Present physiologic concepts suggest that the pituitary gland is of definite secondary importance in the control of aldosterone secretion and therefore a mechanism for production of hyponatremia in.. Pituitary hormone deficiency leading to severe hyponatremia as a result of nonfunctional pituitary macroadenoma is a quite rare presentation in clinical practice . In this prospective study, the authors documented water balance in patients fo
. A low serum sodium may result from salt losses or else from an excess amount of water in the bloodstream. The latter is definitely the more common cause of hyponatremia. Arginine vasopressin is produced by the posterior pituitary gland Rarely, hyponatraemia can be the consequence of acute or chronic adrenal insufficiency [ 1, 2 ]. Adrenal insufficiency may result from dysfunction of the adrenal glands, or from disorders of the pituitary gland or the hypothalamus Pituitary adenomas may be the cause of the syndrome of inappropriate secretion of antidiuretic hormone (SIADH), although few cases have so far been reported. We described a case of hypotonic hyponatremia in a 76-yr-old man with a pituitary macroadenoma. He had a recent history of two syncopal attacks which had occurred in the last two months The pituitary gland stops producing the hormone, ADH, so a person releases a large amount of urine. I hope that all makes sense. Finally, I mentioned that liver disease increases hyponatremia, but I wanted to specify that cirrhosis of the liver increases your chance of developing hyponatremia In all instances of excess ADH secretion, patients have abnormally low concentrations of sodium ions in their blood (a condition known as hyponatremia). A low serum sodium may result from salt losses or from an excess amount of water in the bloodstream. Arginine vasopressin is produced by the posterior pituitary gland
Hyponatremia caused by AI is explained by the dysfunction of hypothalamo-pituitary-adrenal axis. The electrolyte disturbance of hyponatremia in AI is due to diminished secretion of cortisol. Cortisol deficiency results in increased hypothalamic secretion of CRH. CRH plays the role of an additional ADH secretagogue Normal volume (euvolemic) hyponatremia The amount of water in the body is normal, but an anti-diuretic hormone is being inappropriately secreted (SIADH =syndrome of inappropriate ADH secretion) from the pituitary gland. This may be seen in patients with pneumonia, small cell lung cancer, bleeding in the brain, or brain tumors Syndrome of inappropriate antidiuretic hormone ADH release (SIADH) is a condition defined by the unsuppressed release of antidiuretic hormone (ADH) from the pituitary gland or nonpituitary sources or its continued action on vasopressin receptors. The condition was first detected in two patients with lung cancer by William Schwartz and Frederic Bartter in 1967
Hyponatremia after Pituitary Surgery. July 21, 2016. From Lewis S Blevins Jr. MD: A 37-year-old woman presented with visual compromise and headache. MRI demonstrated a 2.0 cm cystic pituitary lesion thought to be representative of a Rathke's cleft cyst. Pituitary functions were normal Hyponatremia Cyst Pituitary Gland Cerebral Salt Wasting 1. Introduction Hyponatremia is a common disorder resulting from a wide variety of causes. Treatment can vary from fluid restriction to rehydration, depending on the pathogenesis of the disorder The pituitary gland is protected well within the sella turcica of the sphenoid bone; however, the pituitary stalk, connected to the anterior pituitary and hypothalamus, is vulnerable to the effects.. the pituitary gland. However, with respect to the analysis of etiology of hyponatremia, evaluation of volume status and determination of serum and urine osmolality, in-cluding urinary sodium levels, are mandatory . In this patient, hypovolemic hyponatremia was consi-dered because there were dry mucous membranes and marginally low blood pressure
Causes of pituitary adenoma-induced hyponatremia include hypopituitarism in association with concurrent dysfunction of the pituitary-adrenal axis and the syndrome of inappropriate secretion of ADH (SIADH) [3-5]. Among the differential diagnoses of hyponatremia, several reports suggest that a pituitary gland corticotrophic adenoma may lead. Hyponatremia was successfully corrected with fluid restriction and both visual function and anterior pituitary function remained intact. Subsequently, the patient developed central diabetes insipidus (CDI), which responded well to desmopressin substitution . One cause of pituitary growth associated with the risk of Sheehan's syndrome is the hyperplasia of lactotrophs (responsible for prolactin production)
