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A
PROJECT REPORT ON
FUNCTIONAL HEALTH ASSESSMENT QUESTIONNAIRE
MASTER OF BUSINESS ADMINNISTRATION
(CLINICAL RESEARCH)
Submitted in partial fulfilment of
The requirements for award of
Master of Business Administration (Clinical Research) of
Tilak Maharashtra University, Pune.
SUBMITTED BY:-
Harshad K More
PRN No.14209008929.
Of
Tilak Maharashtra University, Belapur.
Guided By
Prof. Vaidehi Limaye.
TILAK MAHARASHTRA UNIVERSITY,
GULTEKDI, PUNE -411037.
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RATIONALE
Pituitary Gland
Position: The pituitary gland (hypophysis) is about the size of a large pea, located below the
brain, behind the nasal cavity on the floor of the cranium. It is attached by a stalk to the
hypothalamus portion of the brain on the under surface of the cerebrum (Figure 22.2). It lies
in the sphenoid bone of the skull and is closely invested by a connective tissue capsule.
Figure - Position of Pituitary gland
The pituitary has been called the "master endocrine gland" because of its control over
several other endocrine glands. However, the bodys realmastergland is the hypothalamus of
the brain which controls the secretions of the anterior pituitary (by releasing and inhibiting
hormones). Also, the pituitary itself is in turn controlled by feedback from other glands.
Structure - The sagittal section shows that the pituitary consists of two main lobes, the
nterior lobe (pars distalis)andthe posterior lobe (pars nervosa). The small intermediate
lobe (pars intermediate) is marked by a cleft (in children) or cystic spaces (in adults)
(Figure 22.3) The part of the anterior lobe which extends upwards as part of pituitary stalk is
called the pars tuberalis. The pars anterior, pars tuberalis and pars intermedia form the
adenohypophysis while the pars nervosa and the pituitary stalk ( infundibulum) form the
neurohypophysis. The anterior lobe produces six different hormones. Of these, two work
directly on body tissue (somatotrophic) and the other four control the action of other
endocrine organs. The middle lobe (pars intermedia) secretes only one hormone,
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intermedin, which controls skin colours in lower vertebrates, but is vestigial in mammals,
and has no function in humans. The posterior lobe serves as storage and release point for
two hormones secreted by the hypothalamus (neurosecretory cells) and carried to the lobe
through a connecting duct (i.e., the neurohypophysis).
Figure - Section of Pituitary
Histology - Histological structure of the pituitary shows different types of cells in three
different parts of the pituitary. The cells are classified as chromophobes orchromphils by
the staining reaction of their cytoplasmic granules. Figure - (Tripple Mellory stain method) In
the anterior lobe, chromophobe cells are smaller, nuclei clumped together and are clustered
near the center. Chromophobe cells stain poorly. The chromophil cells stain red or purple
blue, contain secretory granules and are distributed at the periphery. The nuclei differ in sizeand in staining intensity. They are of two types, oxyphilic cells and basophilic cells. Blood
vessels and lymph spaces are also seen.
Pituitary hormones
The pituitary gland has 2 parts -- the posterior pituitary and the anterior pituitary -- each with
distinct functions.
Posterior pituitary
The smaller posterior pituitary (back part of the pituitary gland) is really an extension of brain
tissue. The posterior pituitary is where the hormones vasopressin (also called antidiuretic
hormone, or ADH) and oxytocin are made and released into the bloodstream.
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Vasopressi causes t e ki ey t retai water for t e body and not lose it all in t e urine.
Wit out vasopressin, a person would urinate (pee) too much and become dehydrated. This
condition is called diabetes insipidus. Vasopressin also can raise blood pressure by causing
blood vessels to contract and narrow. Oxytocin causes the uterus to contract during childbirth
and the breasts to release milk when a woman nurses her baby. Tumors rarely develop in the
posterior pituitary.
erior pi i ary
Most pituitary tumors begin in the larger anterior pituitary (front part ofthe pituitary gland).
This is not brain tissue. It is a true gland. It produces several hormones that control other
endocrine (hormone producing) glands.
Growth hormone (GH, also known as somatotropin) promotes body growth during childhood.
Iftoo much is made in a child they will grow very tall. Normally, adults make only small
amounts of growth hormone. If an adult continues to make growth hormone, the bones ofthe
hands, feet, and face continue to grow and become quite large, causing their normal features
to become distorted. This condition is called acromegaly.
T yroi sti lati hormone (TSH, also called thy ot opin) stimulates growth of the
thyroid gland and the release of thyroid hormone. Thyroid hormone regulates metabolism.
Too much makes you hyperactive and shaky, and too little makes you sluggish.
Overproduction of TSH by a pituitary tumor is one cause ofhyp thy oidi (an overactive
thyroid gland).
Adrenocorticotropic hormone (ACTH, also known as co ticot opin) causes adrenal gland
growth and production of steroid hormones (such as cortisone) by the adrenal glands. Too
much ofthis hormone from the pituitary produces a disease called Cu hing' di , named
afterthe famous neurosurgeon, Harvey Cushing, who first described it.
L teinizing hormone (L ) and ollicle-stimulating hormone (F H) are also called
gon dot opin . They regulate ovulation and the hormones estrogen and progesterone in
women. In men, LH and FSH controltestosterone and sperm production in the testicles.
Prolactin, another pituitary hormone, causes milk production in the female breast. Its
function in men is not known.
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Pituitary tumors
Pituitary cancers are rare. Almost all pituitary tumors are benign (non cancerous) glandular
tumors called adenomas.
Pituitary carcinomas
Cancerous tumors of the pituitary gland (calledpituit y carcino as) are rare. Only about
140 have been described in medical journals. Although they can occur at any age, most are
found in older persons. Most ofthem make hormones justlike adenomas do. Most pituitary
carcinomas look very much like large pituitary adenomas. In factthere is no good way to tell
if a pituitary tumoris a carcinoma and not an adenoma untilthe tumor spreads to another part
ofthe body. Most often it spreads to the brain, spinal cord, meninges (the layer oftissue that
covers the brain and spinal cord), or bone around the pituitary. These cancers rarely spread to
the liver, ovaries, heart, or lungs. Often, when these tumors are first removed, they are
thoughtto be an adenoma (benign). Itis only when the tumor comes back at a distantlocation
that the doctors reali e that it is a carcinoma. This typically happens 5 to 10 years afterthe
first surgery.
Pituitary adenomas
These benign tumors do not spread outside the skull. They usually remain confined to the
sella turcica (the tiny bony space thatthe pituitary gland sits in). Sometimes they grow into
the walls of the sella turcica and surrounding vessels, nerves, and coverings of the brain.
Although they do not grow very large, they can have a big impact on a person's health.
There is very little room fortumors to grow in this part ofthe skull. Therefore, ifthe tumor
becomes largerthan an inch, it can compress and cause damage to nearby parts ofthe brain.
Loss: the nerves leading to the eye pass by the pituitary gland. An enlarged pituitary can
press on these nerves and affect vision.
Hormones: many adenomas produce and release too much pituitary hormone, which can
cause serious symptoms.
Deficiency: sometimes the pituitary adenoma can crowd out the healthy pituitary tissue
that remains. Damage to this tissue can lead to a shortage ofthe other pituitary hormones.
