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Robbins Pathology- Endocrine (Chapter 24) > Chapter 24- Pituitary > Flashcards

Chapter 24- Pituitary Flashcards

1
Q

What are the specific symptoms commonly seen with a mass effect of pituitary lesions

A
  • Bilateral temporal hemianopsia (compression of the nasal portion of the optic chiasm)
  • Pituitary apoplexy (hemorrhage into adenoma)
  • Underproduction of pituitary hormones
  • Hyperprolactinemia
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2
Q

Which cells can be intermixed with somatotroph adenomas

A

Prolactin secreting cells

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3
Q

What are the treatments for a corticotroph adenoma

A

Somatostatin or dopamine agonists

*Express dopamine and somatostatin receptors

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4
Q

What is the released from the hypothalamus onto the pituitary for the release of TSH

A

Thyroid releasing hormone (TRH)

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5
Q

USP8 mutations are most commonly seen in which pituitary adenomas

A

Sporadic Corticotroph adenomas

*Results in EGFR up regulations

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6
Q

What is the released from the hypothalamus onto the pituitary for the release of prolactin

A

Dopamine

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7
Q

What are the causes for Cushing syndrome if there is high ACTH

A

ACTH dependent:

  • Pituitary tumor (Cushing Disease)
  • Ectopic ACTH producing tumor
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8
Q

How does the posterior pituitary receive regulatory hormones

A

Direct stimulation and release from the hypothalamus

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9
Q

How does a nonfunctioning pituitary adenoma usually get found

A

Mass effect

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10
Q

What are the hormones released from the posterior pituitary

A

ADH and oxytocin

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11
Q

What is the result of the hypothalamus releasing GHRH

A

Increased GH released

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12
Q

What is the result of a craniopharyngioma in kids 5-15 years of age

A

Adamatntinomatous craniopharyngiomas, which is hardening of the bone there
-Results in Growth retardation from hypopharnygiomas

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13
Q

What are the characteristics of pituitary carcinomas

A
  • Very rare

- Metastasized to brain

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14
Q

What are the complications seen with a Rathke’s cleft cyst

A
  • Hypopituitarism

- Rupture leading to inflammation of meninges and pituitary

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15
Q

What are the conditions that can cause hyperprolactinemia

A
  • Pregnancy
  • nipple/lactation stimulation
  • Loss of dopamine
  • Mass lesion
  • Renal failure (decreased production and decreased clearance of PRL)
  • Hypothyroidism (increased TSH can stimulate PRL)
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16
Q

How does the anterior pituitary receive input via regulatory hormones

A

-Released from the hypothalamus into the hypophyseal portal system to reach that anterior pituitary

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17
Q

What is the most common cause of cushing syndome

A

Glucocorticoids

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18
Q

What is the tissue origin of the anterior pituitary

A

Oral ectoderm

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19
Q

What is the most common secretory pituitary adenoma

A

Lactotroph adenoma (aka prolactinoma)

*30%

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20
Q

What is the released from the hypothalamus onto the pituitary for the release of FSH

A

Gonadotropin releasing hormone

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21
Q

What are the general symptoms of mass effect of pituitary lesions

A 
Result of increased intracranial pressure:
Headache
Confusion 
Shallow breathing 
Nausea
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22
Q

What is the method used to establish a diagnosis of somatotroph adenoma

A

1) Serum levels of IGF-1 are measured looking for elevations

2) If IGF-1 is elevated, then perform a oral glucose tolerance test. If remains elevated, then positive

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23
Q

What conditions are caused by somatotroph adenoma

A

Gigantism and acromegaly

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24
Q

What is cushing’s disease

A

Caused by excess pituitary ACTH

*usually a corticotroph adenoma

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25
Q

What is empty sell syndrome

A

Hypopituitarism condition:

-CSF builds up and compresses the pituitary

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26
Q

What is the common neoplasm causing cushing syndrome

A

Small cell carcinoma of the lung

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27
Q

What are the findings in lactotroph adenomas as they progress

A
  • Stromal hyalinization with psommoma bodies

- Dense calcification in the form of a pituitary stone

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28
Q

What is the released from the hypothalamus onto the pituitary for the release of growth hormone

A

Growth hormone releasing hormone

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29
Q

What is the histological finding in the anterior lobe

A

Glands, so forms adenohypophysis

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30
Q

What is the result of the hypothalamus releasing TRH

A

Increased TSH release

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31
Q

What is the released from the hypothalamus onto the pituitary for the release of ACTH