causes of pituitary gland disorders-pituitary and brain tumors or infection-shock or severe hypotension-head trauma or brain injury -radiation or surgery of the head and brain -hyponatremia: salt cravings, anorexia, N/V-hyperkalemia: cardiac dysrhythmias, bradycardia, irregular HR, cardiac arres . Key words: hyponatremia, lack of high signal intensity in the posterior pituitary lobe, depletion of the posterior pituitary (Intern Med 56: 3205-3209, 2017) (DOI: 10.2169/internalmedicine.8616-16) Introduction On T1-weighted magnetic resonance imaging (MRI), hig Mean of s-Na levels: 132.3 mMol/L ± 1.7 (123-134) Moderate or severe hyponatremia (< 130 mMol/L) was observed in 12% of the patients. Hyponatremia was associated with: male gender, higher rates of admission to hospital, extension of pulmonary lesions at admission, ICU admission, mechanic ventilation and death Irreversible adrenal insufficiency or hypoadrenalism (Addison disease) results from failure of the adrenal gland to produce adrenocortical hormones (mineralocorticoids and glucocorticoids). 531. Relative adrenal insufficiency (RAI) is a transient form of AI that often occurs in critically ill people, neonatal foals, and horses. RAI is defined as an inadequate production of cortisol in relation. Acromegaly: Diagnosis. A pituitary adenoma may be suspected based on symptoms, the medical history, and physical findings of acromegaly. Explaining your symptoms is a crucial part of diagnosis, as your doctor uses the information to determine whether a pituitary tumor is secreting an excess of hormones and if there is evidence of pituitary insufficiency
Hyponatremia is commonly seen in hospitalized patients. In euvolemic individuals, syndrome of inappropriate antidiuretic hormone secretion (SIADH) is a common differential. However, before establishing a diagnosis of SIADH, it is imperative to evaluate for hypocortisolism and hypothyroidism. and an ectopic pituitary gland in the posterior. Hyponatremia Study (Delayed Hyponatremia After Pituitary Surgery) (DHAPS) The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government The pituitary gland is compressed and the pituitary stalk is displaced by the tumor Full size image He was treated with 3 % saline during the acute phase, which led to a marked improvement in his muscle power and rapid reduction of his serum creatine phosphokinase (CPK) levels, which paralleled the correction of severe hyponatremia over 2 to 3.
After pituitary surgery, 25% of the patients developed spontaneous isolated hyponatremia (Day 7 ± 0.4). Twenty percent of the patients developed diabetes insipidus and 46% remained normonatremic. Plasma arginine vasopressin (AVP) was not suppressed in hyponatremic patients during hypoosmolality or in two-thirds of the normonatremic patients. Half of the patients presenting with hyponatremia, including 6 of 10 patients with adenomas and 2 of 3 patients with RCCs, had pituitary apoplexy or cyst rupture. All patients had anterior pituitary gland dysfunction, including 81% with hypoadrenalism and 69% with hypothyroidism
Hyponatremia is defined as a serum sodium concentration of less than 135 mEq/L but can vary to some extent depending upon the set values of varied laboratories. Hyponatremia is a common electrolyte abnormality caused by an excess of total body water in comparison to that of the total body sodium content. Edelman approved of the fact that serum sodium concentration does not depend on total. The hypothalamus produces ADH, and the pituitary gland releases it. Very high ADH levels may be dangerous because they can cause fluid imbalances that lead to seizures or cerebral edema. A person may also have high ADH levels if they have heart failure. This can result in excess fluid building up in the body Hyponatremia. Hyponatremia is decrease in serum sodium concentration < 136 mEq/L ( < 136 mmol/L) caused by an excess of water relative to solute. Common causes include diuretic use, diarrhea, heart failure, liver disease, renal disease, and the syndrome of inappropriate antidiuretic hormone secretion (SIADH) The pituitary gland is a small organ which is located at the base of the brain. It is referred to as the master gland because it regulates and controls several endocrine glands of the body. The size of this regulating gland is that of a pea size. Pituitary gland is connected to the brain through the hypothalamus Background . Hyponatremia is commonly seen in hospitalized patients. In euvolemic individuals, syndrome of inappropriate antidiuretic hormone secretion (SIADH) is a common differential. However, before establishing a diagnosis of SIADH, it is imperative to evaluate for hypocortisolism and hypothyroidism. The finding of endocrine abnormalities determined to be of pituitary origin should prompt.
