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Endocrine > Pathology of the pituitary and adrenal glands > Flashcards

Pathology of the pituitary and adrenal glands Flashcards

1
Q

What bony area does the pituitary lie within?

A

sella turcica

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2
Q

What trophic hormones does the anterior pituitary release?

A

TSH; ACTH; FSH; LH

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3
Q

What non-trophic hormones does the anterior pituitary release?

A

GH and prolactin

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4
Q

What does the posterior pituitary consist of?

A

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

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5
Q

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

A

acidophils and basophils

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6
Q

What are the reasosn for hypofunction of the anterior pituitary?

A

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

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7
Q

What is Sheehan syndrome?

A

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

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8
Q

What is the most common functional type of pituitary adenoma?

A

prolactinoma

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9
Q

What symptoms occur with a prolactinoma?

A

infertility; lack of libido; amenorrhea

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10
Q

What is the second most commmon functional pituitary adenoma?

A

growth hormone secreting

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11
Q

What happens with a growht hormone secreting adenoma?

A

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

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12
Q

What does an ACTH secreting adenoma cause?

A

Cushing’s disease

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13
Q

What type of pituitary hypofunction usually occurs?

A

panhypopituitarism

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14
Q

What is a craniopharyngioma derived from?

A

remnants of Rathke’s pouch

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15
Q

What ar ethe features of a craniopharyngioma?

A

slow growing
often cystic
may calcify

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16
Q

What are the symtpoms of craniopharyngioma?

A

headaches and visual disturbances

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17
Q

What are hte 2 types of diabetes insipidus?

A

central or nephrogenic

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18
Q

what happens with nephrogenic diabetes insipidus?

A

renal resistance to ADH effects

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19
Q

What are the causes of central diabetes insipidus?

A

trauma; tumours and inflammatory disorders of hypothalamus and pituitary

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20
Q

What are the causes of adrenocortical hyperfunction?

A

hyperplasia; adenoma; carcinoma

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21
Q

What are the causes of adrenocortical hypofunction?

A

acute- waterhouse-friderichsen; chronic- Addison’s

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22
Q

What is the primary problem in congenital adrenocortical hyperplasia?

A

deficiency/lack of enzyme required for steroid biosynthesis

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23
Q

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

A

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

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24
Q

What are the symptoms of increased androgen production?

A

masculinisation; precocious puberty

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25
Q

What are the causes of acquired adrenocortical hyperplasia?

A

excess ACTH production; bilateral adrenal enlargement; diffuse or nodular

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26
Q

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

A

small cell lung carcinoma

27
Q

What is the difference between diffuse and nodular hyperplasia?

A

diffuse-ACTH driven wherease nodular is usually ACTH independent

28
Q

What causes fever with a cancer?

A

when the carcinoma necroses

29
Q

What are the features of an adrenocortical adenoma?

A

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

30
Q

What is the general difference between adrenocortical carcinoma and adenoma?

A

carcinoma are much rare and more likely to be functional

31
Q

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

A

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

32
Q

What is primary hyperaldosteroniism called?

A

Conn’s syndrome

33
Q

What causes Conn’s syndrome?

A

diffuse or nodular hyperplasia of both adrenal glands; adenoma

34
Q

What is hypercortisolism called?

A

Cushing’s syndrome or disease

35
Q

What are the causes of ACTH dependent hypercortisolism?

A

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

36
Q

What are the causes of ACTH independent hypercortisolism?

A

adrenal adenoma or carcinoma; non-lesional adrenal gland

37
Q

what are the causes of secondary adrenocortical hypofunction?

A

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

38
Q

What are the causes of acute primary adrenocortical insufficiency?

A

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

39
Q

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

A

autoimmune adrenalitis; infectious; metastatic malignancy

40
Q

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

A

more than 90%

41
Q

What are the uncommon causes of Addison’s ?

A

amyloid; sarcoidosis; haemochromatosis

42
Q

What are the symptoms of Addison’s disease?

A

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

43
Q

What innervates the medulla?

A

pre-synpatic fibres from sympathietic nervous system

44
Q

What cells secrete catecholamines?

A

chromaffin cells

45
Q

What are the types of adrenal medullary tumours?

A

phaeochromocytoma; neuroblastoma

46
Q

How old are patients usually when diagnosed with a neuroblastoma?

A

within 18 months

47
Q

Where do neuroblastoma usually arise?

A

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

48
Q

What type of cells make up a neuroblastoma?

A

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

49
Q

What can trigger paroxysmal episode of hypertension in phaemochromocytoma?

A

stress; exercise; posture; palpation of tumour

50
Q

What are the complications of phaemochromocytoma?

A

cardiac failure; infarction; arrhythmias; CVA

51
Q

How is phaeochromocytoma diagnosed?

A

detection of urinary excretion of catecholamines and metabolites

52
Q

What are the extra-adrenal phaeochromocytomas called?

A

paragangliomas

53
Q

Why are phaeochromocytomas called the 10% tumour?

A

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

54
Q

How many cases of phaeochromocytoma are familial?

A

25%

55
Q

What will turn a phaeochromocytoma dark brown?

A

potassium dichromate due to oxidation of catecholamines in tumour cells

56
Q

Where do phaeochromocytomas tend to metastasise?

A

bone; regional lymph nodes; liver; lung

57
Q

What multiple endocrine neoplasia syndromes is phaeochromocytoma a feature of ?

A

MEN2A and MEN2B

58
Q

What else is seen with MEN2A?

A

medullary thryoid carcinoma; parathyroid hyperplasia

59
Q

What else is seen with MEN2B?

A

medullary thyroid carcinoma; neuromas or ganglioneuromas; marfanoid habitus

60
Q

What are the 3 zones of the adrenal cortex?

A

zona glomerulosa; zona fasciculata; zona reticularis

61
Q

What is produced in the zona glomerulosa?

A

mineralocorticoids- aldosterone

62
Q

What is produced in the zona fasciculata?

A

glucocorticoids-cortisol

63
Q

What is produced in the zona reticularis?

A

sex steroids and glucocorticoids

Endocrine (27 decks)

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