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The Endocrine System > Pathology of the Pituitary and Adrenal Glands > Flashcards

Pathology of the Pituitary and Adrenal Glands Flashcards

1
Q

By which other name is the anterior pituitary known?

A

Adenohypophysis

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2
Q

What is the anterior pituitary dervived from?

A

Rathke’s pouch

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3
Q

Which 2 types of hormones does the anterior pituitary secrete?

A
  1. Trophic
  2. Non-trophic
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4
Q

What is a trophic hormone?

A

A hormone which stimulates the activity of another endocrine gland

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5
Q

By which other name is the posterior pituitary known?

A

Neurohypophysis

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6
Q

What does the posterior pituitary mostly consist of?

A

Extension of neural tissue:

  1. Modified glial cells
  2. Axonal processes
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7
Q

Which 3 cell types are found in the anterior pituitary?

A
  1. Acidophils
  2. Basophils
  3. Chromophobes
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8
Q

What are the two types of acidophils found in the anterior pituitary and which hormones do they each secrete?

A
  1. Somatotrophs - GH
  2. Mammotrophs - PRL
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9
Q

What are the 3 types of basophils found in the anterior pituitary and which hormones does each secrete?

A
  1. Corticotrophs - ACTH
  2. Thyrotrophs - TSH
  3. Gonadotrophs - FSH/LH
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10
Q

What may be the cause of anterior pituitary hyperfunction?

A

Adenoma/carcinoma

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11
Q

What may be the cause of anterior pituitary hypofunction?

A
  1. Surgery/radiation
  2. Sudden gland haemorrhage
  3. Ischaemic necrosis
  4. Tumours extending into the sella
  5. Inflammatory conditions such as sarcoidosis
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12
Q

What is Sheenhan syndorme?

A

Hypopituitarism due to ischemic necrosis as a result of blood loss and hypovolemic shock associated with childbirth.

(it is also known as postpartum pituitary gland necrosis)

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13
Q

What is SIADH?

A

Syndrome of inappropriate ADH secretion

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14
Q

SIADH may have which two underlying causes?

A
  1. Ectopic secretion of ADH (tumours)
  2. Primary pituitary disorder
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15
Q

How can pituitary adenomas be classified?

A
  1. Cell type affected
  2. Hormone produced (or not produced in some cases)
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16
Q

A pituitary adenoma may be sporadic or associated with which condition?

A

MEN1

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17
Q

What are the major problems associated with large pituitary adenomas?

A
  1. Visual field defects
  2. Pressure atrophy of surrounding tissue
  3. Infarction leading to panhypopituitarism
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18
Q

What is the most common functional pituitary adenoma?

A

Prolactinoma

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19
Q

What is the second most functional pituitary adenoma?

A

GH secreting adenoma

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20
Q

GH secreting adenomas can cause which two things based on the age and development of the affceted individual?

A
  1. Giantism
  2. Acromegaly
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21
Q

An ACTH secreting pituitary adenoma can cause Cushing’s disease, what is another major cause of the condition?

A

Bilateral adrenocortical hyperplasia

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22
Q

Pituitary hypofunction rarely affects just one hormone, it affects many. This is called what?

A

Pan hypopituitarism

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23
Q

Pituitary hypofunction (or pan hypoituitarism) can be caused by which three things?

A
  1. Granulomatous inflammation (e.g. sarcoidosis)
  2. Infarction (e.g. Sheehan’s syndrome)
  3. Primary or metastatic tumours
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24
Q

What is the name given to the brain tumour derived from Rathke’s pouch?

A

Craniopharyngioma

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25
Q

What may be a key diagnostic sign on a scan for a craniopharyngioma?

A

Presence of calcification

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26
Q

What are the key clinical signs of a craniopharyngioma?

A
  1. Visual disturbances
  2. Growth retardation in children
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27
Q

Following radiation for a craniopharyngioma, what may subsequently develop?

A

Squamous cell carcinoma (SCC)

(this is rare)

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28
Q

For which three reasons may diabetes insipidus develop?

A
  1. Centrally - Deficient ADH production
  2. Peripherally - Renal resistance to ADH effects
  3. SIADH - Ectopic ADH release
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29
Q

Each adrenal gland is composed of an outer ________ and an inner __________

A

Each adrenal gland is composed of an outer cortex and an inner medulla

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30
Q

Waterhouse-Friderichsen syndrome is caused by ________ adrenal _____________

A

Waterhouse-Friderichsen syndrome is caused by acute adrenal hypofunction

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31
Q

What causes Waterhouse-Friderichsen syndrome?

