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SM Endocrine > Pathology of the Pituitary and Adrenal Glands > Flashcards

Pathology of the Pituitary and Adrenal Glands Flashcards

1
Q

What is the anterior pituitary derived from

A

Rathke’s pouch

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2
Q

What does the anterior pituitary secrete

A

trophic and non-trophic hormones
Trophic: TSH, ACTH, FSH, LH
Non-trophic: GH and prolactin

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3
Q

What is the posterior pituitary an extension of

A

neural tissue consisting of modified flail cells and axonal processes

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4
Q

What does the posterior pituitary secrete

A

ADH and oxytocin

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5
Q

What are the types of cells found in the anterior pituitary

A

Islands, cords of cells,
Acidophils (Somatotrophs and Mammotrophs)
Basophils (corticotrophs, thyrotophs, gonadotrophs
Chromophobe

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6
Q

What does the posterior pituitary contain

A

Non-myelinated axons of neurosecretory neurones

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7
Q

What can cause hyper function of the anterior pituitary

A

Adenoma or carcinoma

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8
Q

What can cause hypo function of the anterior pituitary

A 
Surgery/ radiation 
Sudden haemorrhage into the gland 
ischamic necrosis (Sheehan syndrome)
Tumours extending into sella 
Inflammatory conditions (Sarcoidosis)
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9
Q

What part of the pituitary gland does Diabetes insipidus

A

Posterior pituitary

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10
Q

What does diabetes insipidus result in

A

Lack of ADH secretion

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11
Q

What does SIADH result in

A

Ectopic secretion of ADH by tumours

Primary disorder in the pituitary

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12
Q

What is a pituitary adenoma sometimes associated with

A

MEN1

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13
Q

How can we classify pituitary adenomas

A

By the cell type / hormone produced

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14
Q

What do large adenomas cause

A

visual field defects

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15
Q

What can infarction caused by a pituitary adenoma lead to

A

Panhypopituitarism

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16
Q

If a pituitary adenoma has a mutation of the p53 gene, it is cancerous. True or False

A

False - they can be benign

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17
Q

What is the most common functional tumour

A

Prolactinoma

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18
Q

What does prolactinoma result in

A

infertility
lack of libido
amenorrhoea

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19
Q

What is the second most common pituitary adenoma

A

Growth hormone secreting

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20
Q

What does a growth hormone secreting adenoma cause

A

Stimulation of bone growth, cartilage and and connective tissue

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21
Q

What can growth hormone secreting adenomas result in

A

Gigantism or acromegaly

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22
Q

What is another form of functional pituitary adenoma ?

A

ACTH secreting

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23
Q

What can be caused as a result of ACTH secreting adenoma

A

Cushing’s disease

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24
Q

What are some of the causes of panhypopituitarism

A 
Primary or metastatic tumours 
Traumatic brain injury 
Subarachnoid haemorrhage 
Surgery or radiation
Granulomatous inflammation (sarcoidosis or tuberculous meningitis 
Infarction 
Hypothalmic lesions
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25
Q

What is a craniopharyngioma derived from

A

remnants of Rathke’s pouch

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26
Q

Describe the growth of craniopharyngioma

A

Slow growing, often cystic and may calcify

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27
Q

What are some of the symptoms of a craniopharyngioma

A

headaches and visual disturbances

Children may have growth retardation

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28
Q

What is the prognosis for a craniopharyngioma

A

Excellent

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29
Q

Where do the adrenal glands sit

A

Superior and medial to the upper pole of the kidneys

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30
Q

What are the adrenal glands composed of

A

An outer cortex and a central medulla

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31
Q

What are the 3 zones of the adrenal cortex

A

Zona glomerulosa
zona fasciculata
zona reticularis

32
Q

What is produced in the zona glomerulosa

A

mineralocirticoids

aldosterone

33
Q

What is produced in the zona fasciculata

A

Glucocorticoids

Cortisol

34
Q

What is produced in the zone reticular

A

sex steroids and glucocorticoids

35
Q

What innervates the adrenal medulla

A

pre-synaptic fibres from sympathetic nervous system

36
Q

What do the neuroendocrine cells in the medulla do

A

Secrete catecholamines

37
Q

What is another name for neuroendocrine cells

A

Chromaffin cells

38
Q

Adrenal pathology may be a manifestation of what ?