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Pituitary adenomas are divided into 2 categories by si e:
Tumors that are smaller than 1 cm (a little less than 1/2 inch) are called microadenomas.
Because these tumors are small, they rarely damage the rest ofthe pituitary or neighboring
tissues. They produce symptoms because they release too much of a certain hormone into thebloodstream.
Tumors larger than 1 cm are called macroad nomas. Macroadenomas can affect a person's
health in 2 ways. First, they can cause symptoms ifthey make a hormone. Second, they may
cause symptoms by pressing on normal pituitary tissue or nearby nerves, such as the optic
nerve (responsible for vision).
In the past, pituitary tumors were classified by their appearance under the microscope after
they were removed by surgery. They were classified into 3 types. Basophilic adenomas had
blue cells, acidophilic adenomas had pink/red cells, and chromophobe adenomas had
relatively colorless cells. This system is no longer considered the best way to classify these
tumors.
Now, adenomas are classified by whetherthey produce a pituitary hormone and, ifthey do,
which type they produce. If a pituitary adenoma makes hormone it is calledfunctional. Ifit
doesn't make any hormone itis called non-functional.Most ofthe pituitary adenomas that are
found produce hormones. The hormone production can be detected by blood tests or by tests
ofthe tumor when itis removed with surgery.
Based on these results, adenomas are classified as:
Prolactin producing adenomas (prolactinomas) about 4 out of 10 pituitary tumors make
prolactin
Growth hormone secreting adenomas (about 1 in 5 pituitary tumors make growth hormone
Corticotropin (ACTH) secreting adenomas (about 7%)
Gonadotropin secreting adenomas (less than 1%)
Thyrotropin (TSH) secreting adenomas (less than 1%)
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Pituitary adenomas that do not make any hormone, called null cell adenomas, account for
about 3 in 10 of all pituitary tumors that are found.
Knowing what kind of hormone an adenoma produces is important because the hormone
strongly affects what signs and symptoms the patient has. This also affects which tests areused for diagnosis, the choice oftreatment, and the patient's outlook.
Other pituitary tumors
There are several othertypes of benign pituitary tumors, as well as some malignant ones. All
are much less common than adenomas. Teratomas, germinomas, and choriocarcinomas are all
rare tumors that usually occurin children or young adults. Although they do not develop from
the pituitary gland itself, they can grow into it and damage it. Rathke cleft cysts and
gangliocytomas ofthe pituitary are rare tumors that are usually found in adults.
Cancer that starts growing in sites otherthan the pituitary (like the breast) can metastasi e
(spread) to the pituitary. These cancers are classified by where they started growing (their
primary site) and are not classified as pituitary tumors
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Causes of pituitary tumors
Scientists do not know exactly what causes most pituitary tumors. During the past few years,
they have made great progress in understanding how certain changes in a person's DNA can
cause cells in the pituitary to produce a tumor. DNA is the molecule that carries the
instructions for nearly everything our cells do. We usually resemble our parents because they
are the source of our DNA. However, DNA affects more than our outward appearance. It also
determines our risk for developing certain diseases, including some types of cancer.
Some genes (parts of our DNA) contain instructions for controlling when our cells grow and
divide. Some genes that promote cell division are called oncogenes. Other genes that slow
down cell division or cause cells to die atthe righttime are called tumor suppressorgenes. It
is known that cancers can be caused by DNA mutations (defects) thatturn on oncogenes or
turn offtumor suppressor genes.
Some people with cancer have inherited DNA mutations (abnormal changes in their DNA)
from a parent, which increases their risk for developing the disease. Usually, DNA mutations
occur during life ratherthan having been inherited. Acquired mutations of some organs may
result from exposure to radiation or carcinogens (cancer causing chemicals). Sometimes
mutations occur for no apparent reason.
The DNA mutations that cause tumors in some people with pituitary tumors have been
identified (see the previous section, Much less is known about the causes of non hereditary
pituitary tumors, although some of these have acquired mutations in the AIP gene. Some
studies indicate about 40% of growth hormone secreting adenomas have an acquired
mutation in a specific protein called Gs alpha. Gs alpha mutations are much less common in
othertypes of pituitary adenomas.
Several other genetic abnormalities have been found in othertypes of pituitary adenomas, but
it is not clear whether abnormal genes are essential for pituitary tumor formation. What isknown is that there is a loss of the normal regulatory mechanism that keeps the glandular
cells from overproducing their hormone and growing. This is probably the result ofthe gene
alterations.
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OBJECT VES
Pituitary Gland Function - The Anterior Pituitary
Also known as adenohypophysis, this section of the pituitary gland is responsible forsecreting vital endocrine hormones such as the growth hormone (GH) for stimulating growth
and cell reproduction and regeneration in humans and other animals; prolactin (PRL) for
stimulating milk for nursing mothers and adrenocorticotropic hormone (ACTH), which is for
stimulating the adrenal cortex. The anteriorlobe releases hormones to stimulate the thyroid
gland, known as the thyroid stimulating hormone (TSH). It also releases the follicle
stimulating hormone (FSH) for taking care of the development, growth, pubertal maturation
and reproductive processes ofthe body. Another hormone, which is the luteini ing hormone
(LH) is secreted in orderto stimulate the ovulation and corpus luteum developmentin female
Pituitary Gland Function - The Intermediate Lobe
The main function of thepituitary gland through the intermediate lobe is, to produce the
melanocyte stimulating hormone (MSH). This belongs to a class of peptide hormones and
works on melanocytes which are skin cells that contain the black pigment.
Pituitary Glan
dFunction - The
Posterior
Pituitary
The posterior lobe is known as neurohypophysis and it is responsible for a function of the
pituitary gland which releases the oxytocin hormone. This hormone is required after
distension ofthe cervix and the vagina during labor. It also stimulates the nipples, facilitating
birth and breast feeding. The antidiuretic hormone (ADH and also known as vasopressin)
release, is also taken care of, by the posterior pituitary. This regulates water balance and
causes the increase in the absorption of waterinto the blood by the kidneys. Ifthis hormone is
not released in adequate quantity, then it may lead to issues of too little hormone (called
diabetes insipidus), or too much hormone (called syndrome of inappropriate ADH)
production.
As mentioned, getting a brief on the working ofthe different parts ofthe pituitary gland, can
give a clearidea about whatthe pituitary gland function is all about and whatit comprises of.
In short, the pituitary gland function is centered around the working of the sections ofthe
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gland; how they work and with what purpose. The most common of all are thepituitary gland
tumors. The several cell types of the gland may malfunction and grow rapidly or may
produce small growths and give rise to tumors. These tumors are, however, notbrain tumors
and are non cancerous. Tumors may be of two types; secretory and non secretory. The
former ones produce too much hormones and thus, imbalance the need of hormones in the
body. The later one interferes with the features of the pituitary gland function.
The overproduction of hormones is known as hypersecretion and it has its effects on milk
production in nursing mothers, adrenal glands and it may also lead to over production of
thyroid hormones. Hyposecretion is referred to the underproduction of hormones by the
pituitary gland. The tumors may give rise to symptoms such as headaches, vision problems,
etc. So, a proper diagnosis is a must fortreating the issue atthe earliest, before it proceeds to
an extent of severity.
Adrenal Gland Function
The adrenal glands are a small pair of glands that form a part of our body's endocrine system.
