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Endocrinology > Pathology of Pituitary and Adrenal Glands > Flashcards

Pathology of Pituitary and Adrenal Glands Flashcards

1
Q

what is the anterior pituitary derived from

A

Rathkes pouch

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2
Q

what trophic hormones does the anterior pituitary produce

A

TSH, ACTH, FSH, LH

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3
Q

what non trophic hormones are produced by the anterior pituitary

A

GH and prolactin

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4
Q

what is a trophic hormone

A

one that has a growth affect on endocrine glands and stimulates them to produce their hormones

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5
Q

what is the andenohypophysis

A

anterior pituitary gland

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6
Q

what is the neurohypophysis

A

posterior pituitary gland

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7
Q

what does posterior pituitary tissue consist of

A

is an extension of neural- consists of modified glial cells and axonal processes

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8
Q

what does the posterior pituitary secrete

A

vasopressin and oxytocin

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9
Q

describe the histology of the posterior pituitary gland

A

non- myelinated axons of neurosecretory neurones

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10
Q

describe the histology of the anterior pituitary gland

A

islands, cords of cells,
acidophils,
basophils,
chromophobes

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11
Q

what cells produce GH

A

type of acidophil called somatotrophs

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12
Q

what type of cell produces PRL

A

type of acidophil called mammotrophs

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13
Q

what type of cell produces ACTH

A

type of basophil called corticotrophs

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14
Q

what type of cell produces TSH

A

type of basophil called thyrotrophs

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15
Q

what type of cell produces FSH, LH

A

type of basophil called gonadotrophs

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16
Q

what can cause hyperfunction of the anterior pituitary

A

adenoma, carcinoma

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17
Q

what can cause hypofunction of the anterior pituitary

A 
surgery/ radiation,
sudden haemorrhage into gland,
ischaemic necrosis (sheehan syndrome in pregnancy),
tumours extending into sella,
inflammatory conditions (sarcoidosis)
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18
Q

what causes SIADH

A

ectopic secretion of ADH by tumours

primary disorder int the pituitary

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19
Q

what condition can

pituitary adenomas be associated with

A

MEN1- werner syndrome

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20
Q

what are pituitary adenomas classified by

A

cell type/ hormone produced

can be hypo/non functional (mass lesion which compresses surrounding normal pituitary tissues which will atrophy)
can produce more than 1 hormone

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21
Q

what are features of large pituitary adenomas

A

visual field defects,
can cause pressure atrophy of surrounding normal tissue,
infarction can lead to panhypopituitarism

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22
Q

what are the functional pituitary adenomas

A

prolactinoma (most common), GH secreting, ACTH secreting

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23
Q

what are the symptoms of a prolactinoma

A

infertility, lack of libido, amenorrhea

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24
Q

what are the features of a growth secreting hormone

A

GH causes increase in insulin like growth factors (IGF)
stimulates growth of bone, cartilage and connective tissue
gigantism or acromegaly

