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Located at the base of the brain, the pituitary gland is protected by a bony structure called the sella turcica(also known as turkish saddle)of the sphenoid bone. The pituitary gland, or hypophysis, is an endocrine gland about the size of a pea that sits in a small, bony cavity (sella turcica) covered by a dural fold (diaphragma sellae) at the base of the brain.
The pituitary gland secretes hormones regulating homeostasis, including trophic hormones that stimulate other endocrine glands. The hypophysis is also the top cell of the suspensor in a dicot embryo, which will differentiate to form part of the root cap. Located at the base of the brain, the pituitary is functionally linked to the hypothalamus. The anterior lobe is derived from the oral ectoderm and is composed of glandular epithelium.
The anterior pituitary synthesizes and secretes important endocrine hormones, such as ACTH, TSH, prolactin, growth hormone, endorphins, FSH, and LH. The posterior lobe is connected to the hypothalamus via the infundibulum or pituitary stalk, giving rise to the tuberoinfundibular pathway.
We have studied the combined use of two procedures, i.e, L-Dopa stimulation and exercise stimula­tion as provocative tests of hGH release in establishing the diagnosis of hGH deficiency in 30 short statured children.
When a child falls repeatedly below the third percentile of height standard in relation to its age, his growth may be considered to be abnormal.
The growth hormone content of human serum may be measured by bioassay, radiore­ceptor assay, or radioimmunoassay (RIA). A large number of stimulatory tests have been employed to aid in the assessment of pos­sible hGH deficiency in the short statured (Table 1).For our study, we selected the L-Dopa Stimulation and the exercise stimulation tests, from among the range of established stiniulatory tests, on account of their ease of performance, simplicity, reliability and lack of necessity of continuous medical surveillance.
This study was aimed at evaluating, in routine outpatient clinic environment the role of the above tests in investigating hGH deficiency in short statured children.
The patients were exercised maximally on a tread­mill at a speed and gradient varying with their physical size and condition and blood samples obtained at the end of the exercise period.
Dac-Cel-hGH-MCA by Weilcome, an inimunora­diometric assay kit utilising antibody to human growth hormone was used to quantify serum hGH. The kit utilises the two-site immunoradio­metric assay(sandwich) principle in which two different antibodies, combining with distinct antigenic determinants on the growth hormone molecule, are used2. Based on th results of the stimulation tests for hGH, the patients were divided into 3 groups.
40% (n12) of the patients tested showed a normal response to at least one provocative test.
17% (n=5) of the patients tested with L-Dopa failed to respond to this stimulus, but showed a normal response to other provocative tests.
Impairment of hGH secretion either due to abnormal function or destruction of somato­trophic cells of the anterior pituitary, or due to lack of hypothalamic stimulation in childhood leads to the impaired growth called pituitary dwarfism. The characteristic secretory pattern of hGH is one of low basal levels with secretory episodes associated with sleep, exercise, stress, and high protein meals3. L-Dopa, a precursor of catecholamines, induces a significant rise in the peripheral hGH levels and is thought to act via its conversion to dopamine and the subsequent perturbation of the hypothalamic catecholamine4s. Our results of the three provocative tests show that the mean response to L-Dopa in the non-deficient and partially deficient patients is higher than that obtained with the other two procedures, and that the mean percentage rise over the basal value by L-Dopa is also greater in these patients.


None of the three stimulation tests in this study produced a positive response in 17-33% of the hGH non-deficient patients (see table II).
The number of patients on whom cold pressor test was performed is as yet too small to merit definite conclusions but the initial results appear promising.
This journal is a member of and subscribes to the principles of the Committee on Publication Ethics. ABCD sponsors treatment for those in need regardless of gender, race or creed, helping them to reach their full potential, to live life with dignity and to take their rightful place in their community. ABCD works through local Palestinian partners, the Bethlehem Arab Society for Rehabilitation (BASR) based in Beit Jala, The Sheepfold in Beit Sahour and two UNWRA Refugee Camps in Jalazone and Nour Shams. Funding is constantly needed for new projects and to update and refurbish existing facilities. You can afford to be a little sloppier on precontest dieting since it will still burn fat when you are taking in a lot of calories since your metabolism is going haywire. The anterior pituitary is functionally linked to the hypothalamus via the hypophysial-portal vascular connection in the pituitary stalk. These hormones are released from the anterior pituitary under the influence of hypothalamic hormones. For example, uterine contractions stimulate the release of oxytocin from the posterior pituitary, which in turn increases uterine contractions. This combination was found to be a simple, reliable and practical regimen for routine use as an outdoor diagnostic procedure. Children wjth growth failure and dwarfism without a clearly defmed abnormality should be studied for hGH deficiency. Furthermore,we report our initial experience with the “Cold pressor test”, a new test for hGH stimulation. Serum samples for the estimation of basal resting hGH levels were obtained from all patients in the morning after an overnight fast. Similarly, 20% (n=5) of the exercise test results also showed a failure to respond, as did 33% of those subjected to cold pressor test.
