1.

RELACIONAR TODOS LOS SIGNOS Y

SÍNTOMAS DE LA PACIENTE DEL CASO
CLÍNICO CON LAS DISTINTAS
HORMONAS ADENOHIPOFISIARIAS (EJE
HIPOTÁLAMO-HIPOFISIARIO). ADECÚE
LA TABLA A SU LETRA Y CANTIDAD DE
SIGNOS Y SÍNTOMAS.
SINTOMA O SIGNO HORMONA HIPOFISIARIA FUNCIONES PRINCIPALES ORGANO BLANCO

- Acné GH 1° Anabolica: síntesis de PIEL Y ANEXOS

proteínas.
- Hirsutismo 2° Acción sobre el metabolismo
-Acantosis nigrican de los carbohidratos: 
- Oleadas de calor Ahorrar glucosa y ser
hiperglicemiante
3° Catabólica
moviliza ácidos grasos para su
uso como fuente de combustible
- Nariz ancha GH durante el ayuno. HUESOS
- Frente prominente 4° Estimula el crecimiento de los
- Aumento rebordes órganos (ej.: hipertrofia cardiaca
y renal), la producción de
supraorbitarios hormonas, el metabolismo, el
- Mandíbula prominente crecimiento y la maduración
- Manos y pies, grandes y esqueletaria, y la función inmune.
5ª Aumenta tamaño
dedos gruesos Visceras, la piel

- Palpitaciones GH CORAZON

- Oligomenorrea PRL Estinmula lactogenesis GLANDULA MAMARIA

Estimula recambio de dopamina
- Dificultad para quedar disminuye la secrecion GnRH HIPOTALAMO
embarazada Secreción progesterona cuerpo GONADAS
- Pérdida de la líbido luteo
Inhibe esteroidogenesis
2. DIBUJE EL EJE HIPOTÁLAMO-
HIPOFISIARIO DE LA HORMONA DEL
CRECIMIENTO NORMAL Y A LA PAR EL
EJE DE LA PACIENTE DEL CASO CLÍNICO.
3. DE LAS HORMONAS ESTUDIADAS EN
LA PACIENTE DEL CASO CLÍNICO,
¿CUÁL O CUÁLES PRESENTAN
RETROALIMENTACIÓN POSITIVA?
Fig. 1. Regulation of prolactin secretion by short-loop
negative feedback. Prolactin secretion is tonically
inhibited by the hypothalamus by means of dopamine
secreted in the median eminence from the
tuberoinfundibular dopaminergic (TIDA) neurones.
Prolactin then regulates its own secretion by
stimulating prolactin receptors (PRL-R) on the TIDA
neurones. Prolactin may access these neurones
directly through fenestrated capillaries in the median
eminence, or after entering the central nervous system
(CNS) via a carrier-mediated transport mechanism in
the choroid plexus
COMPRESION
TALLO
HIPOFISIARIO
¨STALK EFFECT¨
4. ¿A QUÉ SE LE LLAMA PERFIL HIPOFISIARIO?
PRESENTE UN CUADRO O TABLA, CON LOS
NOMBRES DE LAS RESPECTIVAS HORMONAS,
ASÍ COMO LOS INTERVALOS O RANGOS DE
VALORES SÉRICOS NORMALES CON SUS
CORRESPONDIENTES UNIDADES DE MEDICIÓN.
Normal values: free T4 index is 0.8–1.5, TSH 0.4–5.5 mcU/ml,
total T4 4–12 mcg/100 ml
5. ¿CUÁLES SON LOS PRINCIPALES HALLAZGOS
CLÍNICOS QUE SE OBSERVAN EN LOS
PACIENTES CON TUMORES HIPOFISARIOS
ACIDÓFILOS, EN ANÁLISIS DE LABORATORIO
CLÍNICO Y EN LOS SIGUIENTES ESTUDIOS
ESPECIALIZADOS: ¿RADIOGRAFÍAS, TAC Y
RMN?
CELULAS ACIDOFILAS CELULAS BASOFILAS
ROJO-NARANJA TIÑEN AZUL – PERIFERIA PARS
COLORANTE: EOSINA COLORANTE: HEMATOXILINA
SOMATOTROPOS - GH CORTICOTROPAS – ACTH
MAMOTROPOS - PRL GONADOTROPAS – FSH
TIROTROPAS - TSH
CELULAS CROMOFOBAS
SE TIÑEN DEBILMENTE
PARS INTERMEDIA RESIDUOS
BOLSA DE RATHKE
PARS TUBERALIS FSH Y LH
6. ¿EXPLIQUE POR QUÉ SE PRESENTAN
LOS CAMBIOS HORMONALES EN EL
CICLO MENSTRUAL Y EL CICLO
ENDOMETRIAL DE LA PACIENTE DEL
CASO CLÍNICO? PARAFRASEE LA
INFORMACIÓN CONSULTADA.
7. HAGA UN DIAGRAMA DE FLUJO DE
LA RELACIÓN ENTRE INSULINA Y
HORMONA DEL CRECIMIENTO.
 INSULINA
INGRESA GLUCOSA EN MUSCULO Y
ADIPOCITOS
ACELERA TRANSPORTE DE GLUCOSA
HACIA MUSCULO E HIGADO
AUMENTA GLICOLISIS
ESTIMULA LA LIPOGENESIS
ESTIMULA GLUCOGÉNESIS
INHIBE GLUCOGENÓLISIS
INHIBE GLUCONEOGENESIS
HIPOGLICEMIANTE
8. DE ACUERDO CON LA REVISIÓN
BIBLIOGRÁFICA QUE REALIZÓ, CUÁLES SON LAS
HORMONAS COMÚNMENTE AFECTADAS POR UN
ADENOMA HIPOFISIARIO Y SUS
MANIFESTACIONES CLÍNICAS. (PUEDE
ELABORAR UN ESQUEMA, MAPA CONCEPTUAL O
UN FLUJOGRAMA
 MACROADENOMAS > 10MM

