Pathology of Pituitary and Adrenal Glands

Question 1

What can go wrong with the pituitary gland?

Answer 1

Adenohypophysis - anterior

Neurohypophysis - posterior

Question 2

Where is Adenohypophysis derived from?

Answer 2

Rathke’s pouch

Question 3

What does the anterior produce?

Answer 3

TSH, ACTH, FSH, LH

GH and prolactin

Question 4

What does the posterior produce?

Answer 4

ADH (vasopressin) and Oxytocin

Question 5

Where does the pituitary sit?

Answer 5

Inferior to hypothalamus

Anterior to Pons

Question 6

What makes up the Anterior P?

Answer 6

Islands, cords of cells
Acidophils: Somatotrophs and Mammotrophs
Basophils: Cortico, Thyro and Gonadotrophs
Chromophobe

Question 7

What makes up the posterior?

Answer 7

Non-myelinated axons of neurosecretory neurons

Question 8

What are hyperfunctions of the anterior?

Answer 8

Adenoma

Carcinoma

Question 9

What are hypofunctions of the anterior?

Answer 9

Surgery/radiation
Haemorrhage into gland
Ischaemic necrosis
Tumours extending into sella
Inflam e.g. sarcoidosis

Question 10

What 2 conditions effect the posterior?

Answer 10

Diabetes insipidus

SIADH

Question 11

What symptoms can occur with an anterior adenoma?

Answer 11

Visual field defects
Atrophy of surrounding tissue
Infarction can lead to panhypopituitarism

Question 12

What conditions can occur due to anterior adenomas?

Answer 12

Prolactinoma
Growth hormone secreting problems -gigantism or acromegaly
ACTH secreting problems - Cushings disease

Question 13

What are reasons for pituitary hypofunction?

Answer 13

Traumatic brain injury 
Subarachnoid haemorrhage 
Surgery/radiation
Granulomatous inflam - sarcoid, TB, meneingitis
Infarction/Haemorrhage
Hypothalmic lesions

Question 14

Describe carniopharyngioma

Answer 14

Derived from rathke’s pouch

Question 15

Describe the adrenal gland

Answer 15

Bilateral, 4-5 grams each
Sit superior and medial to upper pole of kindeys
Composed of outer cortext and a central medulla

Question 16

What are the 3 areas of the central medulla of the kindey?

Answer 16

Zona Glomerulosa
Zona Fasciculata
Zona Reticularis

Question 17

What is produced in the Zona Glomerulosa?

Answer 17

Mineralocoticoids

Aldesterone

Question 18

What is produced in the Zone Fasciculata?

Answer 18

Glucocorticoids

Cortisol

Question 19

What is produced in the Zona Reticularis?

Answer 19

Sex steroids

Glucocorticoids

Question 20

Describe the adrenal gland medulla

Answer 20

Distinct from cortex
Innervated by pre-synaptic fibres from sympathetic nervous system
Neuroendocrine (Chromaffin) cells decrete catecholamines

Question 21

What are adrenal hyperfunctions?

Answer 21

Hyperplasia
Adenoma
Carcinoma

Question 22

What are adrenal hypofunctions?

Answer 22

Acute - waterhouse fridrichsen

Chronic - Addison’s disease

Question 23

What systemic symptom can carcinomas with necrosis cause?

Answer 23

Fever

Question 24

Describe an adrenalcorticol adenoma

Answer 24

Well circumscribed, encapsulated lesions
Usually small (2-3 cm)
Yellow/Yellow brown cut surface (lipid)
Composed of cells resembling adrenalcortical cells

Question 25

Describe Addison’s disease

Answer 25

Insidious onset causing decreased gluco/mineralocorticoid levels

Question 26

What are symptoms of addison’s?

Answer 26

Weakness, fatigue, anorexia, nausea, vomiting, weight loss, diarrhoea
Pigmentation (raised POMC) (not seen in hypopituitarism)