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25
what are the symptoms of an ACTH tumour
cushings disease | bilateral adrenocortical hyperplasia
26
what do functional pituitary carcinomas usually secrete
prolactin or ACTH
27
what can cause panhypopituitarism
granulomatous inflammation- sarcoidosis infarction- sheehans syndrome primary or metastatic tumours
28
what is a craniopharyngioma
intracranial tumour derived from remnants of rathke's pouch, often suprasellar
29
who gets craniopharynogioma
5-15 years | eldery- 6th to 7th decades
30
what are the symptoms of craniopharyngioma
visual disturbances, children may have growth retardation
31
what is the prognosis like for craniopharyngioma
very good (especially if under 5cm)
32
what are the central causes of diabetes insipidus
ADH deficiency | trauma (including surgery), tumours, inflammatory disorders of the hypothalamus an pituitary
33
what are the nephrogenic causes of diabetes insipidus
renal resistance to ADH effects
34
what causes SIADH
ectopic production of ADH- paraneoplastic syndrome
35
how much does an adrenal gland weigh
4-5 grams each
36
where are the adrenal glands
sit superior and medial to the upper pole of the kidneys
37
what are the components of the adrenal glands
outer cortex enclosing a central medulla
38
what diseases can manifest as adrenal pathologies
pituitary disease (ACTH secretion from function adenoma) Shock, DIC conditions that damage/ destroy adrenal tissue
39
is it the cortex or medulla of the adrenal glands that can be affected by hypo/hyper function
both
40
what can cause hyperfunction of the adrenal cortex
hyperplasia, adenoma, carcinoma
41
what can cause hypofunction of the adrenal cortex
acute: waterhouse-friderichsen chronic: addisons disease
42
what are the congenital causes of adrenocortical hyperplasia - how does it cause it
group of autosomal recessive disorders where there is a deficiency or lack of enzyme required for steroid biosynthesis which leads to increased androgen production (masculinisation and precocious puberty) stimulates ACTH release and cortisol hyperplasia
43
what are the causes of acquired adrenocortical hyperplasia
endogenous ACTH production: cushings disease (pituitary adenoma), ectopic ACTH (paraneoplastic syndrome)
44
what happens to the adrenal gland in acquired adrenocortical hyperplasia
bilateral adrenal enlargement | diffuse (ACTH driven) or nodular (ACTH independent)
45
what is produced by the adrenal cortex
aldosterone, cortisol and testosterone
46
who gets adrenocortical tumours
usually adults, males more than females
47
what is the usual presentation of an adrenocortical tumour
incidental finding hormonal effects mass lesion (almost always carcinomas) carcinomas with necrosis can cause fever
48
describe what adenocortical adenomas are like
well circumscribed, encapsulated lesions usually small yellow/ brownish surface (lipids) cells resemble adrenocortical cells are well differentiates, small nuclei, rare mitoses can be function, usually not
49
what are virulising adrenocortical carcinomas usually
malignant
50
describe the spread of an adrenocortical carcinoma
local invasion (retroperitoneum, kidney) metastasis (vascular- to liver, lung and bone) peritoneum and pleura regional lymph nodes
51
what is the survival for adrenocortical carcinomas
5 year 20-35%
52
what is the only definite discriminating factor between adrenocortical tumours
whether or not they metastasis
53
what features suggest a adrenocortical tumour
``` large haemorrhage and necrosis frequent mitosis atypical mitosis lack of clear cells capsular or vascular invasion ```
54
what is primary hyperaldosteronism
conns- hypersecretion of aldosterone
55
is conns under the influence of ACTH
yes
56
what changes to the adrenal gland is conns associated with
diffuse or nodular hyperplasia of both adrenal glands
57
what can cause hypercortisolism
cushings syndrome | exogenous (iatrogenic) or endogenous (ACTH dependent and independent)
58
what are the ACTH dependent causes of hypercortisolism
``` ACTH secreting pituitary adenoma (cushings) ectopic ACTH (small cell lung cancer) ```
59
what are the ACTH independent cause of hypercortisolism
adrenal adenoma or carcinoma non lesional adrenal gland atrophies
60
what can cause secondary adrenocortical hypofunction
failure to stimulate adrenal cortex (hypothalamic-pituitary disorder) suppression of adrenal cortex (treatment with steroids)
61
what can cause acute primary adrenocortical insufficiency
rapid withdrawal of steroid treatment addisons crisis adrenal haemorrhage (newborn, antocoagulatant treatment, DIC, septicaemic infection, waterhouse friderichsen)
62
what can cause chronic primary adrenocortical insifficiency
addisons disease: autoimmune adrenalitis, infections (TB, fungal, HIV), metastases rare: amyloid, sarcoidosis, haemochromatosis
63
describe the onset of addisons disease
insidious - manifests once there is a significant decrease in glucocorticoid and mineralocorticoid levels
64
what are the symptoms of addisons disease
weakness, fatigue, anorexia, nausea, vomiting, weight loss, diarrhoea pigmentation
65
what is decreased in addisons
mineralocorticoids (K+ retention, Na+ loss, hyperkalaemia, hyponatraemia, volume depletion and hypotension) decreased glucocorticoids (hypoglycaemia)
66
what are the symptoms of addisons crisis
vomiting, abdo pain, hypotension, shock and death
67
what is the precipitating factor in addisons crisis
stress- infection, trauma, surgery
68
what is the adrenal medulla innervated by
pre-synaptic fibres from sympathetic nervous system
69
what cells in the adrenal medulla secrete catecholamines
neuroendocrine (chromaffin) cells
70
what are the two tumours seen in the adrenal medulla
phaochromocytoma and neuroblastoma
71
where can neuroblastomas arise
40% in adrenal medulla | remainder along sympathetic chain
72
what cells make up neuroblastomas
primitive appearing cells, can show maturation and differentiation towards ganglion cells
73
what cells are pheochromocytomas derived from
chromaffin cells of the adrenal medulla
74
explain the triad of symptoms of a phaeochromocytoma
headache, hypertension (paroxysmal episodes) and sweating as secretes catcholamines
75
what are the complications of phaeochromocytomas
cardiac failure, infarction, arrhythmias, cerebrovascular accident
76
how do you lab diagnose a phaeochromocytoma
urinary excretion of catecholamines and metabolites
77
what are the 10%s in phaeochromocytoma
``` 10% are extra-adrenal 10% are bilateral 10% are biologically malignant 10% are NOT associated with hypertension 25% are familial ```
78
where do phaeochromocytoma spread to
skeletal metastasis, regional lymph nodes, liver and lung
79
what genetic condition is phaeochromoytoma a feature of
MEN2

Endocrinology (46 decks)

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