Pituitary apoplexy should be regarded as a differential diagnosis of hyponatremia. For management, steroid therapy is mandatory in the first place as adrenal insufficiency is seen in 50-80% of patients with pituitary apoplexy onset and may be life threatening, potentially leading to severe hemodynamic problems and hyponatremia ( 5 ) When compared with patients with gland manipulation < 4, moderate to severe gland manipulation was associated with a significantly higher rate of post-operative pituitary gland damage, defined as a new anterior pituitary hormone axis deficit or delayed hyponatremia: 6 of 12 (50.0%) patients with a high manipulation score developed pituitary.
The pituitary gland makes a hormone called adrenocorticotropic hormone (ACTH). ACTH in turn stimulates the adrenal cortex to produce its hormones. Benign pituitary tumors, inflammation and prior pituitary surgery are common causes of not producing enough pituitary hormone Over a 4-year interval, 373 procedures were performed in 339 patients who underwent TSS for sellar and parasellar lesions involving the pituitary gland. The mean (± SD) age of patients was 48 ± 18 years; 61.3% of the patients were female and 46.1% were obese (defined as a body mass index [BMI] ≥ 30) Syndrome of inappropriate antidiuretic hormone secretion (SIADH) is characterized by excessive unsuppressible release of antidiuretic hormone (ADH) either from the posterior pituitary gland, or an abnormal non-pituitary source. Unsuppressed ADH causes an unrelenting increase in solute-free water being returned by the tubules of the kidney to the venous circulation (A) Pre-ipilimumab MRI showing baseline pituitary measuring 6 mm craniocaudal dimension with concave-down shape of superior margin of pituitary gland. (B) After the third cycle of ipilimumab, the patient presented with fatigue, hypotension, hyponatremia, hypocortisolemia, and central hypothyroidism To our knowledge, this is the first case report of acute Sheehan's syndrome presenting with both hyponatremia and suggestive hypoglycemia. Pituitary necrosis is an uncommon complication of peripartum hemorrhagic shock. Since the initial description by Sheehan in 1937, the incidence of the syndrome has gradually declined through improved.
Diederich S, Franzen NF, Bähr V, Oelkers W. Severe hyponatremia due to hypopituitarism with adrenal insufficiency: report on 28 cases. Eur J Endocrinol 2003; 148:609. Olchovsky D, Ezra D, Vered I, et al. Symptomatic hyponatremia as a presenting sign of hypothalamic-pituitary disease: a syndrome of inappropriate secretion of antidiuretic. Secondary adrenal insufficiency is caused by disordered function of the hypothalamus and pituitary gland and is characterized by a low cortisol production rate and a normal or low plasma ACTH concentration. cases) hypoglycemia. Mineralocorticoid deficiency is clinically manifested through isosmotic dehydration, leading to hyponatremia. (inﬂammaon of the pituitary gland) • Relavely rare with PD-1, PDL-1 Inhibitors (Nivolumab, Pembrolizumab) • Very common with CTLA-4 inhibitors - 10-15% of paents receiving Ipilimumab - Incidence is increasing as clinical recogni?on improves and deﬁni?ons become more precise. Faje, Pituitary, 201 After pituitary surgery, 25% of the patients developed spontaneous isolated hyponatremia (Day 7 +/- 0.4). Twenty percent of the patients developed diabetes insipidus and 46% remained normonatremic. Plasma arginine vasopressin (AVP) was not suppressed in hyponatremic patients during hypoosmolality or in two-thirds of the normonatremic patients. Too low a concentration of sodium, or hyponatremia, can be corrected either by increasing sodium or by decreasing body water. The existence of separate mechanisms that regulate sodium concentration account for the fact that there are numerous diseases that can cause hyponatremia, including diseases of the kidney, pituitary gland, and hypothalamus
Endocrinology -pituitary gland 1. Surrounded by sphenoid bone,cover by sellar diaphragm. 2 lobes: Adenohypophysis ( anterior) Neurohypophysis (posterior) Hypothalamus-pituitary axis Pituitary gland- general Hyponatremia is common secondary to hypothyroidism and isolated glucocorticoid underproduction. Potassium levels remain normal because. Pituitary ACE-2 expression. Coronavirus entry into host cells is mediated by the viral transmembrane spike (S) glycoprotein binding the metallopeptidase ACE2 [43, 44].ACE2 has been identified as the functional receptor for infection of SARS-CoV and SARS-CoV-2 mediating viral entry in concert with S glycoprotein priming by the host cell transmembrane serine protease 2 (TMPRSS2) [43, 44] Pathophysiology. The pituitary gland is located at the base of the brain, and intimately connected with the hypothalamus.It consists of two lobes: the posterior pituitary, which consists of nervous tissue branching out of the hypothalamus, and the anterior pituitary, which consists of hormone-producing epithelium.The posterior pituitary secretes antidiuretic hormone, which regulates osmolarity.
