided along
anatomical differences, primarily between the anterior and
posterior pituitary glands (adenohypophysis and
neurohypophysis).
• The main distinction is the pituitary portal venous system
involved in the regulation of the adenohypophysis.
• The neurohypophysis is controlled directly by hypothalamic
neurons with axons terminating in this gland
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• The anterior pituitary gland is regulated by the hypothalamus,
and each hormone system is considered a hypothalamic-
pituitary axis (HPA).
• These hormone systems include the adrenal axis, governing
cortisol production and the stress response; the thyroid axis,
regulating metabolism; the gonadotropin axis, regulating
reproduction, sexual function, and anabolism; the growth
hormone axis, regulating growth and tissue health; and the
prolactin axis, regulating lactation.
• With some exceptions, each of these systems has intermediary
target organs that produce a secondary hormone that casts a
wider effect on the body and its organ systems.
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 HOMEOSTASIS
• The hypothalamus in conjunction with the pituitary gland and its feedback loops
regulate the homeostasis of systemic organ systems.
• This is mediated through homeostatic mechanisms (e.g., hunger, thirst, libido, and
circadian rhythm), endocrine control (via the pituitary gland and intermediary
glands), autonomic control, and limbic mechanisms.
• For example, thermo-regulation is governed by the anterior and posterior
hypothalamic nuclei and mediated via thyroid hormone release as well as a
balance of sympathetic and parasympathetic tone.
• Many of the hormones secreted by the pituitary gland and their downstream
glands rely on circadian rhythm generated by the interaction of the
suprachiasmatic hypothalamic nuclei, pineal gland, and visual stimuli.
• Systemic energy homeostasis involves multiple pituitary axes systems (i.e.,
thyroid, adrenal, and growth hormone) and a balance between the hunger and
satiety centers of the hypothalamus.
• This is tied to the limbic reward systems, affecting behavior.

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 HYPOPITUITARISM
• Pituitary dysfunction can occur as a result of a multitude of etiologies, including tumors, trauma,
vascular injury, inflammatory conditions, adverse medication effects, congenital causes, and
infections.
• Each of these can affect the different HPAs differentially. Intrinsic pituitary tumors, such as
pituitary adenomas, have a somewhat predictable sequence of dys-function, starting with
hypogonadism and hyposomatism, followed by hypothyroidism and ultimately hypocortisolism.
• These patients rarely present with diabetes insipidus.
• Conversely, patients with the autoimmune condition, lymphocytic hypophysitis, initially present
with hypocortisolism, and a number of patients also develop diabetes insipidus.
• The pituitary is a very resilient gland and can tolerate significant compromise before
demonstrating dysfunction.
• As with other endocrine organs, the gland can tolerate partial resection without developing
significant new endocrinopathy.
• Patients who present with hypopituitarism can experience improvement of their dysfunction.
• This is dependent on the etiology of the hypopituitarism, number of axes involved, and the
duration of symptoms.
• Hypopituitary patients with pituitary tumors and inflammatory conditions have a higher chance
of improvement than those who sustained traumatic brain injury or subarachnoid hemorrhage.

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 CONCLUSIONS
• The pituitary gland has numerous regulatory
and homeostatic roles as the master gland of
the body.
• Its unique location and intimate relation with
the hypothalamus allows it to be the primary
communication between the CNS and the
other organ systems.
• Understanding normal pituitary physiology,
including the feedback loop system of each
HPA and their crossreactivity, is necessary to 22
 References
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2. De Groot L, Beck-Peccoz P, Chrousos G, et al. Functional anatomy of the hypothalamus
and pituitary. Endotext. [Internet]. South Dartmouth, MA: MDText.com, 2000.
3. Hyrtl J. Onomatologia Anatomica: Geschichte und Kritik der Anatomischen Sprache der
Gegenwart, mit Besonderer Berücksichtigung ihrer Barbarismen, Widersinnigkeiten,
Tropen, und Grammatikalischen Fehler. Wien: Wilhem Braumüller; 1880.
4. Schreger C, Schreger H, Schreger T. Synonymia Anatomica. Furth: Bureau par Literatur;
1803.
5. Rathke M. Über die entstehung der glandula pituitaria. Arch Anat Physiol Wiss Med
1838;5:482–5.
6. Swedenborg E. The Brain, Considered Anatomically, Physiologically and Philosophically.
London: James Speirs; 1882.
7. Luschka H. Der Hirnanhang und die Striessdruse des Menschen. Berlin: Reimer; 1860.
8. Hutchinson J. A case of acromegaly. Arch Surg II. 1889;141:148.
9. Cushing H. The Pituitary Body and Its Disorders. Philadelphia and London: Lippincott;
1912.
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THANK YOU!!!

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