survey -“functional health assessment questionnaire” prepared by harshad more

8/8/2019 Survey -FUNCTIONAL HEALTH ASSESSMENT QUESTIONNAIRE Prepared by Harshad More

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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


19/41

Page 19 of41

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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Page 20 of41

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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Page 27 of41

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


1.85 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


1.84 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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Page 37 of41

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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