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Endocrine > Pathology of the Pituitary and Adrenal Glands > Flashcards

Pathology of the Pituitary and Adrenal Glands Flashcards

1
Q

what is the anterior pituitary also known as and where does it come from?

A

adenohypophysis

derived from Rathkes pouch

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2
Q

what type of hormones does the anterior pituitary secrete>

A 
trophic = TSH, ACTH, FSH, LH
non-trophic = GH and prolactin
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3
Q

what is the posterior pituitary also known as and where does it come from?

A

neurohypophysis

extension of neural tissue consists of modified glial cells and axonal processes

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4
Q

what cells are present in the anterior pituitary?

A 
islands, cords of cells
acidophils
- somatotrophs (GH)
- mammotrophs (prolactin)
basophils
- corticotrophs (ACTH)
- thyrotrophs (TSH)
- gonadotrophs (FSH/LH)
chromophobes
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5
Q

what cells are present in the posterior pituitary?

A

non-myelinated axons of neurosecretory neurons

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6
Q

what anterior pituitary pathology can cause hyperfunction?

A

adenoma

carcinoma

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7
Q

what anterior pituitary pathology can cause hypofunction?

A 
surgery/radiation
sudden haemorrhage into gland
ischaemic necrosis (sheehan syndrome)
tumours extending into sella
inflammatory conditions (sarcoidosis)
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8
Q

what posterior pituitary pathology can cause decreased ADH secretion?

A

diabetes insipidus

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9
Q

what posterior pituitary pathology can cause increased ADH secretion?

A

SIADH

  • ectopic secretion of ADH by tumours
  • primary disorder in pituitary
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10
Q

what is a pituitary adenoma and what causes it?

A

tumour derived from cells of anterior pituitary

can be sporadic or associated with MEN1 gene (wermer syndrome)

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11
Q

what are the possible complications of a large adenoma?

A

visual field defects
atrophy of surrounding normal tissue
infarction leading to panhypopituitarism

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12
Q

classification of pituitary adenoma?

A 
by cell type/hormone produced
prolactin
ACTH
FSH/LH
GH
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13
Q

name 3 functional pituitary adenomas

A

prolactinoma (most common)
growth hormone secreting (2nd most common)
ACTH secreting (cushings)

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14
Q

possible features of functional pituitary adenomas?

A

prolactinoma = infertility, amenorrhoea, lack of libido
GH secreting = bone, cartilage and connective tissue growth - gigantism/acromegaly
ACTH secreting = cushings

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15
Q

what usually causes pituitary hypofunction?

A 
panhypopituitarism
causes
- granulomatous inflammation - sarcoidosis
- infarction (shehans)
- primary or metastatic tumours
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16
Q

what is craniopharyngioma?

A

tumour derived from remnants of rathkes pouch

slow growing, often cystic, can calcify, most are suprasellar

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17
Q

how do craniopharyngiomas present?

A

usually 5-15 yrs old or 60s-70s
headaches and visual disturbances
children may have growth retardation
excellent prognosis

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18
Q

name 2 syndromes of the posterior pituitary?

A

diabetes insipidus
SIADH secretion
- paraneoplastic syndrome of ectopic ADH production

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19
Q

what are the 2 types of diabetes insipidus?

A 
central
- ADH deficiency
- trauma, tumours and inflammatory disorders of hypothalamus/pituitary
nephrogenic
- renal resistance to ADH effects
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20
Q

what are the 2 compartments of the adrenal gland?

A

outer cortex
central medulla
(capsule surrounds gland)

21
Q

what other diseases may manifest as adrenal pathology?

A

pituitary disease (ACTH from functional adenoma)
Shock/DIC
any condition which destroys adrenal tissue

22
Q

3 causes of adrenal hyperfunction?

A

hyperplasia
adenoma
carcinoma

23
Q

2 types of adrenal hypofunction and what causes them?

A

acute
- waterhouse-friderichsen
chronic
- addisons disease

24
Q

what causes congenital adrenocortical hyperplasia and what happens as a result?

A

group of autosomal recessive disorders causing deficiency/lack of enzyme required for steroid synthesis
altered synthesis leads to increased androgen production
reduced cortisol stimulates ACTH release and cortical hyperplasia
- can cause masculinisation or precocious puberty

25
Q

what causes acquired adrenocortical hyperplasia and what happens?

