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For instructor materials including Power Points, Answers to Clinical Encounter Questions, please contact userservices@mhprofessional.com.
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LEARNING OBJECTIVES
Upon completion of the chapter, the reader will be able to:
List the mediators and primary effects of pituitary hormones.
Identify clinical features of patients with acromegaly.
Discuss the role of surgery and radiation therapy for patients with acromegaly.
Select appropriate pharmacotherapy for patients with acromegaly based on patient-specific factors.
Identify clinical features of children and adults with growth hormone (GH) deficiency and select appropriate pharmacotherapy for these patients.
Recommend monitoring parameters necessary to assess therapeutic outcomes and adverse effects in patients receiving GH therapy.
List common etiologies of hyperprolactinemia.
Identify clinical features of patients with hyperprolactinemia.
Select appropriate pharmacologic and nonpharmacologic treatments for patients with hyperprolactinemia based on patient-specific factors.
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PHYSIOLOGY OF THE PITUITARY GLAND
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The pituitary, referred to as the “master gland,” is a small endocrine gland located at the base of the brain and is responsible for the regulation of many other endocrine glands and body systems. Growth, development, metabolism, reproduction, and stress homeostasis are among the functions influenced by the pituitary. Functionally, the gland consists of two distinct sections: the anterior pituitary lobe and the posterior pituitary lobe. The pituitary receives neural and hormonal input from the inferior hypothalamus via blood vessels and neurons.
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The posterior pituitary is innervated by nervous stimulation from the hypothalamus, resulting in the release of specific hormones to exert direct tissue effects. The hypothalamus synthesizes two hormones, oxytocin and vasopressin. These hormones are stored and released from the posterior pituitary lobe. The anterior pituitary lobe is under the control of several releasing and inhibiting hormones secreted from the hypothalamus via a portal vein system. It synthesizes and secretes six major hormones. Figure 46–1 summarizes the physiologic mediators and effects of each of these hormones.
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