These triangular shaped glands are located on the top of our kidneys. They comprise of an
external cortex and an interior medulla. The adrenal glands also secrete hormones into the
bloodstream. Secretion of these hormones is the most important adrenal gland function.
These hormones play a vital role in the process of development and growth of our body.
Both the adrenal cortex and the medulla secrete hormones. Out of the several hormones
secreted by the adrenal cortex, the mostimportant ones include hormones such as aldosterone
and cortisol. Hormones such as epinephrine and norepinephrine are produced by the medulla.
Dehydroepiandrosterone sulfate and some sexual hormones are also secreted by the adrenal
gland. Since adrenal glands are anti-stress glands that hel p up cope with stress, our body's
ability to deal with stressful situations is greatly affected due to adrenal gland malfunction.
The pituitary gland along with hypothalamus is responsible for providing the adrenal gland
the required stimulus to secrete hormones. When the corticotropin-releasing hormones that
are produced by the hypothalamus stimulate the pituitary gland, it gets activated and produces
corticotropin hormones. Itis these corticotropin hormones that stimulate the adrenal glands to
produce corticosteroid hormones. As you are already aware, adrenal gland function involves
the secretion of hormones that are vital for many bodily processes. Whenever we are faced
with stressful situations, these adrenal glands spring into action and secrete the hormones to
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deal with stress. These help in preparing our body for responding to stress. As mentioned
earlier, both adrenal cortex and adrenal medulla secrete some vitally important hormones,
here's some information on the hormones secreted by the adrenal gland and the functions.
Aldosterone is one of the most important adrenal cortex hormones. It is categori ed as amineralocorticoid. It helps in maintaining the balance of water and salt in our body.
Aldosterone helps in regulating the amount of sodium that is excreted into the urine. The
production of aldosterone is regulated by the renin angiotensin. Wheneverthe blood pressure
fluctuates orthe balance of salt and wateris disturbed, the kidney secretes renin. This triggers
the production of angiotensin. Angiotensin stimulates the adrenal glands to release the
aldosterone hormone. Aldosterone prevents the kidneys from filtering excess amounts of salt
into the urine. Even when one is suffering from dehydration, aldosterone is released in order
to maintain the balance of saltin the body. Thus, aldosterone helps in maintaining the blood
pressure.Adrenal glands are the anti-stress glands which hel p our body deal with stress. Release of
cortisol is our body's own way of combating stress. The adrenal cortex releases
corticosteriods that help our body to deal with stressful situations. The secretion of cortisolis
controlled by the pituitary gland. Whenever we are stressed out, the adrenal glands release
cortisol. Not only does it raise the blood sugar and blood pressure levels, it also strengthens
the immune system. When there is a dip in the cortisol levels, it is indicative of a decreased
adrenal gland function. A person with low adrenal gland function or adrenal fatigue becomes
quite vulnerable to developing conditions such as low blood pressure, hypoglycemia and
allergies. Those suffering from low adrenal gland function generally experience fatigue and
recurrent infections. Their ability to handle stressful situations also gets adversely affected.Adrenal medulla is the core ofthe adrenal gland. Epinephrine and norepinephrine are some of
the hormones secreted by the adrenal medulla. Epinephrine or adrenaline facilitates the
conversion of glycogen to glucose in the liver. I am sure you might have heard of a term
called 'adrenaline rush'. This term is used for referring to the adrenal gland function in afight/flight response. When the adrenal gland release adrenaline, the force of heart
contractions and the heart rate increases considerably. The effects of epinephrine also include
increased flow of blood to the muscles and brain. Due to the release of epinephrine, the
muscles are able to perform respiration a higher rate.Norepinephrine is also a stress hormonethat helps in increasing heart rate and prepares the body for a fight/flight response. Adrenal
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gland malfunction can make one vulnerable to several health problems. The ability to deal
with stress will be greatly reduced. Adrenal problems such as an enlarged adrenal gland,
adrenal fatigue and adrenalinsufficiency can give rise to several problems.
Risk factors for pituitary tumors
A risk factor is anything that changes a person's chance of getting a disease such as cancer.
Different cancers have different risk factors. For example, exposing skin to strong sunlightis
a risk factor for skin cancer. Smoking is a risk factor for cancer ofthe lung and many other
cancers. But risk factors don'ttell us everything. Having a risk factor, or even several, does
not mean that a person will get the disease. Pituitary tumors have very few known risk
factors.
Family history
Rarely, pituitary tumors seem to run in families. In some cases, pituitary tumors are found
along with a number of othertumors as part of an inherited genetic syndrome (see the next
section). Sometimes, though, only pituitary tumors occur. This can be due to abnormal
changes (mutations) in a gene called AIP. These mutations can be inherited from a parent but
also can occur during a person's lifetime.
Genetic syndromes
Pituitary tumors can also be a part of a syndrome caused by having an abnormal copy
(mutation) of a gene. These include:
Multiple endocrine neoplasia, type I
(MEN1) is a hereditary condition that has a very high risk of developing tumors of 3 glands:
the pituitary, parathyroid, and pancreas. It is caused by the gene MEN1, and is passed on to
about half ofthe children of each affected parent. Ifthe MEN1 syndrome affects your family,
you should discuss testing forthis condition with your doctor.
Multiple endocrine neoplasia, type IV
(MEN4) is a syndrome that includes pituitary tumors and a certain type of benign kidney
tumor. The gene that causes this syndrome is called CDKN1B.
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Carney complex is caused by inherited mutations in at least 2 genes. So far, the gene
PRKAR1A is known to cause Carney complex, but some cases are caused by mutations in
another gene that has not yet been identified. People with this syndrome can have heart
problems, skin problems, and adrenal problems. They also have a high risk of a number of
differenttypes oftumors, including pituitary tumors.
McCune-Albright syndrome is caused by mutations in a gene called GNAS1 that aren't
inherited but occur before birth. People with this syndrome have brown patches on their skin
(called caf-au-laitspots) and develop many bone problems. They also may have hormone
problems and pituitary tumors
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Scope
Pituitary Disorders Treatment
Several types of drugs can help to relieve pituitary problems. Prolactinomas, for example,
respond well to a dopamine agonist drug. If surgery does not remove the entire pituitary
gland tumor, sometimes octreotide is used in patients with acromegaly or TSH-secreting
tumors. Medication is used to lower high hormone levels orto shrinkthe tumor. Sometimes
pegvisomant may be used to block the action of growth hormone. In many cases, drug
therapy is combined with surgery and/or radiation treatment.
Hormone Therapy
Hormone replacement therapy is an important part of any treatment for a pituitary disorder.
Hormones must be prescribed to meet your individual needs precisely. Sometimes tumors
cause a lack of a hormone, which can lead to the symptoms you are having. Othertimes, the
lack of a hormone is caused by the treatment you have for pituitary tumors. Radiation
therapy, for example, can lead to permanentloss of hormone secretion.
Some types of hormones are absolutely necessary for survival. These hormones must be
replaced immediately. The replacement of cortisol is important, because this hormone
regulates blood pressure and blood glucose levels. Cortisol replacement is common during
tumor surgeries because it helps the body to handle stress.
TSH, orthyroid stimulating hormone, is also vitalto survival, because it regulates the body's
metabolism. If TSH secretion is low, you may also need to start thyroid hormone
replacement.
