Pathology of the pituitary and adrenal glands

Question 1

What bony area does the pituitary lie within?

Answer 1

sella turcica

Question 2

What trophic hormones does the anterior pituitary release?

Answer 2

TSH; ACTH; FSH; LH

Question 3

What non-trophic hormones does the anterior pituitary release?

Answer 3

GH and prolactin

Question 4

What does the posterior pituitary consist of?

Answer 4

modified glial cells and axonal processes- extension of neural tissue. non-myelinated axons of neurosecretory neurons

Question 5

What are the 2 types of cell found in the anterior pituitary?

Answer 5

acidophils and basophils

Question 6

What are the reasosn for hypofunction of the anterior pituitary?

Answer 6

surgery-radiation; sudden haemorrhage into gland; ischaemic necrosis; tumours extended into sella; inflammatory conditions

Question 7

What is Sheehan syndrome?

Answer 7

postpartum hypopituitarism restulting from ischaemic necrosis due to blood loss and hypovolaemic shock during childbirth

Question 8

What is the most common functional type of pituitary adenoma?

Answer 8

prolactinoma

Question 9

What symptoms occur with a prolactinoma?

Answer 9

infertility; lack of libido; amenorrhea

Question 10

What is the second most commmon functional pituitary adenoma?

Answer 10

growth hormone secreting

Question 11

What happens with a growht hormone secreting adenoma?

Answer 11

growth of bone; cartilage and connective tissue is stimulating causing gigantism or acromegaly

Question 12

What does an ACTH secreting adenoma cause?

Answer 12

Cushing’s disease

Question 13

What type of pituitary hypofunction usually occurs?

Answer 13

panhypopituitarism

Question 14

What is a craniopharyngioma derived from?

Answer 14

remnants of Rathke’s pouch

Question 15

What ar ethe features of a craniopharyngioma?

Answer 15

slow growing
often cystic
may calcify

Question 16

What are the symtpoms of craniopharyngioma?

Answer 16

headaches and visual disturbances

Question 17

What are hte 2 types of diabetes insipidus?

Answer 17

central or nephrogenic

Question 18

what happens with nephrogenic diabetes insipidus?

Answer 18

renal resistance to ADH effects

Question 19

What are the causes of central diabetes insipidus?

Answer 19

trauma; tumours and inflammatory disorders of hypothalamus and pituitary

Question 20

What are the causes of adrenocortical hyperfunction?

Answer 20

hyperplasia; adenoma; carcinoma

Question 21

What are the causes of adrenocortical hypofunction?

Answer 21

acute- waterhouse-friderichsen; chronic- Addison’s

Question 22

What is the primary problem in congenital adrenocortical hyperplasia?

Answer 22

deficiency/lack of enzyme required for steroid biosynthesis

Question 23

what does a lack of enzyme for steroid biosynthesis result in?

Answer 23

increased androgen production; reduced cortisol stimulates ACTH release and cortical hyperplasisa

Question 24

What are the symptoms of increased androgen production?

Answer 24

masculinisation; precocious puberty

Question 25

What are the causes of acquired adrenocortical hyperplasia?

Answer 25

excess ACTH production; bilateral adrenal enlargement; diffuse or nodular

Question 26

What cancer typically ectopically produces ACTH as part of its paraneoplastic syndrome?

Answer 26

small cell lung carcinoma

Question 27

What is the difference between diffuse and nodular hyperplasia?

Answer 27

diffuse-ACTH driven wherease nodular is usually ACTH independent

Question 28

What causes fever with a cancer?

Answer 28

when the carcinoma necroses

Question 29

What are the features of an adrenocortical adenoma?

Answer 29

well circumscribed, encapsulated lesions; small. composed of cells resembling adrenocortical cells; well differentiated, small nuclei, rare mitoses

Question 30

What is the general difference between adrenocortical carcinoma and adenoma?

Answer 30

carcinoma are much rare and more likely to be functional

Question 31

What are the features suggesting that the tumour is more likely to be a carcinoma than adenoma?

Answer 31

large size; haemorrhage and necrosis; frequent mitoses; atypical mitoses; lack of clear cells; capsular or vascular invasion

Question 32

What is primary hyperaldosteroniism called?

Answer 32

Conn's syndrome

Question 33

What causes Conn's syndrome?