Congenital defects in hypothalamus/pituitary gland (e.g., septo-optic dysplasia) to avoid water intoxication and hyponatremia. Higher levels of vasopressin (>1000 pg/mL) must be avoided to. causes of pituitary gland disorders-pituitary and brain tumors or infection-shock or severe hypotension-head trauma or brain injury -radiation or surgery of the head and brain -hyponatremia: salt cravings, anorexia, N/V-hyperkalemia: cardiac dysrhythmias, bradycardia, irregular HR, cardiac arres Her laboratory testing revealed leukocytosis, hyponatremia, and hypokalemia. A non-contrast computed tomography scan of the head revealed an enlarged sella turcica and pituitary gland with hemorrhage and deviation of the optic chiasm. Conclusion. Her symptoms improved and she was discharged from the hospital in stable condition
Pituitary apoplexy is bleeding into or impaired blood supply of the pituitary gland.This usually occurs in the presence of a tumor of the pituitary, although in 80% of cases this has not been diagnosed previously.The most common initial symptom is a sudden headache, often associated with a rapidly worsening visual field defect or double vision caused by compression of nerves surrounding the gland Abstract: Pituitary apoplexy is a life-threatening syndrome caused by acute infarction of the pituitary gland. The most common symptoms associated with pituitary apoplexy are headache, nausea, vomiting, visual symptoms, hypopituitarism, and altered mental status. Both oculomotor nerve palsy and hyponatremia In SIADH, unregulated AVP secretion either from the posterior pituitary gland or an abnormal nonpituitary source results in antidiuresis, eventually resulting in hyponatremia. Disorders affecting the pituitary and/or the hypothalamus are known to be associated with dysregulation of AVP/ADH secretion, such as SIADH [9, 10] Historical note and terminology. Pituitary aplasia (absence) is a rare condition first described in the 1950s and 1960s (27; 168; 196).It has been related to ciliary gene mutations, exemplified in patients with type 9 oral-facial-digital syndrome (03).Pituitary hypoplasia, in which the pituitary gland is diminutive and leads to congenital hypopituitarism, is not always an anatomical anomaly of.
A mass arising from the pituitary gland commonly damages cells of the anterior pituitary gland and affects the secretion of gonadotropins and growth hormone. However, central hypothyroidism and secondary adrenal insufficiency from such damage is a rare phenomenon. Acute urinary retention as the main symptom of central hypothyroidism is also an unusual initial presentation. We report a male. Serum osmolality is maintained by a feedback system involving the hypothalamus, pituitary gland, and the kidney. An increase in serum osmolality is sensed by osmoreceptors located in the anterior hypothalamus resulting in release of antidiuretic hormone (ADH) from the posterior pituitary gland
It is then released by the pituitary gland at the base of the brain. Causes. Low sodium that occurs rapidly, in less than 48 hours (acute hyponatremia), is more dangerous than low sodium that develops slowly over time. When sodium level falls slowly over days or weeks (chronic hyponatremia), the brain cells have time to adjust and the acute. BACKGROUND Hyponatremia is an electrolyte disorder frequently encountered by clinicians. Secondary adrenal insufficiency due to pituitary metastatic tumors should be considered as an alternative diagnosis when clinicians encounter patients with lung cancer who demonstrate hyponatremia
Introduction. Hyponatremia is the most common electrolyte abnormality in clinical medicine. 1 Delayed symptomatic hyponatremia (DSH) is a known complication of both microscopic and endoscopic transsphenoidal pituitary surgery, with a peak incidence of 4-7 days postoperatively.2, 3, 4 It is a common cause of readmission to the hospital due to fluid retention resulting in reduction of plasma. The pituitary gland is a kidney-bean-sized gland situated at the base of your brain. It is part of your body's endocrine system, which consists of all the glands that produce and regulate hormones. Despite its small size, the pituitary gland creates and releases a number of hormones that act on nearly every part of your body