ADH, or vasopressin, needs immediate replacement, because it controls the body's water
balance. If it is missing, this can cause excess thirst and urination, which is usually a
temporary condition. The symptoms of low levels ofthis hormone are commonly confusedwith diabetes mellitus, which is a different disorder. Levels that are too high also may cause
problems with water balance.
Other hormones, such as estrogen and progesterone in women, and testosterone in men, also
may need to be replaced to address hormone imbalances. While they are not vital for
survival, they may help you to live a full and healthy life. In addition to reproductive effects,
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these hormones are important for many functions such as maintaining normal bone mass;
hormone imbalances are one ofthe causes of osteoporosis, the loss of bone mass and density
Itis importantto rememberthat hormone replacement of estrogen and progesterone in young
women; i.e., replacing hormones backto where they would be ifthe pituitary works is notthesame as post-menopausal hormone therapy. In the latter case, hormones are being given at a
time in life when they are not normally made.
Surgery
The most common form of surgery to remove pituitary tumors is transsphenoidal
microsurgery. A neurosurgeon approaches the pituitary gland tumorthrough the nose, in the
sphenoid sinus cavity. Using this natural pathway the surgeon does not need to operate on
your skull. With a surgical microscope and special instruments, the surgeon can typically
safely remove the tumor without damaging the surrounding pituitary gland.
This surgery is not very painful, and you will not have any outer scars. You may have a sore
nose or what feels like a sinus headache. The biggest discomfort usually is from the padding
inserted in the nose for 24 to 48 hours after surgery. However with newer techniques, packs
are often not required at all. You will probably be in the hospital fortwo orthree days. You
should take it easy for a few weeks after the surgery, until your doctor says it is time to
resume your usual activities, including exercise.
Radiation therapy
To treat a pituitary gland tumor with radiation, doctors may use a variety of techniques
depending on the si e and location ofthe tumor. Conventional radiation covers a wide area in
and around the tumor and is usually given daily for several weeks. A number of more focused
"radiosurgery" therapies are also available and may be appropriate for your case including
gamma knife and proton beam. Radiosurgery methods begin with an MRI scan to image your
brain. The scan locates the precise location and si e ofthe tumor.
Afterthe MRI, you go into a specialtreatment room. Using the points mapped from the MRI,
several narrow beams of high-dose radiation are delivered to the exacttumorlocation. These
beams are so precise thatthey can avoid the normaltissue surrounding the tumor
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All radiation therapy works slowly and it may take from six months to several years for your
condition to improve. This is why radiation therapy is usually used together with other
therapies, such as hormone therapy. If you are considering radiation therapy, itis importantto
go to a hospital or medical center with expertise in treating pituitary tumors.
Pituitary Disorders Lifestyle andPrevention
Always take your medications or follow your course of hormone therapy as directed. If you
seem to be experiencing previous symptoms again or a different set of symptoms, call your
physician. You may need further treatment or your dose of medication may need to be
adjusted. Remember that sometimes symptoms take a while to disappear. Some symptoms
may never go away. Ask your doctor if you have questions or frustrations about your
progress aftertreatment.
You will also need to keep up with your regular physician visits and monitoring of your
condition. Keeping the proper balance of hormones in your body is important for normal
functioning. Most people who have had pituitary gland tumors treated go on to live normal
lives, as long as they follow their doctor's advice.
Diseases of the pituitary gland may have psychological aspects. These may include
symptoms of depression, moodiness, nervousness, and reduced sex drive. Many of these
symptoms will improve once you receive treatment for your pituitary condition. It isimportant that you communicate with your doctor about any symptoms you may be
experiencing. You may also seek additional professional hel p and the support of a patient
group or counselorto help you cope with these symptoms.
There is little a person can do to prevent pituitary gland tumors from forming except in the
case of severe injury ortrauma to the head. Anything you can do to protect your head and the
pituitary gland will help to preserve your hormonal system and potentially save yourlife.
Symptoms could include:
General Weakness ,Weight Loss, Cold Intolerance, Eye Swelling, Decreased Sense of Smell
Breast Enlargement in Men ,Unintentional Weight Gain, Cushingoid Facies, Fatigue
Headache, Erectile Dysfunction ,Infertility ,Sei ures ,Constipation , Weight Gain ,Lethargy
Visual Impairment, Low Blood Pressure ,Irritability, Heat Intolerance, Loss of Appetite
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REVIEWOF LITERATURE
History of pituitary disorders
In the past 15 years the clinical appreciation of the impact of Pituitary Disorders has
accelerated at a gratifying yet dangerously expeditious manner, leaving little time for the
advancing knowledge and proper medical practice guidelines to percolate through the
medical/patient/public sector and so allow for uniform improvement in understanding and
patient care. Medicine, hormonal replacements, surgical and radiological treatment options
flourish, to the great satisfaction of the inventing scientists/academic medical practitioners
while leaving the great majority of patients both un- and under- treated and in too many
instances, un- or under-diagnosed.
Atthe same time the overwhelming reach ofPituitary dysfunction on the patients life and
his/her family entity, whether hyper or hypo secretory, non-functioning, gonadotrophic,
incidentally discovered or sought adenomas, because of patient complaints, may also
include true tumors, or another ofthe myriad disorders, diseases, cysts and lesions plaguing
the patients and confounding his/her physicians. Conflicting conclusions most often lead to
conflicting and ineffective treatment, and an apparently never-ending treadmill of
symptoms, complaints and misdirected treatmentlead to enormous patient/societal costs and
deep conflict between patients and theirPhysicians/Surgeons. Patients too often despair of
finding competent help, are denied furthertesting ortreatment by their Insurance Companies
and eventually settle for Disability Benefits (the dole) or other forms of
governmental/charitable existence without reaching a satisfactory answerto their ailments.
The situational issues would perhaps not be so alarming were it not for the myriad
discoveries about Hormonal effects on Mental, Sexual, Metabolic, Reproductive and Bone
Health. The often overlapping issues are both conflicting and very costly, and Public Health
concerns come into play. The sheer NUMBER of patients, their great variety of complaints
and constellation of symptoms, will not for long go unchallenged or unappreciated.
Fortuitously, Hormonal Disorders/Diseases are not de-novo concerns like AIDS or Avian Flu
or SARS; the Endocrine Community has studied and concerned itself with the issues at hand
for many generations but their work goes largely under appreciated in the Great Medical
Scheme of Things. Firstly, the Endocrine medical community is not one for raising alarms or
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issuing warnings. Secondly, the issues are too complicated for the cursory coverage by the
lay media.
The myriad of clinical features:
Itis both confusing and sometimes disturbing to reali e that weight gain, obesity and eating
disorders are not always associated with over-indulgence and an inability and/or
unwillingness to control ones urges, but may indeed be linked to Hormonal hypo-or
hypersecretion by the Pituitary gland. Infertility and/or lack of libido can be linked to
Hormonal insufficiencies or excess. Classically, a psychological assessment would view
eating and sexual disorders from a strictly learning- and/or behavioral perspective or due to
dysfunctional relationship patterns or due to childhood trauma and would ignore the potential
physiological aspect altogether.
