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Renal and Endocrine > 2.5.1 Hypothalamus-Pituitary Pathology > Flashcards

2.5.1 Hypothalamus-Pituitary Pathology Flashcards

1
Q

Where do these three histological images come from within the pituitary?

A

Top: Anterior (glandular)

Middle: Intermediate zone - Cleft

Bottom: Posterior (neural tissue)

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2
Q

What is pituitary apoplexy?

A

Sudden enlargement of adenoma due to hemorrhage/infarction

Leads to emergency decompression of optic system

Usually from a nonfunctional adenoma

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3
Q

What are some of the inherited genes linked to adenomas?

A

MEN1, CDKN1B, PRKAR1A, AIP

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4
Q

Identify the three cell types in the anterior pituitary.

A

Circle: acidophil; Square: basophils; Thick oval: chromophobes

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5
Q

What is used to differentiate b/t different cell types found in the anterior pituitary?

A

Hormonal evaluation (IHC)

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6
Q

If Sean could start a farm with only one type of animal, what type of animal would he choose?

A

Goat. There is nothing Sean likes more in this world than a nice warm glass of goat milk before bed.

Disclaimer: This may or may not be accurrate, but he seems pretty darn happy with this goat.

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7
Q

Wat dis b?

A

Craniopharyngioma

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8
Q

What occurs as a result of optic nerve compression?

A

Bitemporal hemianopia (lateral field defects)

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9
Q

Why does the diagram help us understand the visual deficits found in bitemporal hemianopia?

A

This image shows the nasal side of retinal optic neurons have axons that pass accross the optic chiasm. When these are compressed, the retinal neurons on the nasal side are damaged leading to poor lateral vision.

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10
Q

What is the #1 pediatric sellar tumor?

A

Craniopharyngioma (Rathke’s pouche remnant)

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11
Q

Name 4 mutations that are associated with “aggressive” adenomas.

A

Cyc D1 overexpression

TP53 mutation

RB

HRAS (pituitary carcinomas)

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12
Q

Which lobe of the pituitary? Identify two structures in this image. What is the arrow pointing at?

A

Posterior lobe

2 structures: Glia (pituicytes) and axons from hypothalmus

Arrow: Herring body

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13
Q

What is another name for corticotroph adenoma? What hormone is excessively expressed?

A

Cushing’s dz; excess ACTH

More common in women (5:1)

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14
Q

What are some consequences of prolactinemia?

A

Amenorrhea, galactorrhea, loss of libido, infertility

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15
Q

What are the three main types of adenomas?

A

Prolactinoma (30%)

Growth hormone adenoma (10-20%)

Corticotroph cell adenoma (Cushing’s dz)

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16
Q

Type of stain? What does it bring out? Which side is tumor tissue?

A

Reticulin stain

Stains the connective tissue

The left side is tumorous and devoid of connective tissue

17
Q

What are the two structures covered in blue?

A

Optic Chiasm

Pituitary Gland

18
Q

What are the 2 arrows pointing at? These are present in what condition?

A

Top: Kidney-shaped nuclei

Bottom: Birbeck granules

Langerhans’ Cell Histiocytosis

19
Q

This is an example of what optic change?

A

Bitemporal hemianopia

20
Q

What is required in the demonstration of pituitary carcinomas?

A

Distant metastases

21
Q

What are some of the symptoms associated with craniopharyngioma?

A

Headache, visual loss, hormonal deficits

22
Q

Name some of the patholgoic lesions involving the sella turcica and pituitary gland.

A

Pituitary adenoma, pituitary carcinoma, craniopharyngioma, inflammatory lesions, metastases, tumor-like lesions, developmental cysts

23
Q

What is the standard route to the pituitary gland during surgery?

A

Through the mouth or nasal cavity

24
Q

Identify these structures

A
25
Q

What are the possible presentations of pituitary GH adenoma in adults? Children?

A

Adults: acromegaly

Children: Gigantism

26
Q

Describe the microscopic pathology

A

Sheets of monotonous cells

Uniform staining

Sparse intervening connective tissue

Pituitary adenoma

27
Q

What percentage of intracranial neoplasms are pituitary adenomas? When in life do they often occur?

A

10%

Age: 30-50s

28
Q

What is a common alteration in pituitary adenomas?

A

G-protein mutations

29
Q

Who is most readily diagnosed with prolactinoma?

A

20-40 y/o women

30
Q

These non-cancerous lesions can compress or destroy the pituitary gland and adjacent structures. Comprised of ciliated cuboidal epithelium.

A

Rathke cleft cyst

31
Q

What are some of the findings in pituitary adenomas?

A

Endocrine excess/deficit

Mass effects

Increased intracranial pressure

Ischemic injury

Hypopituitarism

Optic nerve compression

32
Q

What type of lesion is Langerhans’ cell histiocytosis?

A

Inflammatory, reactive lesion

Renal and Endocrine (46 decks)

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