A

Adrenal gland failure due to bleeding into the adrenal glands

Commonly caused by severe bacterial infection, typically

Neisseria meningitidis

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32
Q

Addison’s disease is caused by ________ adrenal _______________

A

Addison’s disease is caused by chronic adrenal hypofunction

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33
Q

What is congenital adrenal hyperplasia?

A

A group of autosomal recessive conditions

Results from mutations in different genes for enzymes which mediate the conversion of cholesterol to mineralocorticoids, glucocorticoids and sex steroids

34
Q

Why does congenital adrenal hyperplasia result in adrenal hyperplasia?

A

Generally in CAH there is poor cortisol production

Low cortisol levels result in high ACTH levels (an attempt to upregulate cortisol)

High ACTH acts on steroid producing cells in the adrenal cortex causing hyperplasia and overactivity

35
Q

What are the clinical features of CAH assoicated with 21-hydroxylase deficiency?

A
  1. Virilisation of female genitalia
  2. Precocious puberty in males
  3. 60-70% of patients have a salt-losing crisis at 1-3 wks of age
36
Q

What are the clinical features of CAH assoicated with 11-beta hydroxylase deficiency?

A
  1. Virilisation of female genitalia
  2. Precocious puberty in males
  3. Hypertension
  4. Hypokalaemia
37
Q

What are the clinical features of CAH assoicated with 17-hydroxylase deficiency?

A
  1. Non-virilising in females
  2. Inter-sex in boys
  3. Hypertension
38
Q

Acquired adrenocortical hyperplasia can be brought about in which ways?

A

Endogenous ACTH production

  1. Pituitary adenoma (Cushing’s disease)
  2. Ectopic ACTH (e.g. small cell lung cancer)
39
Q

Adrenocortical adenomas are usually functional

True or false?

A

False

40
Q

It can be very difficult to differentiate between adrenalcortical adenomas and adrenocortical carcinomas. In which ways may an adrenalcortical carcinoma be suspected?

A
  1. Large size (>50g, often >20cm)
  2. Haemorrhage and necrosis
  3. Frequent mitoses, atypical mitoses
  4. Lack of clear cells
  5. Capsular or vascular invasion
41
Q

What is the name given to primary hyperaldosteronism?

A

Conn’s syndrome

42
Q

Which two things is Conn’s syndrome most commonly associated with?

A
  1. Adrenal adenoma
  2. Diffuse or nodular hyperplasia of both adrenal glands
43
Q

Conn’s syndrome is responsible for causing ____________

A

Conn’s syndrome is responsible for causing hypertension

44
Q

A triad of which three things should cause suspicion of Conn’s syndrome?

A
  1. Hypokalaemia
  2. Hypertension
  3. Alkalosis
45
Q

The clinical picture of Conn’s syndrome is similar to which other condition, yet how can the two be differentiated?

A

Renal artery stenosis

  1. Conn’s - low plasma renin
  2. Renal artery stenosis - high plasma renin
46
Q

Hypercortisolism is also known by which other name?

A

Cushing’s disease or syndrome

47
Q

Cushing’s can be caused by either ___________ or ____________ causes

A

Cushing’s can be caused by either endogenous or exogenous causes

48
Q

What is the exogenous cause for Cushing’s syndrome?

A

Steroid therapy overdose

49
Q

Endogenous Cushing’s disease can be either ________ dependedent or independent

A

Endogenous Cushing’s disease can be either ACTH dependedent or independent

50
Q

What does any cause of ACTH dependent Cushing’s disease lead to?

A

Adrenal hyperplasia

51
Q

What are the two main causes of ACTH dependent Cushing’s?

A
  1. ACTH secreting pituitary adenoma (70%)
  2. Ectopic ACTH release (e.g. small cell lung cancer) (10%)
52
Q

ACTH independent Cushing’s is most likely caused by what?

A
  1. Adrenal adenoma
  2. Adrenal carcinoma
53
Q

How does ACTH independent Cushing’s affect the adrenal glands?

A

Non-lesional adrenal gland atrophies

54
Q

Adrenocortical hypofunction can have _________ or __________ causes

A

Adrenocortical hypofunction can have primary or secondary causes

55
Q

Secondary adrenocortical hypofunction usually results mainly from which two things?

A
  1. Failure to stimulate adrenal cortex (e.g. hypopituitarism)
  2. Suppression of adrenal cortex (e.g. treatment with steroids)
56
Q

Acute primary adrenocortical insufficiency can be induced when which type of medication is rapidly withdrawn?