A

Pituitary disease
Shock/ DIC
Various conditions that may damage or destroy adrenal tissue

39
Q

What are some of the causes of hyper function of of the cortex of the adrenal gland

A

Hyperplasia
Adenoma
Carcinoma

40
Q

What are some of the causes of hypo function of the cortex of the adrenal gland

A

Acute (Waterhouse-Friderichsen)

Chronic (Addison’s disease)

41
Q

What is there a deficiency in in congenital adenocortical hyperplasia

A

The enzyme required for steer biosynthesis

42
Q

What does altered biosynthesis lead to in terms of adrenocortical hyperplasia

A

Increased androgen production

43
Q

What does reduced cortisol stimulate?

A

ACTH release and cortical hyperplasia

44
Q

What are some examples of acquired adrenocortical hyperplasia

A

Pituitary adenoma
Cushing’s disease
Ectopic ACTH
Bilaterla adrenal enlargement

45
Q

What is the difference between a nodular or diffuse adrenocortical hyperplasia

A

Diffuse is ACTH driven and nodular is usually ACTH independent

46
Q

What is required to form aldosterone, cortisol and testosterone

A

Cholesterol

47
Q

What is cholesterol converted to in order to produce hormones

A

Pregnolone

48
Q

Who is usually affected by an adrenocortial tumour

A

Mainly adults - both males and females

49
Q

How is an adrenocortical tumour found

A

As an incidental finding

50
Q

Describe an adrenocortical adenoma

A

Well circumscribed, encapsulated lesion
usually small - up to 2-3cm
yellow / yellow brown cut surface
Composed of cells resembling adrenocortical cells
Well differentiated, small nuclei, rare mitoses
Can be functional, but most likely not

51
Q

How common is adrenocortical carcinoma

A

Rare

52
Q

What can adrenocortical carcinomas resemble

A

Adenoma

53
Q

Where can adrenocortical carcinomas spread to

A

Retroperitoneum, kidney or metastasis to liver, lung and bone

54
Q

What is the survival rate of adrenocortical carcinoma

A

5 year is 30-25%

50% dead in 2 years

55
Q

What are some features that suggest an adrenocortical carcinoma

A 
Large size >50g or >20cm
Haemorrhage and necrosis 
Frequent mitoses, atypical mitosis
Lack of clear cells 
Capsular or vascular invasion
56
Q

What syndrome is a form of primary hyperaldosteronism

A

Conn’s syndrome

57
Q

What syndrome is a form of a Hypercortisolism

A

Cushings syndrome or disease

58
Q

What disease is associated with primary adrenocortical insufficiency

A

Addison’s disease

59
Q

What are some causes of acute adrenocortical insufficiency

A

Rapid withdrawal of steroid treatment
Crisis in patients with chronic adrenocortical insufficiency
Massive adrenal haemorrhage (newborn, anticoagulant treatment, DIC, septicaemia infection)

60
Q

What are some other causes of chronic adrenocortical insufficiency

A

TB
Fungal infection
HIV
Metastatic malignancy

61
Q

When do symptoms of primary adrenocortical insufficiency occur

A

Once >90% of the gland is destroyed

62
Q

Describe some symptoms of Addison’s disease

A 
Weakness
Fatigue 
Anorexia 
Nausea
Vomiting 
Weight loss 
Diarrhoea
Hyper pigmentation
63
Q

Describe the mineralocorticoids in Addison’s disease

A 
K+ retention 
Na+ loss 
Hyperkalaemia 
Hyponatraemia 
Volume depletion and hypotension
64
Q

What are the 2 types of adrenal medullary tumours

A

Phaeochromocytoma

Neuroblastoma

65
Q

At what age are patients with neuroblastoma diagnosed

A

18 months

66
Q

What are 2 important aspects for a prognosis

A

Age and stage

67
Q

What predicts a poor outcome in neuroblastoma

A

Amplification of N-myc and expression of telomerase predict a poor outcome

68
Q

What is a pheochromocytoma

A

A neoplasm derived from chromaffin cells of the adrenal medulla

69
Q

What do phaeochromocytomas secrete

A

catecholamines

70
Q

What main thing does phaeochromocytoma cause

A

Hypertension

71
Q

What are some complications of phaeochromocytoma

A

Cardiac failure
Infarction
Arrhythmias
CVA

72
Q

How is pheochromocytoma diagnosed

A

Detection of urinary excretion of catecholamines and metabolites

73
Q

What is pheochromocytoma also known as

A

the 10% tumour

74
Q

Why does phaeochromocytoma have the 10% tumour title

A

10% are extra-adrenal
10% are bilateral
10% are biologically malignant
10% are NOT associated with hypertension

75
Q

What do malignant phaeochromocytoma tumours ten to be

A

Large and necrotic

76
Q

What does MEN stand for

A

Multiple Endocrine Neoplasia

77
Q

What is a feature of both MEN1 and MEN2

A

Phaeochromocytoma

SM Endocrine (27 decks)

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