MICROADENOMAS < 10MM

McNeill, K. A. (2016). Epidemiology of Brain Tumors. Neurologic Clinics, 34(4), 981–998. doi:10.1016/j.ncl.2016.06.014 
 Daly, A. F., & Beckers, A. (2020). The
Epidemiology of Pituitary Adenomas.
Endocrinology and Metabolism Clinics of North
America.doi:10.1016/j.ecl.2020.04.002 

Estimates from cancer registries suggest that pituitary

adenomas are uncommon (prevalence is 19 to 28
cases per 100,000 people), particularly compared to
solid tumors like breast, lung, and colon cancer.2 In
contrast, a meta-analysis of autopsy data and
radiologic studies performed in healthy volunteers
indicates that pituitary adenomas are 700 times more
common than registry data suggests and are found in
14% of autopsies and 23% of CT/MRI studies, giving a
mean prevalence of 17%, or 1 in 6 people with
pituitary tumors and 1 in 600 with macroadenomas.3 

Ezzat S, Asa SL, Couldwell WT, et al. The prevalence of

pituitary adenomas: A systematic review. Cancer. Aug 1
2004;101(3):613-619. 
TIPOS Y FRECUENCIA DE ADENOMAS PITUITARIOS
BASADO EN SU ESTADO FUNCIONAL EN PACIENTES
ADULTOS
Iglesias, P., Bernal, C., Villabona, C., Castro, J. C., Arrieta, F., & Díez,
J. J. (2012). Prolactinomas in men: a multicentre and retrospective
analysis of treatment outcome. Clinical Endocrinology, 77(2), 281–
287. doi:10.1111/j.1365-2265.2012.04351.x 
NO FUNCIONANTES
EECTO DE MASA

HIPER O HIPOFUNCIONANTES
ALTERACION HORMONAL
 Hormone oversecretion (secretory tumor)
≈ 65% of adenomas secrete an active hormone (48% prolactin, 10% GH, 6% ACTH, 1% TSH)5 :

1. PROLACTIN (PRL): can cause amenorrhea-galactorrhea syndrome in females, impotence in males. Etiologies:

a) prolactinoma: neoplasia of pituitary lactotrophs

b) stalk effect: pressure on the pituitary stalk may reduce the inhibitory control over PRL secretion causing a modest increase in serum prolactin