Answer 33

diffuse or nodular hyperplasia of both adrenal glands; adenoma

Question 34

What is hypercortisolism called?

Answer 34

Cushing's syndrome or disease

Question 35

What are the causes of ACTH dependent hypercortisolism?

Answer 35

ACTH secreting pituitary adenoma (Cushing's disease); ectopic ACTH- small cell lung cancer

Question 36

What are the causes of ACTH independent hypercortisolism?

Answer 36

adrenal adenoma or carcinoma; non-lesional adrenal gland

Question 37

what are the causes of secondary adrenocortical hypofunction?

Answer 37

failure to stimulate the adrenal cortex eg hypopituitarism or suppression of adrenal cortex eg Tx with steroids

Question 38

What are the causes of acute primary adrenocortical insufficiency?

Answer 38

rapid withdrawal of steroid Tx; crissis in pt with chronic adrenocortical insufficiency due to stress; massive adrenal haemorrhage

Question 39

What are the 3 common causes of Addison's disease?

Answer 39

autoimmune adrenalitis; infectious; metastatic malignancy

Question 40

How much of the gland needs to be destroyed before a pt gets symptoms of adrenocortical insufficiency?

Answer 40

more than 90%

Question 41

What are the uncommon causes of Addison's ?

Answer 41

amyloid; sarcoidosis; haemochromatosis

Question 42

What are the symptoms of Addison's disease?

Answer 42

weakness; fatigue; anorexia; nausa; vomiting; wt loss; diarrhoea; pigmentation; hyperkalaemial hyponatraemia; volume depletion and hypotension; hypoglycaemia

Question 43

What innervates the medulla?

Answer 43

pre-synpatic fibres from sympathietic nervous system

Question 44

What cells secrete catecholamines?

Answer 44

chromaffin cells

Question 45

What are the types of adrenal medullary tumours?

Answer 45

phaeochromocytoma; neuroblastoma

Question 46

How old are patients usually when diagnosed with a neuroblastoma?

Answer 46

within 18 months

Question 47

Where do neuroblastoma usually arise?

Answer 47

in the adrenal medulla (40%), the rest mostly along the sympathic chain

Question 48

What type of cells make up a neuroblastoma?

Answer 48

primitive appearing cells but can show maturation and differentiation towards ganglion cells

Question 49

What can trigger paroxysmal episode of hypertension in phaemochromocytoma?

Answer 49

stress; exercise; posture; palpation of tumour

Question 50

What are the complications of phaemochromocytoma?

Answer 50

cardiac failure; infarction; arrhythmias; CVA

Question 51

How is phaeochromocytoma diagnosed?

Answer 51

detection of urinary excretion of catecholamines and metabolites

Question 52

What are the extra-adrenal phaeochromocytomas called?

Answer 52

paragangliomas

Question 53

Why are phaeochromocytomas called the 10% tumour?

Answer 53

10% are extra-adrenal; 10% are bilateral; 10% are bioloigcally malignant; 10% are not associated with HT: 10% occur in children

Question 54

How many cases of phaeochromocytoma are familial?

Answer 54

25%

Question 55

What will turn a phaeochromocytoma dark brown?

Answer 55

potassium dichromate due to oxidation of catecholamines in tumour cells

Question 56

Where do phaeochromocytomas tend to metastasise?

Answer 56

bone; regional lymph nodes; liver; lung

Question 57

What multiple endocrine neoplasia syndromes is phaeochromocytoma a feature of ?

Answer 57

MEN2A and MEN2B

Question 58

What else is seen with MEN2A?

Answer 58

medullary thryoid carcinoma; parathyroid hyperplasia

Question 59

What else is seen with MEN2B?

Answer 59

medullary thyroid carcinoma; neuromas or ganglioneuromas; marfanoid habitus

Question 60

What are the 3 zones of the adrenal cortex?

Answer 60

zona glomerulosa; zona fasciculata; zona reticularis

Question 61

What is produced in the zona glomerulosa?

Answer 61

mineralocorticoids- aldosterone

Question 62

What is produced in the zona fasciculata?

Answer 62

glucocorticoids-cortisol

Question 63

What is produced in the zona reticularis?

Answer 63

sex steroids and glucocorticoids