Addison's disease causes hyponatremia as a result of low levels of aldosterone due to damage to the adrenal gland. The hypothalamus and pituitary gland are also involved in sodium regulation by making and releasing vasopressin, known as anti-diuretic hormone, into the bloodstream. Like aldosterone, vasopressin acts in the kidney, but it causes. The diagnosis of hyponatremia involves assessing levels of sodium in the blood. A healthy sodium level is between 135 and 145 mmol/l and a person is considered to be hyponatremic if the level. Hyponatremia is a common electrolyte disturbance, but less commonly utilized and require a thorough evaluation to unmask etiology. It has variety of causes and is rarely due to hypopituitarism. Hyponatremia is a very early complication of pituitary tumor. Here, we report a case, who presented to us with hyponatremia and eventually thorough work-up led us to a diagnosis of Non-functioning. Hypopituitarism (also called pituitary insufficiency) is a rare condition in which your pituitary gland doesn't make enough of certain hormones. Hormones coming from the pituitary gland control the function of other glands in your body: thyroid gland, adrenal glands, ovaries, and testes. Your body can't work properly when important glands, such.
A direct result of the autoimmune attack on the pituitary gland is a reduction several pituitary hormones, which can lead to several other conditions, such as adrenal insufficiency, hypothyroidism, hypogonadism, and diabetes insipidus. Symptoms of these conditions can include: Polyuria (excessive urination) Polydipsia (excessive thirst hyponatremia as the presenting symptom in RCC.2,6,13 In a retrospective analysis, Ogawa et al.13 described the largest series. They described 8 patients with an RCC who pre-sented with symptomatic hyponatremia, which was postu-lated to be due to hypocortisolemia caused by inflamma-tory damage from the RCC within the anterior pituitary gland
- hyponatremia, - cerebral edema, and resultant neurologic dysfunction. -Although total body water is increased, blood volume remains normal, and peripheral edema does not develop. Title: Pathology of pituitary gland Author: toshiba Created Date physiology of the pituitary gland, which, if corrected, would serve to empower nurses in science-based prac-tice and provide safe, quality patient care. Physiology of the Pituitary The pituitary, a small but important endocrine gland acting as the ''conductor of the endocrine orchestra'' (Ben-Shalomo & Melmed, 2011), is located at th Hyponatremia should be recognized as a possible complication after transsphenoidal resection of NASBTs. Intraoperative extradural retraction of the pituitary gland was the only significant factor for serological hyponatremia, suggesting the maneuver and subsequent dysregulation of the hypothalamo-hypophyseal axis may be responsible
Peripheral enhancement of the gland is demonstrated. Figure 3 MRI of pituitary four months post delivery. Sagittal T pre contrast scan reveals atrophic pituitary 1 gland and empty sella. Figure 4 MRI of pituitary gland 4 months post delivery. T coronal section post gadolinium reveals no residual 1 pituitary enhancement Widening of the posterior pituitary stalk has been reported with a variety of diseases which cause diabetes insipidus, and may also be an early sign of inflammation of the neurohypophysis. A thickened stalk with absence of the posterior pituitary bright spot should prompt a thorough search for systemic diseases known to cause diabetes insipidus
Without enough ADH being released from the posterior pituitary gland, the kidneys are not getting the signal to reabsorb water. The prefix neuro- in neurogenic means nervous system, or more specifically, brain. The hypothalamus and pituitary gland are in the brain, so that's how you can remember neurogenic diabetes insipidus Hyponatremia is caused when ecstasy induces antiduretic vaspopressin. Basically antiduretic is a hormone that has the responsibility of reducing the loss of water in urine. When hyponatremia sets it, antiduretic vasopressin occurs by the pituitary gland, which means the kidney is now retaining water During the following 2 years, my thyroid medicine needed to be changed frequently in response to varying TH levels. In 2016, I began having a series of episodes characterized by muscle spasms, insomnia, nausea, anxiety, depression, fatigue, weakness and vivid dreams. The first couple lasted less than two weeks each, but the current one has been. Diabetes insipidus is an entirely different disorder than diabetes mellitus, or sugar diabetes. Diabetes insipidus occurs in patients with pituitary disease, such as a pituitary tumor, or recent surgery to the pituitary gland, and in patients with disease of the hypothalamus and pituitary stalk