The manner in which exercise stimulates hGH release is not known, although it has been observed that for a reliable response the subject should be exercised to exhaustion.
The results of the exercise stimula­tion in the partially hGH deficient patients were not satisfactory in that 50% of these patients failed to respond adequately to the stimulus (see figure). In a comparative study of 5 provocative test procedures conducted in normal volunteers to ascertain the relative effectiveness of each stimulus, Eddy et al found that the most consistent stimulus for producing a positive hGH response was L-Dopa (95%), followed by insulin (90%), arginine (80%), vasopressin (60%), and glucagon (55%). Although insulin-induced hypoglycaemia has been regarded as the standard hGH stimulation test, the incidence and severity of side effects and the need for constant medical survefflance often curtail its usefulness.
It evoked a higher response than L-Dopa in S out of 9 patients who under­went both tests, and also a greater response than to exercise in 3 out of 4 patients subjected to both exercise and cold stimulation.
Please mail us [2] to indicate your interest in serving either as an Editor-In-Chief of the entire topic or as an Associate Editor-In-Chief for a subtopic. The adenohypophysis, also referred to as the anterior pituitary is divided into anatomical regions known as the pars tuberalis and pars distalis. Through this vascular connection the hypothalamus integrates stimulatory and inhibitory central and peripheral signals to the five phenotypically distinct pituitary cell types.


The hypothalamic hormones travel to the anterior lobe by way of a special capillary system, called the hypothalamic-hypophyseal portal system. In adult humans it is just a thin layer of cells between the anterior and posterior pituitary. Our initial experience with the “Cold pressor test”, a new test of hGH stimulation is also reported (JPMA 37:256 ,1987).
Prior to the introduction of RIA techniques for measuring hGH levels in plasma, the definite diagnosis of pituitary dwarfism presented great difficulties. Thus the estimation of plasma hGH appears to have a decisive role to play in establishing the diagnosis of pituitary dwarfism. These results agree with the reports in the literature and confirm that failure to responc to one stimulus does not necessarily imply a lack of responsiveness to another, nor does it unequivocally establish the diagnosis of hypopi­tuitarism. L-Dopa has proved to be a safe and reliable stimulus of hGH release, with few side effects, and the additional use of exercise testing has effectively reduced false interpretation. The intermediate lobe produces melanocyte-stimulating hormone (MSH), although this function is often (imprecisely) attributed to the anterior pituitary.
The use of RIA for the measurement of hGH levels in the serum has brought about major impact on physiological studies and clinical practice. L—Dopa stimulation test was performed in 29 patients, exercise stimulation in 25 patients and 10 patients were subjected to the “Cold pressor” stimulation test. The labelled antibody-hGH-second anti­body complex is then separated from free labelled antibody using an anti-rabbit serum covalently coupled to cellulose. These results indicate that this simple, safe, and less time consuming test may be valuable in discriminating patients with hGH deficiency from the non-deficient patients. In most normal subjects, the basal secretion of hGH is low and it is not possible to differentiate with confidence the normal from hypopituitarism by a single determination of plasma hGH.
26 children received a combination of two provocative tests and 4 children underwent all three provocative procedures.
After solid-phase separation of this “sandwich”, the distribution of radioac tivity is determined.
This means that one in four of the normal subjects will have partial hGH deficiency on the basis of one test. The amount of radioactivity increases proportionately with the concentration of hGH in the sample, which is determined by reference to a standard curve set up at the same time. The labelled antibody to hGH is of mono­clonal origin conferring high specificity on the assay . This product is an excellent fat burner since your metabolism is greatly increased while being on it.
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