Other transcription factors and hypopituitarism

Pituitary gland commitment from oral ectoderm occurs in response to inductive signals from the neuroepithelium of the ventral diencephalon. Invagination of the oral ectoderm leads to the creation of Rathke's pouch. Intensified cell proliferation within Rathke's pouch results in formation of the anterior pituitary lobe. Subsequently, highly differentiated cell types arise sequentially due to overlapping, but distinct spatial and temporal patterns of signaling molecules and transcription factors. Mutations in some of the pituitary-specific transcription factors have been identified in patients with hypopituitarism (Table 1) confirming the role of these factors in pituitary development. It is likely that many other cases of CPHD defined as "idiopathic" actually have a molecular basis. Thus, any patient with mono-hormonal deficiency of the anterior pituitary gland should be clinically evaluated for multihormonal deficiencies. Although the numbers of patients with mutations in the described pituitary developmental/transcription factors is relatively small at present, the authors believe that any patient with 'idiopathic' anterior pituitary hormone deficiency should be considered a candidate for genetic evaluation.