Emotional/Mental health care has undergone a major overhaul since the days of Jung and
Adler. The concept that a myriad of emotional disorders, from Depression to Bi-Polar
disorder to Apathy, may be related to a Hormonal imbalance is new for the psychological
community. Hormonal imbalance as a potential etiological factor, not just a difficult
childhood or stressful environment and relationships is just beginning to become part ofthe
clinical assessment protocol. Additionally, a potential relationshi p between psychological
and/or physicaltrauma and imbalances in the endocrine system are slowly being recogni ed
and yet to be fully understood. The psychologists, family therapists, social workers and
others are now learning to broaden their understanding of the role ofthe endocrine system
and deepen diagnostic skills to include more interaction with medical professionals who can
appropriately rule-out pituitary and hormonalimbalances.
The largest, almostintractable, difficulty facing both patients and the medical community, is
an apparent un-willingness or in-ability to agree on fairly simple issues such as symptoms,
definitions and classifications. Atthe one side ofthe spectrum are the learned, well reasoned
words of Dr. Harvey Cushing who in 1913 said: It is quite probable that the
psychopathology of everyday life depends largely upon the effects of the discharge of the
ductless gland upon the nervous system.
OrPlato who said: That as you ought notto attemptto cure the eyes withoutthe head, orthe
head withoutthe body, so neither ought you to attemptto cure the body withoutthe soul; and
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this," he said, "is the reason why the cure of many diseases is unknown to the physicians of
Hellas, because they are ignorant ofthe whole, which ought to be studied also; for the part
can never be well unless the whole is well."
Though thousand of years separate the two in time; their wisdom and learning was the same.Though the Physiological part of Endocrinology is Hard science and the Psychological
part is Soft science, the two simply have to come together in order to make any major,
meaningful advances in Pituitary Endocrinology diagnoses and treatment. Whereas the
definition and diagnosis of Diabetes, forinstance, is measured in quantifiable terms of blood
and Thyroid disorders are evaluated and judged in similar ways, the definition and
determination of Pituitary/Hormonal diseases is left almost solely to the judgment of
individual medical practitioners, who feel free to include or discount patient reported
symptoms and complaints at will. To some Medical personnel a headache is a meaningfulsymptom of a disorder; to others it is merely an incidental happening, with little or no
relationship to either mass-effect nor hormonal hypersecretion. Mood-swings and depression
to most clinicians are recogni ed as a minor issue usually treated with antidepressants and a
recommended change oflife-style.
Family and general relationship functioning is a key indicatorto overall patient functioning
yet often ignored both pre-and post diagnosis and treatment. Family members often observe
and are deeply affected by patient symptoms of increased anger outbursts, sexual
dysfunction, depression, and changes in a patients overall sense and awareness of
themselves. The impact of pituitary and hormonal dysfunction on the family cannot be
overstated. Assessing marital, family, and relationshi p functioning as yet another key
indicator for diagnosis and treatment has largely been ignored.
Loss of libido, erectile dysfunction, irregular or missing menses are frequently regarded as
issues of extraneous, non Pituitary/Hormonal origin, rarely used as a basis for further
exploration or a specific diagnostic work-up. Again, change of lifestyle, avoid stress, etc.is
the popular medical recommendation. However, those on the Psychological/Mental health
side of medicine may well be attempting to treat Physiological symptoms and disorders,
caused by hypo or hyper secretion of hormones, often caused by a tumor, in Pituitary patients
without making any attempts to link the rather distinct constellation of symptoms to an
underlying Physiological origin.
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However, once a diagnosis of a pituitary adenoma is made, or of a cyst or other related lesion,
the Neurosurgeon will often insist this is HIS/HER proscribed territory and if a successful
resection is made the surgeon will, too often, tellthe patientthat he or she is cured and go
home, recover and get on with life. Sadly, this does not often happen, and whether months or
years later, the patients is complaining of new, often worse, symptoms and not understanding
why the cure did not last! Endocrinologists, on the other hand, too often insist that their
prescribed regimen ofMedication is sufficient,and the patient should just resign her/himself
to be grateful for life, regardless of the Quality! Only in very rare instances do the two
opposing views recogni e the need for Psycho-Social intervention and even medical
treatment for mental, behavioral,family/relationship, or cognitive dysfunction.
One cannot help but believe that once a commonality of understanding is reached, treatment
and solution will follow in rapid order. It is clear from studies conducted over the lastcentury that secretory pituitary tumors are prevalent, by a magnitude of hundreds of times
over those numbers previously believed. Non-secretory (previously referred to as non-
functional) may indeed be gonadotrophs, first and foremost attacking the sexual well-being
and functioning of the patients before progressing to the emotional/.mental health states. In
addition, we have a remarkably large array of disease states affecting the pituitary from
Hypophysitis to Craniopharyngiomas. All such conditions can result in profound impact
manifested by serious and life altering health problems.
The study of pituitary began in China. The Chinese were isolating sex and pituitary hormones
from human urine and using them for medicinal purposes by 200 BC. They used many
complex methods, such as sublimation. Eventually, when Berthold noted that castrated
cockerels did not develop combs and wattles or exhibit overtly male behaviour, European
endocrinology began (however, it should be noted thatthe Chinese anticipated the science by
over 1500 years.) He found that replacement oftestes backinto the abdominal cavity of the
same bird or another castrated bird resulted in normal behavioural and morphological
development, and he concluded (erroneously) that the testes secreted a substance that"conditioned" the blood that, in turn, acted on the body of the cockerel. In fact, one of two
otherthings could have been true: that the testes modified or activated a constituent of the
blood or that the testes removed an inhibitory factor from the blood. It was not proven that
the testes released a substance that engenders male characteristics untilit was shown thatthe
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extract of testes could replace their function in castrated animals. Pure, crystalline
testosterone was isolated in 1938.
Although most of the relevant tissues and endocrine glands had been identified by early
anatomists, a more humoral approach to understanding biological function and disease wasfavoured by the ancient Greek and Roman thinkers such as Aristotle, Hippocrates, Lucretius,
Celsus, and Galen, according to Freeman et al., and these theories held sway untilthe advent
of germ theory, physiology, and organ basis of pathology in the 19th century.
In medievalPersia, Avicenna (980-1037) provided a detailed account on diabetes mellitus in
The Canon of Medicine (c. 1025), "describing the abnormal appetite and the collapse of
sexual functions and he documented the sweet taste of diabetic urine." Like Aretaeus of
Cappadocia before him, Avicenna recogni ed primary and secondary diabetes. He also
descri bed diabetic gangrene, and treated diabetes using a mixture of lupine, trigonella
(fenugreek), and zedoary seed, which produces a considerable reduction in the excretion of
sugar, a treatment which is still prescribed in modern times. Avicenna also "described
diabetes insipidus very precisely for the first time", though it was later Johann Peter Frank
(17451821) who first differentiated between diabetes mellitus and diabetes insipidus.[
In the 12th century, Zayn al-Din al-Jurjani, another Muslim physician, provided the first
description of Graves' disease after noting the association of goitre and exophthalmos in his
Thesaurus ofthe ShahofKhwarazm, the major medical dictionary ofits time. Al-Jurjani also
established an association between goitre and palpitation. The disease was later named after
Irish doctor Robert James Graves, who described a case of goiter with exophthalmos in 1835.
The German Karl Adolph von Basedow also independently reported the same constellation of
symptoms in 1840, while earlier reports of the disease were also published by the Italians
Giuseppe Flajani and Antonio Giuseppe Testa, in 1802 and 1810 respectively, and by the
English physician Caleb HillierParry (a friend of Edward Jenner) in the late 18th century.