Pituitary Gland Pharmacology Exam: 6 DM patho, 3 glands patho (Andy has 16Q and wants 20Q) *TESTED ON WHOLE ENDOCRINE AXIS. ORDER goes tertiary, secondary, primary. The hypothalamic-pituitary portal system Neurons in the hypothalamus release neurotransmitters and peptides that are carried by the hypothalamic- pituitary portal system to the. The posterior pituitary gland has its blood supply which functions under higher pressure than the anterior pituitary, so it is not usually affected by shock or hypovolemia.  Sheehan syndrome is the clinical manifestation of anterior pituitary cell necrosis and may present as pan-hypopituitarism or as selective loss of pituitary function It is a part of the pituitary gland. Its embryological origin is from the neuroectodermal layer called the infundibulum. The neurohypophysis is divided into two regions; the pars nervosa and the infundibular stalk. Sometimes the pars intermedia and the median eminence are included. Hyponatremia affects 15% of hospitalized patients Pituitary Gland The master gland Located at the base of the brain Influenced by the hypothalamus Directly affects function of other endocrine glands Promotes growth of body tissue Influences water absorption by the kidney Controls sexual development and function 8. Pituitary Gland 9
Care of Patients with Pituitary and Adrenal Gland Problem The pituitary gland sits in the sella and is divided into 2 parts, the anterior and posterior. Hypopituitarism results from the partial or complete loss of 1 or more of 6 hormones made and released by the anterior pituitary gland. Non-tumoral causes constitute a major group of childhood hypopituitarism
The anterior pituitary gland, called the adenohypophysis, secretes the following hormones that target glands and tissues: • Growth hormone (GH), which stimulates growth in tissue and bone. • Thyroid-stimulating hormone (TSH), which acts on the thyroid gland. • Adrenocorticotropic hormone (ACTH), which stimulates the adrenal gland The pituitary gland sits behind the nose at the base of the brain. It is thought of as the command center for the body's endocrine or hormone system. It stimulates the thyroid gland to produce thyroid hormone, the adrenal glands to produce cortisol (or stress hormone), and the gonads to produce sex hormones Nonfunctioning tumors press on or damage the pituitary and prevent it from secreting enough hormones. If there is too little of a particular hormone, the gland or organ it normally controls will not function correctly. Symptoms of nonfunctioning pituitary tumors are 1: Headache; Some loss of vision; Loss of body hai
Adrenal insufficiency is a condition in which the adrenal glands do not produce adequate amounts of steroid hormones, primarily cortisol; but may also include impaired production of aldosterone (a mineralocorticoid), which regulates sodium conservation, potassium secretion, and water retention. Craving for salt or salty foods due to the urinary losses of sodium is common The pituitary gland, or hypophysis, has an anterior and a posterior lobe. The anterior pituitary gland, called the adenohypophysis, Side effects and adverse reactions include hyponatremia, cephalgia, dyspepsia, diarrhea, nausea, and vomiting. Seizures may occur due to hyponatremia. Hypotension and tachycardia can occur due to hypovolemia Study The Posterior Pituitary Gland dysfunction flashcards from Warren Keyser's University of Colorado Denver class online, or in Brainscape's iPhone or Android app. Learn faster with spaced repetition Introduction. The hypothalamus is the region in the ventral brain which coordinates the endocrine system. It receives many signals from various regions of the brain and in return, releases both releasing and inhibiting hormones, which then act on the pituitary gland to direct the functions of the thyroid gland, adrenal glands, and reproductive organs and to influence growth, fluid balance, and. Pituitary Gland. The endocrine system's most influential gland. Under the influence of the hypothalamus, it regulates growth and controls other endocrine glands. Disorder of Increased ADH that results in hyponatremia, and low volumes of concentrated urine. Dysgeusia. Impaired or altered unpleasant taste seen as a symptom of SIADH caused by. the pituitary gland is Rathke's pouch homeobox, (called HESX1), mutations of which have been found in a few cases of septo-optic dysplasia. • Other early transcription factor genes important in the formation of various pituitary cell populations are LHX3, LHX4, and PROP-1 (Prophet of Pit-1), and PIT-1/POUF1