Krafts: Pituitary Pathology Flashcards

1
Q

What does the anterior pituitary secrete?

A

*everything but ADH and oxytocin

GH
ACTH
TSH
LH
FSH
PRL (under inhibitory control by DA--everything else is under stimulatory control)
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2
Q

What controls the anterior pituitary?

A

Hypothalamus

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3
Q

What hormones do acidophils secrete?

A

GH

PL

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4
Q

What hormones do basophils secrete?

A
BFLAT
FSH
LH
ACTH
TSH
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5
Q

Where are oxytocin and ADH made and stored?

A

Hypothalamus MAKES

Post pit STORES

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6
Q

What does oxytocin do?

A

“the trust-happy-cuddle hormone”

labor
milk let-down
cuddling (after orgasm)
monogamy (vole studies)
trust (investment experiment)
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7
Q

What is hyperpituitarism?

A

Too much of one or ALL anterior pituitary hormones

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8
Q

What is the main cause of hyperpituitarism?

A
  1. PITUITARY ADENOMA*

Others are pretty uncommon:

  1. destruction of end organs–> pit responds by secreting MORE hormone
  2. hypothalamic disorders (rare)-> release to much + hormone
  3. hyperplasia of anterior lobe (rare)
  4. carcinoma of anterior lobe (rare)
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9
Q

A pt presents with occasional endocrine abnormalities as well as some mass effects including: VISUAL DEFICITS, increased ICP and HYPOpituitarism.

Dx?

A

Pituitary adenoma

A pt w/ non-secreting adenoma may present w/ mass effect related to ICP. HYPOpit may also occur if there is a big adenoma that squishes the rest of the pituitary so nothing gets secreted.

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10
Q

What visual deficit is a common finding in a pt with a pituitary adenoma that is non-secreting?

A

Bilateral hemianopsia

Lose vision in the LATERAL FIELDS of both eyes b/c the adenoma that is BIG can grow and press on the MEDIAL portion of the optic nerves which supplies the OUTER part of the eye.

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11
Q

When do you commonly found pituitary adenomas?

A

Fairly common in adults, but usually found on autopsy because they’re subclinical.

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12
Q

What inherited genetic syndrome is pituitary adenoma associated with?

A

MEN I

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13
Q

What is a macroadenoma?

A

bigger than 1 cm in the sella turcica

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14
Q

Are pituitary adenomas invasive?

A

rarely–but can be aggressive and appear invasive

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15
Q

What is one of the dangers of a pituitary adenoma?

A

They can BLEED suddenly. This is an EMERGENCY…b/c blood pours into your head. (hi mortality rate)

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16
Q

How do pituitary adenomas appear microscopically?

A
sheets/cords
Uniform cells of ONE TYPE
May be pleomorphic
May have mitoses
CAN'T tell hormonal type
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17
Q

How do you tell what type of hormone a pituitary adenoma is secreting?

A

Immunohistochemical stain

Binds to anything (like hormones). Brown spots are where hormones are.

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18
Q

What is the MC type of pituitary adenoma?

A

One that makes PRL

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19
Q

What is the LEAST common type of pituitary adenoma?

A

One that makes TSH

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20
Q

What is the MC molecular change seen with a pituitary adenoma?

A

**Mutated GNAS1 gene–> mutation in a G3 protein

21
Q

What is a prolactinoma?

A

The MC type of pituitary adenoma

*many other things can increase PRL (DA antag–> don’t have inhibition of PRL)

22
Q

How do pts w/ prolactinoma present clinically?

A

amenorrhea (F)

galacorrhea (f/m)

23
Q

How do you tx a prolactinoma?

A

DA receptor agonists

24
Q

What causes gigantism and acromegaly?

A

GH Adenoma

25
What is gigantism?
PRE-pubertal adenoma Very TALL Very very long arms, legs *tall but look proportional (before epiphyseal plates close)
26
What is acromegaly?
POST-pubertal adenoma Very tall Enlarged bones of face (coarseness + frontal bossing, dental finding), big hands *after epiphyeal plates close
27
What are other manifestations of GH Adenoma?
Diabetes mellitus Hypertension Arthritis Gastrointestinal carcinoma (Andre the giant)
28
How do you diagnose a GH Adenoma? What is the best way?
Increased GH (spurts, not great) **Increased IGF-I (better, not secreted in pulsatile fashion) GH unresponsive to glucose
29
What diseases are associated with an ACTH Adenoma?
Cushing syndrome Cushing disease Nelson syndrome
30
What syndrome is associated w/ too much cortisol in the blood?
Cushing syndrome
31
What is Cushing disease?
High cortisol caused by an ACTH producing adenoma
32
What is Nelson Syndrome?
Pre-existing pituitary making ACTH. Take out adrenals--> no suppressive effect on pituitary--> it grows bigger.
33
What is hypopituitarism?
too little anterior pituitary hormones
34
What are the 5 causes of hypopituitarism?
1. Pituitary destruction 2. Ischemic necrosis 3. Empty sella syndrome 4. Pituitary apoplexy 5. Hypothalamic lesions
35
What can destroy the pituitary and lead to hypopituitarism?
Big pituitary adenoma (too hard to get just the adenoma and not normal tissue) Surgery or radiation
36
How is a pituitary adenoma removed?
endoscope is placed in the nose> enter through sphenoid sinus> remove pituitary
37
What is the MC cause of ischemic necrosis that leads to HYPOpituitarism? Other causes?
Pituitary gets BIG (prego) but blood flow stays same Hemorrhage (delivery) causes hypotension> drains away from pituitary> necrosis Pituitary (already hypoxic) becomes necrotic
38
What is empty sella syndrome?
Usually found incidentally and you see that there is NO pituitary gland. Arachnoid, CSF herniation> Pituitary compression> appears empty Usually NO hypopituitarism--pt still has enough pituitary left to make hormones at a normal rate
39
What is pituitary apoplexy (to strike down--act like they've had a stroke)?
Adenoma suddenly starts to bleed> Sudden infarction of adenoma> Meningeal symptoms Can be deadly
40
What causes hypothalamic lesions?
tumors and infections SUPER rare
41
What clinical findings are associated w/ hypopituitarism?
Slow onset, chronic> drop in 1/2 hormones> end organs don't work
42
What is the first hormone to disappear in a pt with hypopituitarism?
GH FSH/LH TSH ACTH *dont need to know for krafts
43
Decreased GH
pituitary dwarfism | muscle weaknes
44
Decreased FSH/LH
loss of libido | menstrual abnormalities
45
Decreased PRL
inability to lactate
46
Decreased TSH/ACTH?
hypothyroidism | adrenal insufficiency
47
What is Diabetes Insipidus?
``` Heat trauma/tumor/alcohol consumption> don't have enough ADH> dilutes urine> serum osmolality increases> increase water intake ```
48
What is the difference between central and nephrogenic diabetes insipidus?
Central- don't make enough ADH Mephrogenic- kidney doesn't respond
49
What is SIADH secretion?
``` Increase ADH> concentrate urine> retain water> blood becomes hypotonic> decreased water intake ``` *usually mild, sometimes bad (brain affected)