2. GROWTH HORMONE (GH): elevated GH is due to a pituitary adenoma > 95% of the time

a) in adults: causes acromegaly (p.746)

b) in prepubertal children (before epiphyseal plate closure): produces pituitary gigantism (very rare)

3. CORTICOTROPIN - ADRENOCORTICOTROPIC HORMONE (ACTH):

a) Cushing’s disease (endogenous hypercortisolism): see below

b) Nelson syndrome: can develop only in patients who have had an adrenalectomy

4. THYROTROPIN (TSH): secondary (central) hyperthyroidism

5. GONADOTROPINS (LUTEINIZING HORMONE (LH) AND/OR FOLLICLE STIMULATING HORMONE (FSH)): usually does not produce a clinical
syndrome (80–90% of “silent” are gonadotroph adenomas. 6 FSH: may produce ovarian hyperstimulation in reproductive age women causing amenhrrhea &
glactorrhea (as with prolactin) along with ovarian cysts. 7 LH: these tumors are even more rare
 Underproduction of pituitary hormones
May be caused by compression of the normal pituitary by large tumors. More common with nonsecretory tumors than with secretory tumors. In order of sensitivity to
compression (i.e., the order in which pituitary hormones become depressed from mass effect): GH (61–100%), gonadotropins (LH & FSH) (36–96%), TSH (8–81%),
ACTH (17–62%), 8 prolactin (mnemonic: Go Look For The Adenoma Please). Chronic deficiency of all pituitary hormones (panhypopituitarism) may produce pituitary
cachexia (AKA Simmonds’ cachexia).

✖ NB: selective reduction of a single pituitary hormone is very atypical with pituitary adenomas. May occur with autoimmune hypophysitis (p.1451), which most
commonly involves ACTH or ADH (causing or diabetes insipidus)

Deficiency of specific hormones:

1. GROWTH HORMONE DEFICIENCY

a) in children: produces growth delay
b) in adults: produces vague symptoms with metabolic syndrome (decreased lean body mass, centripetal obesity, reduced exercise tolerance, impaired sense of well-
being)
c) hypogonadism: amenorrhea (women), loss of libido, infertility

2. HYPOTHYROIDISM: cold intolerance, myxedema, entrapment neuropathies (e.g. carpal tunnel syndrome), weight gain, memory disturbance, integumentary
changes (dry skin, coarse hair, brittle nails), constipation, increased sleep demand Pituitary Tumors

3. HYPOADRENALISM: orthostatic hypotension, easy fatigability

4. DIABETES INSIPIDUS: almost never seen preoperatively with pituitary tumors (except possibly with pituitary apoplexy, see below). If DI is present, other
etiologies should be sought, including:
a) autoimmune hypophysitis (p.1451)
b) hypothalamic glioma
c) suprasellar germ cell tumor

5. GONADOTROPIN DEFICIENCY (hypogonadotrophic hypogonadism) with anosmia is part of Kallmann syndrome10

 Mass effect (other than compression of the pituitary)
Because they tend to get to a larger size before detection, this is more common with nonfunctioning tumors. Of functional tumors, prolactinoma
is the most likely to become large enough to cause mass effect (especially in males or non-menstruating females); ACTH tumor is least likely.
Nonspecific symptoms include headaches. ✖ Seizures are rarely attributable to pituitary adenomas and other etiologies should be sought. Mass
effect may occur suddenly as a result of expansion with pituitary apoplexy.

1. OPTIC CHIASM: from tumor growth superiorly through the diaphragma sella
Classically produces bitemporal hemianopsia (non-congruous). May also cause decreasing visual acuity

2. involvement of third ventricle may produce obstructive HYDROCEPHALUS

3. CAVERNOUS SINUS

a) pressure on cranial nerves contained within (III, IV, V1, V2, VI): ptosis, facial pain, diplopia
b) occlusion of the cavernous sinus: proptosis, chemosis
c) encasement of the carotid artery by tumor: may cause slight narrowing, but complete occlusion is rare

4. invasive adenomas infrequently present with FISTULA LCR NASAL; with invasive prolactinomas this may be precipitated by shrinkage resulting
from medical treatment

5. macroadenomas may produce H/A possibly via increased intrasellar pressure