A

Corticotroph releasing hormone (CRH)

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32
Q

What is the negative regulator for TSH release on both the hypothalamus and pituitary

A

T3/T4

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33
Q

What is the hormone released with somatotroph adenomas

A

Growth hormones

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34
Q

What is Cushing syndrome

A
  • Central obesity
  • Diabetes
  • Hirsutism (hair on face/cheeks)
  • Adrenal hyperplasia

*All stemming from hypercortisolism

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35
Q

What is the typical presentation of lactotroph adenomas (prolactinoma) in women

A
  • Menstral irregulations and amenorrhea
  • Galactorrhea
  • Diminished libido
  • Infertility
  • Mass effect
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36
Q

What type of cell releases growth hormone

A

Somatotroph

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37
Q

What is the result of the hypothalamus releasing somatostatin

A

Inhibition on GH

38
Q

What is the primary cause if empty sella syndome

A

Diaphragma seller does not form, allowing CSF to leak in and compress the pituitary

  • Most commonly seen in obese women with a history of multiple pregnancies
39
Q

The posterior pituitary is from what tissue origin

A

Brain, so neuroectoderm

40
Q

What classification of lactotroph adenomas are most common

A

Sparsely granulated

41
Q

What is the relative lifespan of a patient with acromegaly and what is the cause

A

Shortened lifespan, usually due to cardiovascular complications

42
Q

What is the significance of receptors expressed by corticotroph adenomas with regards to treatment

A

-Dopamine and somatostatin receptors are expressed, so analogs can be used in treatment as they inhibit ACTH production

43
Q

How are gonadotropin adenomas normally found

A

Mass effect and are typically silent adenomas

44
Q

What is a craniopharyngioma

A

Tumor leading to hypopituitarism

45
Q

Why is the anterior pituitary susceptible in the cause of Sheehan syndome

A

Mostly dependant on venous blood supply, so sensitive to compression

46
Q

What type of cell releases prolactin

A

Lactotroph

47
Q

What is the negative regulator on only the hypothalamus with release of ACTH

A

CRH

48
Q

What is the purpose of a dexamethasone suppression test

A

High lively os dexamethasone sed in the case of ACTH dependent Cushing syndrome:

  • Pituitary tumor will decreased ACTH production slightly during test (retains some negative feedback loop)
  • Ectopic ACTH tumor will not change ACTH production (such as in small cell carcinoma)
49
Q

What is the result of a craniopharyngioma in adults >65 years of age

A
  • Papillary craniopharyngioma

- Causes increased incracranial pressure and hypopituitarism

50
Q

What si the histological finding of a Rathke’s cleft cyst

A

-Ciliated, as it is derived from the oropharynx

51
Q

What is the imaging done for an ACTH independent Cushing syndrome

A

Abdominal CAT scan/MRI

52
Q

How does a hyperfunctioning adenoma usually get found

A

Hormone excess

53
Q

What are the histological components of craniopharyngiomas

A
  • Derived from Rathke’s pouch
  • Squamous epithelium
  • “wet” keratin
  • Calcified cysts
54
Q

Which drugs can cause hyperprolactinemia and what is the mechanism

A

Blocks dopamine release:

  • Antiphyschotics,
  • antidepressants
  • Verapamil
  • Metoclopramide
55
Q

What type of cell releases TSH

A

Thyrotroph

56
Q

What is the product being released during a corticotroph adenoma

A

ACTH and subsequent cortisol release

57
Q

What is Rathke’s cleft cyst

A

Hypopituitarism condition :

-Cystic mass derived from Rathke’s pouch expands and compresses the pituitary

58
Q

What is the purpose and mechanism of an oral glucose test

A

used to test for somatotroph adenomas:

  • Oral glucose causes increased somatostatin levels
  • Somatostatins inhibit the release of GH and subsequent IGF-1
59
Q

What is the result of the hypothalamus releasing CRH

A

Increased ACTH release

60
Q

How will Sheehan syndome usually present

A

Lack of lactation

61
Q

What is the presentation of lactotroph adenoma (prolactinoma) in males

A

Decreased libido
Decreased sperm count
Mass effect*

*Most common findings since the other effects are not usually enough to be seen

62
Q

What are the systemic conditions that can cause hyperprolactinemia

A
  • Renal failure

- Hypothyroidism

63
Q

What is the treatment of prolactin pituitary adenomas

A

Dopamine Agonists

64
Q

What is occurring in secondary empty sella syndrome

A

Pituitary expands and infarcts within the sella, leaving and empty space for the CSF to build up and compress the pituitary

