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The posterior pituitary is not glandular as is the anterior pituitary. Instead, it is largely a collection of axonal projections from the hypothalamus that terminate behind the anterior pituitary, and serve as a site for the secretion of neurohypophysial hormones ( oxytocin and vasopressin ) directly into the blood. [ 2 ]
The anterior pituitary is more commonly affected in Sheehan's syndrome because of the structure of the portal venous system. Posterior pituitary involvement leading to central diabetes insipidus is much rarer, and typically reflects more extensive damage to the organ and more severe disease. [13]
Hypophysitis, inflammation of the pituitary gland. Autoimmune hypophysitis (or lymphocytic hypophysitis), inflammation of the pituitary gland due to autoimmunity. Nelson's syndrome, may occur after surgical removal of both adrenal glands, an out-dated method of treating Cushing's disease. Pituitary tumour, a tumor of the pituitary gland.
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.
[17] [18] Pituitary stalk and posterior pituitary lymphocytic inflammation is a hallmark of the autoimmune process. [19] Lymphocytic infundibuloneurohypophysitis (LINH) is the name of the disease process that most likely explains autoimmune cases of central diabetes insipidus. [20]
Autoimmune hypophysitis can lead to deficiencies in one or more pituitary hormones, causing central diabetes insipidus if the posterior pituitary gland is affected as well as central adrenal insufficiency and central hypothyroidism if the anterior pituitary gland is affected. [1] The symptoms depend on what part of the pituitary is affected.
Central nervous system (CNS) disorders or conditions may cause SIADH in 9% of cases, this includes subarachnoid hemorrhage (56% of CNS causes), pituitary surgery (35% of CNS causes), brain cancer, infections, stroke and head trauma. [2] No cause of inappropriate antidiuresis is initially found in 17–60% of cases. [2]
Pituitary stalk interruption syndrome (PSIS) is a congenital disorder characterised by the triad of an absent or exceedingly thin pituitary stalk, an ectopic or absent posterior pituitary and/or absent or hypoplastic anterior pituitary. [1] [2]