The Neuroanatomy of Reproduction: Seeing Is Believing

Abstract

The pituitary gland controls important body functions and the hormonal system. It is a protrusion at the base of the brain and similar in size to a pea, which is why it is also called "hypophysis" (which is Greek for "growth attached below"). It sits in the sella turcica of the sphenoid bone, immediately behind and superior to the sphenoid sinus. The pituitary gland is sometimes called the "master endocrine gland" because it secretes hormones that directly affect the way many parts of the body work. It also modulates secretion of hormones made by many other glands in the body and ultimately contributes to the control of the involuntary nervous system, which manages the balance of energy, heat, and water in the body. It is through the hormonal action of the pituitary that the brain acts as the central modulator of reproductive function and the menstrual cycle. Reproductive endocrinologists frequently care for patients with imbalances in these hormones, in conditions such as hyperprolactinemia, anovulation, and hypothalamic amenorrhea. It is through the pituitary that the brain acts as the central controller of reproduction and the menstrual cycle. In the early 20th century, researchers such as Crowe and Aschner made several pioneering discoveries demonstrating the connection of the pituitary gland to gonadal function. 1 Over the next 40 years, gonadotropin-releasing hormone (GnRH), follicle-stimulating hormone (FSH), and luteinizing hormone (LH) were discovered; eventually purified; and are now mass produced for the treatment of a variety of endocrine disorders. Reproductive endocrinologists frequently care for patients with disturbances in reproduction as a result of pituitary pathology and manipulate the balance of pituitary hormones to restore or enhance fertility to patients.Schioffer of Vienna successfully performed the first transsphenoidal pituitary tumor resection in 1907. Surgical approaches to the pituitary were later refined by the likes of Harvey Cushing and other neurosurgeons and eventually made increasingly safe, accurate, and less invasive through technological advancements such as the surgical microscope, endoscope, and eventually MRI and CT-based surgical guidance. Of note is the fact that nearly half a century ago, it would be a rarity to see a patient's pituitary function preserved following the removal of a pituitary tumor. Not only was increased treatment success achieved through the technological developments described earlier, it was also achieved through the intricate study of the skull base, cranial nerves, and pituitary structure and blood supply by dedicated neurosurgeons throughout the world. Even drugs, such as the dopamine agonists, bromocriptine and cabergoline, AbstractThe brain is the central controller of reproduction and the menstrual cycle. Reproductive endocrinologists spend their days treating patients with perturbations in reproduction as a result of pituitary diseases and manipulate pituitary hormones to enhance fertility and quality of life. Microscopic neuroanatomical ima...