Pathology of the Pituitary

Question 1

Where are the hormones of the posterior pituitary made?

Answer 1

Hypothalamus

Question 2

What are the 3 cells of the anterior pituitary?

Answer 2

• Chromophobes
• Acidophils
• Basophils

Question 3

What network makes up the anterior pituitary?

Answer 3

Reticulin Network

Question 4

Hyperpituitarism

Answer 4

Over secretion of 1 or more hormones

Question 5

What is the most common cause of hyperpituitarism?

Answer 5

Anterior Pituitary Adenoma

Question 6

What are pituitary adenomas that produce hormones called?

Answer 6

Functional

Question 7

What is the most common type of pituitary adenoma?

Answer 7

Prolactinoma

Question 8

What are other common hormones secreted by pituitary adenomas?

Answer 8

• GH

- ACTH

Question 9

What are some manifestations of pituitary adenoma?

Answer 9

• Headache

- Bitemporal Hemianopsia

Question 10

What is the effect of GNAS1 mutation?

Answer 10

Leads to unchecked cellular proliferation - turning cell cycle on permanently.

Question 11

What is the presentation of prolactinomas in females?

Answer 11

• Galactorrhea

- Amenorrhea

Question 12

What is the presentation of prolactinomas in males?

Answer 12

• Impotence

- Infertility

Question 13

What else can cause elevated prolactin?

Answer 13

• Decreased DOPA

- Drugs

Question 14

What drugs are used to treat prolactinomas?

Answer 14

• Bromocriptine

- Cabergoline

Question 15

What is the effect of GH-secretitng adenoma on prepubertal patients?

Answer 15

Gigantism

Question 16

What is the effect of GH-secretitng adenoma on postpubertal patients?

Answer 16

Acromegaly

Question 17

What are lab features of GH adenomas?

Answer 17

• Elevated GH
• Elevated IGF-1
• Lack of GH suppression by oral glucose

Question 18

What is the treatment for GH adenomas?

Answer 18

• Surgery
• Somatostatin
• Octreotide
• Lantreotide

Question 19

What can ACTH adenomas cause?

Answer 19

Cushing Disease

Question 20

What is Cushing Syndrome?

Answer 20

Excess cortisol due to increased released from adrenals.

Distinct from Cushing Disease which is due to ACTH adenoma.

Question 21

• Round face
• “buffolo hump”
• Osteopenia
• Hypertension
• Atherosclerosis
• Glucose intolerance
• Hyperlipidemia
• Increased susceptibly to Infections
• Depression

Answer 21

Cushing Syndrome

Question 22

Nelson Syndrome

Answer 22

Adrenal glands removed for treatment of hypercortisolism due to Cushing Disease with an unknown presence of coritoctroph micro adenoma.

• No inhibitory effect of adrenal corticosteroids on pituitary adenoma so the adenoma will grow

Question 23

Hypopituitarism

Answer 23

Deficiency of pituitary hormones

Question 24

Pituitary Apoplexy

Answer 24

Acute hemorrhage into an adenoma

Question 25

What is the most lethal hormone loss with loss of the pituitary?

Answer 25

ACTH

Question 26

Sheehan Syndrome

Answer 26

Postpartum hemorrhage leads to necrosis of the anterior pituitary leading to lactation failure and lethal adrenal insufficiency

Question 27

What are other causes of hypopituitarism?

Answer 27

- DIC - Sickle Cell Disease - Trauma

Question 28

Empty Sella Syndrome

Answer 28

Enlarged sella turcica not filled entirely with pituitary tissue which leads to CSF leak and increases pressure around the pituitary and results in pituitary atrophy

Question 29

Central Diabetes Insipidus

Answer 29

ADH deficiency - polyuria

Question 30

SIADH

Answer 30

Excess ADH

Question 31

Nephrogenic Diabetes Insipidus

Answer 31

Renal tubules do not respond to ADH

Question 32

What are the causes of SIADH?

Answer 32

- Drugs - CNS Injury - Ectopic Secretion (Lung SCC) - Idiopathic

Question 33

Craniopharhygioma

Answer 33

– Benign tumor – Arises from vestigial remnants of Rathke’s pouch – Primarily suprasellar location

Question 34

– Developmental Failure of Rathke’s pouch obliteration – Lined by cuboidal epithelium with cilia and/or goblet cells – Growth may compromise pituitary gland

Answer 34

Rathke Cleft Cysts

Question 35

A 30‐year‐old woman, who has three healthy children, notes that she has had no menstrual periods for the past 6 months, but she is not pregnant and takes no medications. Within the past week, she has noted some milk production from her breasts. She has been bothered by headaches for the past 4 months. After nearly hitting a bus while changing lanes driving her vehicle, she is concerned with her vision. On physical examination she is afebrile and normotensive. Her lateral vision is reduced. Which of the following laboratory test findings is most likely to be present in this woman? ``` A. Increased serum cortisol B. Lack of growth hormone suppression C. Hyperprolactinemia D. Hyponatremia E. Abnormal glucose tolerance test F. Decreased serum TSH ```

Answer 35

C. Hyperprolactinemia

Question 36

A 24‐year‐old presents with the onset of labor at 38 weeks gestation. As a consequence of placenta accreta she develops severe hemorrhage. She remains hypotensive for 4 hours and requires transfusion of 10 packed RBC units. Postpartum, she becomes unable to breast‐feed the infant. She does not have a resumption of normal menstrual cycles. She becomes more sluggish and tired. Laboratory findings include hyponatremia, hyperkalemia, and hypoglycemia. Which of the following pathologic lesions is she most likely to have had following delivery? ``` A. Bilateral adrenal hemorrhage B. Pituitary necrosis C. Metastatic choriocarcinoma D. Subacute thyroiditis E. Posterior pituitary adenoma ```

Answer 36

B. Pituitary necrosis