In 1902 Bayliss and Starling performed an experiment in which they observed that acid
instilled into the duodenum caused the pancreas to begin secretion, even after they had
removed all nervous connections between the two. The same response could be produced by
injecting extract of jejunum mucosa into the jugular vein, showing that some factor in the
mucosa was responsible. They named this substance "secretin" and coined the term hormone
for chemicals that actin this way.
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Von Mering and Minkowski made the observation in 1889 that removing the pancreas
surgically led to an increase in blood sugar, followed by a coma and eventual death
symptoms of diabetes mellitus. In 1922, Banting and Best realized that homogenizing the
pancreas and injecting the derived extract reversed this condition. The hormone responsible,
insulin, was not discovered until Frederick Sanger sequenced itin 1953.
Neurohormones were first identified by Otto Loewi in 1921. He incubated a frog's heart
(innervated with its vagus nerve attached) in a saline bath, and left in the solution for some
time. The solution was then used to bathe a non-innervated second heart. Ifthe vagus nerve
on the first heart was stimulated, negative inotropic (beat amplitude) and chronotropic (beat
rate) activity were seen in both hearts. This did not occur in either heart if the vagus nerve
was not stimulated. The vagus nerve was adding something to the saline solution. The effect
could be blocked using atropine, a known inhibitorto heart vagal nerve stimulation. Clearly,something was being secreted by the vagus nerve and affecting the heart. The "vagusstuff"
(as Loewi called it) causing the myotropic effects was lateridentified to be acetylcholine and
norepinephrine. Loewi won the NobelPrize for his discovery.
Recent work in endocrinology focuses on the molecular mechanisms responsible for
triggering the effects of hormones. The first example of such work being done was in 1962
by Earl Sutherland. Sutherland investigated whether hormones enter cells to evoke action, or
stayed outside of cells. He studied norepinephrine, which acts on the liver to convert
glycogen into glucose via the activation of the phosphorylase enzyme. He homogenized the
liver into a membrane fraction and soluble fraction (phosphorylase is soluble), added
norepinephrine to the membrane fraction, extracted its soluble products, and added them to
the first soluble fraction. Phosphorylase activated, indicating that norepinephrine's target
receptor was on the cell membrane, not located intracellularly. He later identified the
compound as cyclic AMP (cAMP) and with his discovery created the concept of second-
messenger-mediated pathways. He, like Loewi, won the NobelPrize for his groundbreaking
workin endocrinology.
Medical discipline dealing with regulation of body functions by hormones and other
biochemicals and treatment of endocrine system imbalances. In 1841 Friedrich Gustav Henle
first recognized ductless glands, which secrete products directly into the bloodstream. The
field was essentially established in the early 20th century, when Ernest H. Starling, who
introduced the term hormone, proposed that chemical and nervous regulation of physiological
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processes were linked. Endocrine therapy is based on replacing deficient hormones with
purified extracts. Nucleartechnology has led to new treatments; use of radioactive iodine for
hyperthyroidism greatly reduced the need forthyroid gland surgery. The detection of minute
amounts of hormone with radioimmunoassays (see radiology) permits early diagnosis and
treatment of endocrine disorders.
Endocrinology
The study of the glands of internal secretion, the endocrine glands, and the hormones which
they synthesize and secrete. These glands are ductless; the hormones are secreted directly into
the blood to be carried to the targettissue or organ. The hormones, or chemical messengers,
are highly specific and their action may be selective or generalized.
the science concerned with the structure and function of the glands of internal secretion, or
endocrine glands, the hormones manufactured by the glands, and the hormones manner of
formation and effect on animals and man. Clinical endocrinology studies the diseases that
result from functionalimpairment ofthe endocrine glands.
Endocrinology is related to many branches of biology, medicine, and veterinary science; it
has particularly close ties to physiology, from which it evolved as an independent science, as
well as to biochemistry, pharmacology, and molecular biology. On the basis ofthe progress
made in understanding how the hormones activate the genes, endocrinology may be defined
as the science concerned with the regulation of the basic functions of the organism. The
modern subspecialty neuroendocrinology studies the interaction of the nervous system and
endocrine glands in regulating body functions.
Historical sketch
The castration of farm animals has been practiced since ancient times. Men, too, were
castratedfor example, the Eastern slaves who served in the harems as eunuchs and the
members of certain religious sects, such as the Skoptsy in prerevolutionary Russia. In all such
cases, distinct changes were observed not only in sexual function butthroughoutthe body
in growth, muscular development, and activity ofthe nervous system. As early as the 16th to
18th centuries, almost allthe organs now known as the glands ofinternal secretion had been
described by many anatomists together with the other organs of animals and man, although
the endocrine glands function was unknown at the time. The concept of an organ or gland
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with internal secretion was formulated in 1830 by the German physiologist and naturalist J. P.
Mller.Endocrinology evolved into a scientific discipline in the 19th century, when certain
diseases resulting from injury to some ofthe endocrine glands were described. For example,
thyroid disease was descri bed by the Irish scientist R. Graves in 1835 and by the German
scientist K. von Basedow in 1840; in 1855 the English physician T. Addison described
adrenal disease in man. The Swiss surgeons T. Kocher and J. L. Reverdin studied endemic
goiter (188283) and scientifically justified its treatment by surgery.
The earliest experiments in endocrinology were performed by the German physiologist A.
Berthold, who in 1849 showed thattransplanting the testes underthe skin orin the abdominal
cavity of young castrated roosters prevents the development of such phenomena as are
observed after castration. Several years later, in 1855, the French physiologist C. Bernard
introduced the concept ofinternal secretion.
The endocrine glands attracted even greaterinterest afterthe studies carried out by the French
scientist C. Brown-Squard (1889) proved, in his opinion, that testicular extracts have a
rejuvenating effect on the aging organism. It was atthis time that extensive research studies
making use of animals were initiated in clinical and experimental endocrinology. In 1889 the
German scientists J. von Mering and O. Minkowsky showed that removal ofthe pancreas in
animals causes diabetes mellitus. In 1901 the Russian scientist L. V. Sobolev made an
important contribution by showing that diabetes mellitus is related to loss ofthe function of
internal secretion in the islet tissue of the pancreas. He also pointed out the possibility of
treating diabetes with a preparation derived from the pancreas.
The functional changes resulting from removal of orinjury to the endocrine glands suggested
that some especially active compounds may be manufactured by the glands. For a long time,
however, efforts to isolate such compounds were unsuccessful. It was not until 1901 that
adrenaline, the hormone produced by the adrenal medulla, was first isolated in crystalline
form by the American scientist T. Aldrich and the Japanese scientist J. Takamine, and not
until 1905 that it was synthesized by the German scientist F. Stolz and the English scientist
H. Dakin. At the same time (1905) the English physiologist E. H. Starling introduced the
term hormone.
The thyroid hormone thyroxine was isolated in 1915 by the American scientist E. Kendall,
and its chemical structure was established in 1926 by the English scientistC. Harington. In
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192122, insulin was isolated from the pancreas by the Canadians F. Banting and C. Best,
and somewhat later the hormone glucagon was found in the gland. Studies by the German
scientists F. Smith, B. Zondek, and S. Aschheim on the hormones of the anterior pituitary
gland date backto the same period, although the hormones themselves were not isolated in
pure form untilthe 1940s.
