Pathology of Pituitary & Adrenal Glands

Question 1

True/False. Pituitary macroadenomas may compress the optic chiasm, leading to bilateral hemianopsia.

Answer 1

True

Question 2

What hormone is secreted due to a somatotrophic pituitary adenoma?

Answer 2

Growth Hormone

Question 3

What hormone is released due to a gonadotrophic pituitary adenoma?

Answer 3

FSH & LH

Question 4

What is the most common pituitary adenoma?

Answer 4

Prolactinoma

Question 5

What hormone is secreted by a lactotroph adenoma?

Answer 5

Prolactin (aka prolactinoma)

Question 6

This type of adenoma presents histologically with calcification, psammoma bodies, and amyloid deposition

Answer 6

Prolactinoma

Question 7

In what population are prolactinomas most common?

Answer 7

Women 20-40yo

Question 8

With what type of adenoma are gigantism and acromegaly associated?

Answer 8

Somatotroph adenoma (growth hormone adenoma)

Question 9

What is the clinical manifestation of a corticotroph adenoma?

Answer 9

Cushing disease due to hypersecretion of cortisol

Question 10

These adenomas are most associated with mass effects and pituitary apoplexy.

Answer 10

Gonadotroph & thryotroph adenomas

Question 11

True/False. IGF-1 levels are low in patients with a somatotroph adenoma.

Answer 11

False - levels are high and necessary for diagnosis

Question 12

True/False. Corticotroph adenomas may present with skin hyperpigmentation.

Answer 12

True - ACTH stimulates melanocytes

Question 13

This disorder is characterized by postpartum necrosis of the anterior pituitary due to obstetric hemorrhage.

Answer 13

Sheehan Syndrome.

Note, the posterior pituitary is unaffected

Question 14

What is generally the first symptom of Sheehan Syndrome?

Answer 14

Agalactorrhea

Question 15

This disorder is caused by arachnoid herniation that compresses the pituitary gland.

Answer 15

Empty sella syndrome

Question 16

This disorder is caused by a deficiency of ADH.

Answer 16

Central diabetes insipidus

Question 17

What is the difference between central and peripheral diabetes insipidus?

Answer 17

Central - ADH deficiency

Peripheral - ADH resistance

Question 18

What electrolyte abnormality is associated with SIADH?

Answer 18

Hyponatremia - water retention causes dilution of plasma and decreased osmolality

Question 19

From where do craniopharyngiomas arise?

Answer 19

Rathke pouch

Question 20

This type of suprasellar tumor is most common in childhood and late adulthood. Histology shows calcifications and cysts and resembles tooth enamel.

Answer 20

Craniopharyngioma

Question 21

What is the most common cause of Cushing Syndrome?

Answer 21

Exogenous glucocoritcoids

Question 22

Cushing disease is a type of ACTH-dependent hypercortisolism. What lab values would be expected?

Answer 22

Increased ACTH, increased cortisol

Question 23

What lab values would be expected in a patient with ACTH-independent hypercortisolism?

Answer 23

Decreased ACTH, high cortisol

This is because the adrenals are secreting cortisol independent of ACTH stimulation. High cortisol negatively feeds back to the HPA axis to decreased ACTH.

Question 24

Cushing disease is a type of Cushing Syndrome. What is the cause?

Answer 24

Pituitary adenoma

Question 25

This neuroendocrine neoplasm is highly associated with ACTH-dependent hypercortisolism.

Answer 25

Small cell lung cancer - releases ACTH

Question 26

True/False. Adrenal adenomas are most associated with bilateral adrenal hyperplasia.

Answer 26

False - hyperplasia may be unilateral or bilateral, depending on the number of adenomas present. Pituitary adenomas and paraendocrine neoplasms are associated with bilateral hypertrophy.

Question 27

Primary hyperaldosteronism presents with sodium retention, potassium excretion, and hypertension. What other lab finding is characteristic?

Answer 27

Normal renin levels

Question 28

What is Conn Syndrome?

Answer 28

Primary hyperaldosteronism

Question 29

Spironolactone bodies are found in patients with this disorder that are treated with spironolactone.

Answer 29

Conn Syndrome (Primary hyperaldosteronism)

Question 30

How can primary and secondary hyperaldosteronism be differentiated?

Answer 30

Primary has normal renin levels, while secondary has high renin levels

Question 31

Describe the pathophysiology of secondary hyperaldosteronism.

Answer 31

Due to excessive activation of the renin-angiotensin system. This is often related to decreased renal perfusion.

Question 32

What is the most common defect associated with adrenogenital syndrome?

Answer 32

21-hydroxylase deficiency

Question 33

21-hydroxylase is deficient in patients with adrenogenital syndrome. What is the effect on hormone production?

Answer 33

This leads to increased production of testosterone in response to ACTH stimulation. Cortisol production is decreased.

Question 34

Adrenogenital syndrome is associated with salt wasting and potassium retention. Why is this?

Answer 34

Deficiency of the 21-hydroxylase reduces synthesis of aldosterone, responsible for salt retention and potassium excretion

Question 35

What is Addison disease?

Answer 35

Primary adrenocortical insufficiency

Question 36

What is the most common cause of Addison disease?

Answer 36

Autoimmune adrenalitis

Question 37

Primary adrenocortical insufficiency may occur due to bacteremia in children. What is this disorder called?

Answer 37

Waterhouse-Friderichsen Syndrome

Question 38

What bacteria is most associated with Waterhouse-Friderichsen Syndrome?

Answer 38

Primary acute adrenocortical insufficiency in children - N. meningitides

Question 39

What is the cause of secondary adrenal insufficiency?

Answer 39

Pituitary pathologies that lead to decreased ACTH stimulating the adrenals

Question 40

This adrenal neoplasm presents in patients 30-40yo, often with hypertension and tachycardia.

Answer 40

Pheochromocytoma - due to excess catecholamine secretion

Question 41

What abnormal urinalysis finding is most associated with pheochromocytoma?

Answer 41

Elevated vanillymandelic acid in the urine

Question 42

This adrenal neoplasm commonly presents in young children with Homer-Wright pseudorosettes.

Answer 42

Neuroblastoma

Question 43

What gene mutation is associated with MEN2A?

Answer 43

RET proto-oncogene

Question 44

What organs are involved with MEN 1?

Answer 44

Pituitary, pancreas, parathyroid