A

endogenous ACTH production
- pituitary adenoma
- ectopic ACTH (paraneoplastic syndrome from small cell lung cancer)
causes bilateral enlargement of adrenal glands
- can be diffuse (ACTH dependant) or nodular (ACTH independent)

26
Q

what is adrenogenital hyperplasia?

A

congenital adrenal hyperplasia

27
Q

how does an adrenocortical tumour usually present?

A 
mainly adults
more males
incidental finding (imaging etc)
hormonal affects
mass lesion
carcinomas with necrosis can cause fever
28
Q

describe adrenocortical adenoma?

A 
well circumscribed, encapsulated lesion
2-3 cm
yellow/yellow brown
cut surface (lipid)
cells resembling adrenocortical cells
can be functional but usually not
small nuclei, rare mitosis
29
Q

describe an adrenocortical carcinoma

A

more likely to be functional, virilising tumours usually malignant
can resemble adenoma
spread
- local invasion
- metastases (usually vascular - liver etc)
- peritoneum and pleura
- regional lymph nodes

30
Q

what features can help distinguish adrenocortical carcinoma from adenoma?

A 
large size (often >20cm)
haemorrhage and necrosis
frequent/atypical mitosis
lack of clear cells (still cytoplasm etc within the cells)
capsular or vascular invasion
31
Q

what are the two types of adrenocortical hypofunction?

A

primary (acute/chronic)

secondary

32
Q

what causes secondary adrenocortical hypofunction?

A

failure to stimulate adrenal cortex (e.g hypopituitarism)

suppression of adrenal cortex (steroid therapy)

33
Q

what causes acute primary adrenocortical insufficiency?

A

rapid withdrawal of steroid treatment
massive adrenal haemorrhage
crisis in patients with chronic adrenocortical insfficiency

34
Q

what causes chronic adrenocortical insufficiency?

A 
addisons disease
autoimmune adrenalitis
infections
metastatic malignancy
unusual causes (amyloid, sarcoidosis, haemochromatosis)
35
Q

when do symptoms occur in chronic adrenocortical insufficiency?

A

once 90% of gland is destroyed

36
Q

what are the symptoms of addisons disease?

A

insidious onset
weakness, fatigue, anorexia, nausea, vomiting, weight loss, diarrhoea
pigmentation (raised POMC)

37
Q

what are the biological features of addisons disease?

A

decreased mineralocorticoids
- K+ retention, Na+ loss
- volume depletion and hypotension
hypoglycaemia

38
Q

what can cause crisis in addisons disease?

A 
stress - infection, trauma, surgery
features 
- vomiting
- abdo pain
- hypotension
- shock
- death
39
Q

describe the anatomical features of the adrenal medulla?

A

innervated by pre-synaptic fibres from sympathetic NS

neuroendocrine (chromaffin) cells secrete catecholamines

40
Q

what tumours can occur in the adrenal medulla?

A

phaeochromocytoma

neuroblastoma

41
Q

what is a neuroblastoma?

A

composed of primitive appearing cells but can show maturation and differentiation towards ganglion cells
40% in adrenal medulla, rest usually in sympathetic chain
diagnosed <18 months

42
Q

what is a phaeochromocytoma?

A

neoplasm derived from chromaffin cells of the adrenal medulla
secrete catecholamines
rare cause of secondary hypertension

43
Q

what are the features of phaemochromocytoma?

A

paroxysmal episodes of hypertension
- associated with stress, exercise, posture etc
complications
- cardiac failure, infarction, arrhythmias
- CVA

44
Q

how is phaemochromocytoma diagnosed?

A

detection of urinary excretion of catecholamines and metabolites

45
Q

“10% tumour”?

A 
phaeochromocytoma
10% extra-adrenal
10% bilateral
10% malignant
10% not associated with hypertension
25% are familial
46
Q

what does a phaeochromocytoma look like?

A

range from small to large (1g - 2Kg)
may see adrenal remnants on surface
yellow, red/brown to haemorrhagic and necrotic
K2Cr2O7 will turn tumour dark brown due to oxidation of catecholamines in tumour cells

47
Q

benign vs malignant phaeochromocytoma?

A

malignant

  • tend to be large and necrotic
  • metastases = only definite evidence of malignancy
48
Q

where is a phaeochromocytoma likely to metastasise?

A

skeletal
regional lymph nodes
liver
long

49
Q

phaeochromocytoma is a feature of what other neoplastic disease?

A

multiple endocrine neoplasia

  • MEN2A (sipple syndrome)
  • MEN2B

Endocrine (45 decks)

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