Various compounds were isolated in the late 1920s and early 1930sspecifically, the
estrogen compounds isolated from the follicular fluid by the American scientists E. Allen and
E. Doisy, the German scientist A. Butenandt, and the Englishman H. Marian (192429); the
hormone progesterone, isolated from the corpus luteum by Allen and Butenandtin 1934; and
the corticosteroids, such as hydrocortisone, cortisone, and corticosterone, isolated from the
adrenal cortex by the Swiss T. Reichstein and the American E. Kendall. Aldosterone was
isolated from the adrenal glands in 1953 by an Anglo-Swiss research team headed by S.Simpson and J. Tait.
The isolation of hormones in their pure form and the establishment oftheir structure made it
possible to obtain many hormones by chemical means, to study their effect on the organism,
and to determine more precisely the role of each gland. As a result of such research, it was
established that the endocrine glands function as part of a unified interrelated system rather
than separately. The hypophysis cerebri, or pituitary gland, was found to be part of a single
functional complex with the hypothalamus. Studies by the English scientist H. Harris (1952),
by the Americans S. McCann and A. Schally, and by the French physiologist R. Guillemin
showed that the medial portion of the hypothalamus secretes various biologically active
substancesknown as releasing hormoneswhich are carried through the blood vessels to
the anterior part ofthe pituitary gland, where they stimulate the synthesis and release ofthe
hypophyseal hormones.
In the second half of the 20th century, much has been learned about how hormones work. It
has been determined that the steroid hormones act at the deoxyribonucleic acid level,
stimulating the corresponding genes; this results in the synthesis ofthe essential enzymes or
other specific proteins that affect metabolism. The proteo hormones do not penetrate into the
cell; they act on the internal cell membrane, which contains the enzyme adenyl cyclase. The
latter converts adenosinetriphosphoric acid (ATP) to cyclic adenosine monophosphate, which
interacts with and activates various intracellular enzymes (protein kinases) and through them
affects the nuclear apparatus ofthe cell.
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The activity of an endocrine gland depends on the degree of concentration ofits hormone (or
hormones) in the blood. For example, an excess of thyroid or adrenocortical hormones
reduces the secretion of hypothalamic releasing hormones, which in turn diminishes the
secretion of hypophyseal hormones and lowers the thyroxine or corticosteroid levels in the
blood. The Soviet biologistM. M. Zavadovskii regarded this long-known mechanism as the
basic principle of humoral interrelation and called it the plus-minus interactiona
particular case of the general law governing the maintenance of hormonal balance in the
body. This principle ofinteraction was subsequently called feedback.
Such interactions in the endocrine system are effected both by the action of certain glands
hormones on other glands and by neural mechanisms; they occur not only in the
hypothalamus but also at lower levels of integration. As early as 1910, M. N. Cheboksarov
showed thatthe adrenal glands medullary secretion is regulated by the nervous system. I. P.Pavlov and his students noted the influence of higher nervous activity on the endocrine
system.
Clinical endocrinology
As a branch of clinical medicine, clinical endocrinology studies diseases of the endocrine
systemtheir epidemiology, etiology, pathogenesis, symptoms, treatment, and prevention
as well as the changes that take place in the endocrine glands in the presence of other
diseases.Modern research methods can reveal the causes of many endocrine disorders, such
as bacterial disorders (for example, tuberculosis of the adrenal cortex with progressive
functional insufficiency) and endocrine gland diseases of the viral, traumatic, and vascular
type. Psychogenic and hereditary factors are also important. Itis often difficultto distinguish
between the factors that are the principal causes of an endocrine disease and the conditions
contributing to the evolution ofthe disease from its preclinical stages into its latent and overt
stages (for example, negative psychic influences in diabetes mellitus). The causes of
endocrine diseases frequently remain unknown.
Current notions about the pathogenesis of endocrine diseases are based on the study of
morphological changes in the corresponding glands and ofthe glands functional condition as
well as the condition of the systems that regulate glandular activity. Diseases that affectthe
glands functionnamely, those characterized by increased glandular activity
(hyperfunction) or decreased activity (hypofunction)are distinguished from those in which
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hormonal secretion remains within normal physiologicallimits. The various stages that mark
the course of endocrine diseases are (1) the preclinical, or earliest, stage, which can be
diagnosed only from indirect symptoms, (2) the latent stage, detected by means of special
diagnostic tests, and (3) the overt stage, with typical manifestations. Thus, for example,
diabetes mellitus in its preclinical stage is presumed to exist at birth in the case of a large
fetus both of whose parents are diabetic; the latent stage is diagnosed by means of a glucose
tolerance test.
The treatment of endocrine diseases is based on the principle of maintaining the hormonal
regulation of functions with physiological limits. Usually, in the absence of complications,
diseases marked by glandular hyperfunction can be successfully treated by means of chemical
agents that selectively reduce excessive glandular activity, X-ray irradiation, the use of
radioactive isotopes that damage the hormone producing cells, or surgery. In the case ofdiseases marked by hypofunction, normal hormonal levels are achieved by means of
hormonal preparations (such treatment being known as replacement therapy, as in the
treatment of diabetes mellitus with insulin) or preparations that stimulate the corresponding
glands. Identification ofthe risk factorsthatis, conditions that favorthe development of a
diseaseis very important. In diabetes mellitus, for example, such factors include hereditary
predisposition to the disease and obesity.
In the USSR, clinical endocrinology is taught in the departments of internal medicine and
departments of endocrinology of medical schools and institutes of advanced medicaltraining.
In the other socialist countries, too, institutes of advanced medical training include
departments of endocrinology.
Practical significance
Modern chemical and physicochemical methods make it possible to detect the presence of
hormones not only in the endocrine glands, where they are usually found in abundance, but
also in the blood and urine, where they are present in minute quantities. Thus certain
hypotheses may be formulated about the manner in which hormones are synthesized and
converted within the organism. The advances made in endocrinology led to advances in the
related branches of medicine, and particularly in clinical endocrinology. The identification of
hormones and ofthe products oftheir conversion resulted in more accurate clinical diagnoses
of various endocrine diseases. At the same time, the availability of pure hormones and
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hormonal preparations made it possible for these diseases to be successfully treated. Many
hormonal preparations have proved effective in the treatment of collagen diseases, bronchial
asthma, cancer ofthe mammary gland and prostate, and some diseases ofthe kidneys, liver,
and other organs.
The findings of endocrinology are being successfully applied in veterinary medicine. In
addition to the ancient practice of castration as a means of altering the behavior of farm
animals and fattening them, livestock breeders are developing other endocrine methods
designed to influence fattening and fertility. Methods have been devised for hormonal
stimulation of multiple births and hormonal regulation of the sexual cycle in farm animals.
Extensive research is under way on the use of a new class of hormonal substancesthe
prostaglandins. Hormonal stimulation ofthe sex glands is an important factorin modern fish
breeding. For example, the gonadotropic hormone ofthe pituitary gland is used in preparingthe fish for spawninga procedure worked out by the Soviet scientist N. A. Gerbilskii.
Throughoutthe world, intensive efforts are devoted to the study of hormones and their action,
especially at the molecular level. Modern endocrinology is chiefly concerned with the
hormonal regulation of such functions as metabolism and with the origin, early diagnosis,
treatment, and prevention of diabetes mellitus and other endocrine disorders.
