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Endo/Repro: Week 1 > Krafts: Pituitary Pathology > Flashcards

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
Q

What is gigantism?

A

PRE-pubertal adenoma
Very TALL
Very very long arms, legs

*tall but look proportional (before epiphyseal plates close)

26
Q

What is acromegaly?

A

POST-pubertal adenoma
Very tall
Enlarged bones of face (coarseness + frontal bossing, dental finding), big hands

*after epiphyeal plates close

27
Q

What are other manifestations of GH Adenoma?

A

Diabetes mellitus
Hypertension

Arthritis

Gastrointestinal carcinoma (Andre the giant)

28
Q

How do you diagnose a GH Adenoma? What is the best way?

A

Increased GH (spurts, not great)

**Increased IGF-I (better, not secreted in pulsatile fashion)

GH unresponsive to glucose

29
Q

What diseases are associated with an ACTH Adenoma?

A

Cushing syndrome
Cushing disease
Nelson syndrome

30
Q

What syndrome is associated w/ too much cortisol in the blood?

A

Cushing syndrome

31
Q

What is Cushing disease?

A

High cortisol caused by an ACTH producing adenoma

32
Q

What is Nelson Syndrome?

A

Pre-existing pituitary making ACTH.

Take out adrenals–> no suppressive effect on pituitary–> it grows bigger.

33
Q

What is hypopituitarism?

A

too little anterior pituitary hormones

34
Q

What are the 5 causes of hypopituitarism?

A
  1. Pituitary destruction
  2. Ischemic necrosis
  3. Empty sella syndrome
  4. Pituitary apoplexy
  5. Hypothalamic lesions
35
Q

What can destroy the pituitary and lead to hypopituitarism?

A

Big pituitary adenoma (too hard to get just the adenoma and not normal tissue)

Surgery or radiation

36
Q

How is a pituitary adenoma removed?

A

endoscope is placed in the nose>
enter through sphenoid sinus>
remove pituitary

37
Q

What is the MC cause of ischemic necrosis that leads to HYPOpituitarism? Other causes?

A

Pituitary gets BIG (prego) but blood flow stays same

Hemorrhage (delivery) causes hypotension> drains away from pituitary> necrosis

Pituitary (already hypoxic) becomes necrotic

38
Q

What is empty sella syndrome?

A

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
Q

What is pituitary apoplexy (to strike down–act like they’ve had a stroke)?

A

Adenoma suddenly starts to bleed>
Sudden infarction of adenoma>
Meningeal symptoms
Can be deadly

40
Q

What causes hypothalamic lesions?

A

tumors and infections

SUPER rare

41
Q

What clinical findings are associated w/ hypopituitarism?

A

Slow onset, chronic>
drop in 1/2 hormones>
end organs don’t work

42
Q

What is the first hormone to disappear in a pt with hypopituitarism?

A

GH
FSH/LH
TSH
ACTH

*dont need to know for krafts

43
Q

Decreased GH

A

pituitary dwarfism

muscle weaknes

44
Q

Decreased FSH/LH

A

loss of libido

menstrual abnormalities

45
Q

Decreased PRL

A

inability to lactate

46
Q

Decreased TSH/ACTH?

A

hypothyroidism

adrenal insufficiency

47
Q

What is Diabetes Insipidus?

A 
Heat trauma/tumor/alcohol consumption>
don't have enough ADH>
dilutes urine>
serum osmolality increases>
increase water intake
48
Q

What is the difference between central and nephrogenic diabetes insipidus?

A

Central- don’t make enough ADH

Mephrogenic- kidney doesn’t respond

49
Q

What is SIADH secretion?

A 
Increase ADH>
concentrate urine>
retain water>
blood becomes hypotonic>
decreased water intake

*usually mild, sometimes bad (brain affected)

Endo/Repro: Week 1 (10 decks)

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