65
Q

What is the blood serum state in the cause of SIADH

A

Hyponatremia due to water retention

66
Q

What is the mechanism that mutations in GNAS results in pituitary adenomas

A

Mutation allows the alpha subunit to lose its GTPase activity , so GTP remains bound and cAMP derived proliferation occurs

67
Q

What is the released from the hypothalamus onto the pituitary for the release of LH

A

Gonadotropin releasing hormone

68
Q

What are the causes for Cushing syndrome if there is low ACTH

A

Adrenal caused Cushing Syndrome (ACTH independent):

  • Adrenal adenoma or carcinoma
  • Bilateral adrenal hyperplasia
69
Q

GNAS mutations are most commonly seen in which pituitary adenomas

A

Somatic somatotroph adenomas

70
Q

What is Nelson syndrome

A

Occurs when the adrenal glands are removed or missing:

  • Increased ACTH levels to try to elevate cortisol levels
  • As a result of elevated ACTH, skin pigmentation will increase, as well symptoms similar to pituitary tumor due to hyperplasia (such as visual defects)
71
Q

What is the structure formed from Rathke’s pouch

A

Anterior pituitary

72
Q

What are the characteristics of aggressive pituitary adenomas

A
  • Poorly circumscribed
  • Can invade the brain
  • More likely in larger adenomas
73
Q

What is a cause of SIADH

A
  • Small cell carcinoma of the lung
  • Traumatic brain injury/subarachnoid hemorrhage
  • Drugs (SSRIs)
74
Q

What is the negative regulator for LH release on both the hypothalamus and pituitary

A

Testosterone
Inhibin
Estradiol
Progesterone

75
Q

What type of cell releases LH

A

Gonadotropin

76
Q

What is the most common cause of hyperpituitism

A

Adenoma of the anterior lobe

77
Q

What is the result of the hypothalamus releasing GnRH

A

FSH

LH

78
Q

AIP is most commonly seen in which pituitary adenomas

A

Familial somatotroph adenomas aka familial gigantism

79
Q

What is the negative regulator for ACTH release on both the hypothalamus and pituitary

A

Cortisol

80
Q

What is the imaging done for ACTH dependent caused Cushing syndrome

A

MRI of brain

Petrosky sinus sampling

81
Q

What is the result of the hypothalamus releasing dopamine

A

Inhibition of prolactin

82
Q

What type of cell releases ACTH

A

Corticotroph

83
Q

What is the treatment for somatotroph adenomas

A

Somatostatin agonist inhibits GH release

84
Q

What is Sheehan syndrome

A

Hypopituitarism condition:
-Post partum necrosis of the anterior pituitary (pregnancy causes enlargement of pituitary gland, so much that in some cases can cause necrosis)

85
Q

What is the negative regulator for GH release on both the hypothalamus and pituitary

A

IGF

86
Q

What are the histological characteristics of a somatotroph adenomas

A

-Diffuse growth and made with using a GH immunostain

87
Q

What determines if a patient with somatotroph adenomas will develop gigantism or acromegaly

A

Depends on whether the growth plates have sealed or not.

  • Gigantism: growth plates have not sealed and long bones grow
  • Acromegaly: growth plates have sealed and features become more course
88
Q

What is the histological findings of the posterior lobe

A

Neuro tissue

89
Q

What are the physical features of acromegaly

A
  • Enlarged face and hands
  • Protruding jaw
  • Enlarged nose
  • Thickened lips
  • Joint point
  • Enlarged viscera
90
Q

What are the characteristics of pituitary adenomas

A
  • Well circumscribed
  • Can erode bone
  • Can bleed
91
Q

What type of cell releases FSH

A

Gonadotroph

92
Q

What is the purpose of a corticotroph releasing hormone (CRH) stimulation test

A

Used in the cause ACTH dependent cushing syndome:

  • Corticotroph adenomas will remain responsive to CRH and increase ACTH production
  • Ectopic will not be responsible to CRH

Robbins Pathology- Endocrine (Chapter 24) (5 decks)

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