A

Steroids

57
Q

Acute primary adrenocortical insufficiency can also be brought about by massive adrenal haemorrhage. What may cause this?

A
  1. Newborn (adrenal glands are much larger in relative size and very vascular)
  2. Anticoagulant treatment
  3. Disseminated intravascular coagulation
  4. Septicaemic infection (leads to Waterhouse-Friderichsen syndrome)
58
Q

Chronic adrenocortical insufficiency is also know by which other name?

A

Addison’s disease

59
Q

What are the four commonest causes of Addison’s disease?

A
  1. Autoimmune adrenalitis
  2. Infections
  3. Metastatic malignancy (lung, breast)
  4. Anti-phospholipid syndrome
60
Q

Which types of infections are associated with inducing Addison’s disease?

A
  1. TB
  2. Fungal
  3. HIV
61
Q

Name four more unusual causes of Addison’s disease

A
  1. Amyloid deposition
  2. Sarcoidosis
  3. Haemochromatosis
62
Q

Signs and symptoms of Addison’s disease develop after how much of the adrenal gland has been destroyed?

A

>90%

63
Q

What are the symptoms of Addison’s disease?

A
  1. Weakness and fatigue
  2. Vomiting and weight loss
  3. Diarrhoea
  4. Pigmentation of the skin and mucosal membranes
64
Q

Addison’s diease is associated with hypo_______ and hyper________

A

Addison’s diease is associated with hyponatraemia and hyperkalaemia

(K+ retention, Na+ loss)

65
Q

In a patient with Addison’s disease, what is the expected blood pressure and why?

A

Low

Volume depletion

66
Q

Which mineralocorticoid is decreased in Addison’s disease?

A

Aldosterone

67
Q

A reduced aldosterone level contributes to which characteristic traits of Addison’s disease?

A
  1. Hyperkalaemia (failure to secrete)
  2. Hyponatraemia (failure to retain)
  3. Hypotension (water follows Na+; failure to retain)
68
Q

In Addison’s disease there is __________ glucocorticoids, what is the effect of this?

A

Decreased glucocorticoids (cortisol)

Cortisol usually acts on the liver to induce gluconeogenesis

In Addison’s disease, this system fails and hypoglycaemia occurs

69
Q

What is an Addisonian crisis?

A

A range of symptoms suggesting severe adrenal insufficiency.

This is a medical emergency

  1. Hypovolaemic shock
  2. Hyponatraemia
  3. Hyperkalaemia
  4. Hypercalcaemia
  5. Fever
  6. Abdominal pain and vomiting
  7. Convulsions
  8. Coma and death
70
Q

Neuroendocrine (chromaffin) cells are located where and secrete what?

A

Adrenal medulla

Catechloamines

(epinephrine, norepinephrine, and dopamine)

71
Q

Which tumour can appear in the adrenal medulla and is composed of primative looking cells which indicate differentiation towards ganglion cells?

A

Neuroblastoma

72
Q

A neuroblastoma is usually diagnosed by which age?

A

18 months

73
Q

What is the name given to a tumour derived from chromaffin cells of the adrenal medulla?

A

Phaechromocytoma

74
Q

Why is a phaechromocytoma is cause of secondary hypertension?

A

Secretion of catechloamines raised blood pressure by activating the sympathetic nervous system

75
Q

What are the key cardiovascular complications of phaeochromocytoma?

A
  1. Cardiac failure
  2. Infarction
  3. Arrhythmias
  4. Stroke
76
Q

How can a phaeochromocytoma be diagnosed?

A

Urinary secretion of catechloamines and metabolities

77
Q

10% of phaeochromocytomas are _______-adrenal and 10% are __________

A

10% of phaeochromocytomas are extra-adrenal and 10% are bilateral

78
Q

Phaeochromocytomas can be associated with genetics

True or false?

A

True

Up to 25% are familial

79
Q

What is the term given to the small nests that phaeochromocytoma tumour cells create?

A

Zellballen

80
Q

Phaeochromocytomas have a propensity for metastases to which location?

A

Skeletal

(they can also metastasise to regional lymph nodes, liver and lung)

81
Q

What is Sipple syndrome?

A

Multiple endocrine neoplasia type 2A (MEN2A)

82
Q

Phaeochromocytoma is a feature of which type of MEN?

A

MEN2A and MEN2B

The Endocrine System (35 decks)

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