Scientific institutions, organizations and periodicals
In the USSR, research studies in endocrinology are carried out atthe I. P. Pavlov Institute of
Physiology of the Academy of Sciences of the USSR (Leningrad), the Institute of
Experimental Endocrinology and Hormone Chemistry of the Academy ofMedical Sciences
ofthe USSR (Moscow), the Kiev Institute of Endocrinology and Metabolism, the Ukrainian
Institute of Experimental Endocrinology and Hormone Chemistry (Kharkov), and at various
other institutes, medical school clinics, and institutes of advanced medical training.
Analogous research systems operate in the other socialist countries as well. In the capitalist
countries, aspects of clinical endocrinology are studied in the laboratories and clinics ofuniversities, hospitals, and specialized research institutes.
National societies of endocrinologists and of diabetes specialists exist in almost all the
developed countries. There are also international societies of endocrinologists and diabetes
specialists. In 1975 the All-Union Scientific Society of Endocrinologists (founded 1947)
joined the International Association of Endocrinologists (founded 1960).
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RESEARCH METHODOLOGY
Research Design
Research Design is defined as plan for collecting and utilizing data, so that desired
information can be obtained with sufficient precision and a hypothesis can be tested properly.
Format of
Questionnaire
Through
personal
meetings
Data Analysis
Filling up the
Questionnaire
Data
Obtained
Interpretation
of Result
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Sampling Size:-
The sample size of a statistical sample is the number of observations that constitute it.
Itis typically denoted as n.
In this project, the sample size of 30 and age criteria between 18 45 years has been taken
for analysing the data.
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DATAANALYSISAND INTERPRETATION
BODY MASS INDEX (BMI)
The body mass index (BMI), or Queteletindex, is a heuristic measure of body weight based
on a person's weight and height. Though it does not actually measure the percentage of body
fat, it is used to estimate a healthy body weight based on a person's height, assuming an
average body composition. Due to its ease of measurement and calculation, it is the most
widely used diagnostic toolto identify weight problems within a population, usually whether
individuals are underweight, overweight or obese. Body mass index is defined as the
individual's body weight divided by the square of his or her height. The formulae universally
used in medicine produce a unit of measure of kg/m2. Body mass index is defined as the
individual's body weight divided by the square of his or her height. The formulae universally
used in medicine produce a unit of measure of kg/m2.
SI units BMI = mass (Kg)
(height (m))2
BMI Weight Status Categories:-
BMI Weight Status
Below 18.5 Under Weight
18.5 24.6 Normal
25 29.9 Over Weight
30.0 & Above Obese
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Body Mass Index of 30 people as follows:-
Height(metre) Weight(kg) BMI(kg/m2) Weight Status
1.62 51 19.43 Normal
1.70 58 20.69 Normal1.68 53 18.77 Normal
1.65 65 23.87 Normal
1.73 55 18.37 Under Weight
1.80 60 18.51 Normal
1.55 52 21.64 Normal
1.60 50 19.53 Normal
1.64 64 23.79 Normal
1.78 58 18.30 Under Weight
1.85 73 21.32 Normal
1.61 63 24.30 Normal
1.70 60 20.76 Normal
1.63 59 22.20 Normal
1.85 72 21.03 Normal
1.79 57 17.78 Under Weight
1.84 69 20.38 Normal
1.72 60 20.28 Normal
1.80 63 19.44 Normal
1.74 83 27.41 Over Weight
1.59 60 23.73 Normal
1.69 61 21.35 Normal
1.76 96 30.99 Obese
1.61 55 21.21 Normal
1.83 66 19.70 Normal1.57 49 19.87 Normal
1.57 60 24.34 Normal
1.67 56 20.07 Normal
1.50 50 22.22 Normal
1.66 67 24.31 Normal
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Graph
0
5
10
15
20
25
30
Underweight Normal Overweight Obese
BMI
BMI
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PITUITARY
Graph
0
5
10
15
20
25
30
35
No Yes
Height (6'6'')
Sexual develop ent
Increased libido
Height (4'10'')
Tolerate Sugar
Delayed sexual develop
ent
(after age 13)
Questionnaire No Yes
Height over 66 30 0
Early sexual development
(before age 10)
30 0
Increased libido 30 0
Height under 410 30 0
Tolerate Sugar 20 10
Delayed sexual development
(after age 13)
28 2
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PITUITARY
Questionnaire No Minor
(Monthly)
Moderate
(Weekly)
Severe (Daily)
S
litting ty e
headache
25 5 0 0
!emory failing 21 6 3 0
Excessive thirst 25 1 2 2
Decreased libido 29 1 0 0
Weight gain
aro " nd hi s or
waist
22 2 5 1
!enstr
"al
disorders
25 3 2 0
Tendency to
"lcers
28 2 0 0
Graph
0
5
10
15
20
25
30
35
No # inor( # onthly) # oderate
(Weekly)
Severe (Daily)
Splitting type headache
$ emory failing
Excessive thirst
Decreased li%
ido
Weight gain aro & nd hips
#enstr
&al disorders
Tendency to'
lcers
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Five major health concerns in order ofimportance
Questionnaire 1 2 3 4 5
Upper Gastrointestinal System 8 2 1 2 2
Adrenal 4 5 3 1 2
Liver & Gallbladder 1 2 5 3 2
Thyroid 2 1 3 1 5
Sugar Handling 3 9 4 3 1
Immune System 0 2 0 1 2
Vitamin Need 2 4 4 5 5
Mineral Need 0 0 1 0 3
Essential Fatty Acids 9 3 2 3 0
Cardiovascular 1 0 2 5 1
Kidney & Bladder 0 0 2 1 1
Pituitary 0 0 1 1 0
Smallintestine 1 1 0 0 1
Large intestine 0 0 2 1 1
Men only 0 0 0 0 3
Women only 0 1 0 2 1
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Graph
0
1
2
3
4
5
6
7
8
9
10
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FINDINGS
According to the data analysis out of 30 people, 25 people are normal whereas 3 people are
underweight, 1 people are overweight and 1people are obese.
PITUITARY
Out of 30 people
1) 10 people can tolerate sugar; feel fine when eating sugar.
2)2 people have delayed sexualdevelopment (after age 13).
3) 5people have minor symptom ofsplitting type headache.
4) 6 people have minor symptom and 3 people have moderate symptom ofmemory failing
5) 1 people have minor symptom, 2 people have moderate symptom and 2 people have
severe symptom ofexcessive thirst
6) 1people have minor symptom ofdecreasedlibido
7) 2people have minor, 5 people have moderate and 1 people have severe weight gain
around hips or waist
8) 3 people have minor symptom and 2 people have moderate symptom of menstrual
disorders
9) 2people have minor symptom oftendency to ulcers
First major health concerns
Out of 30 people 9 people have essential fatty acids concerns.
Second major health concerns
Out of 30 people 9 people have sugar handling concerns.
Third major health concerns
Out of 30 people 5 people have liver & gallbladder concerns.
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Fourth major health concerns
Out of 30 people 5 people have vitamin need and cardiovascular concerns.
Fifth major health concerns
Out of 30 people 5 people have thyroid concerns.
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APPENDIX
COPY OF QUESTIONNAIRE
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References
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