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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 embryological origin of the anterior pituitary?

A

Rathkes pouch

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2
Q

What are the trophic hormones?

A

TSH
ACTH
FSH
LH

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3
Q

What are the non trophic hormones?

A

GH

Prolactin

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4
Q

What is the embryological origin of the posterior pituitary?

A

Extension of neural tissue and modified gliacl cells and axonal processes

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5
Q

What does the posteiror pituiary secrete?

A

ADH

Oxytocin

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6
Q

What does the anteiror pituitary look like histologically?

A 
Islands
Cords of cells
Aciodphils
Basophils
Chromophobe
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7
Q

What are the different types of aciodophils and what do they secrete?

A

Somatotrophs - GH

Mammotrophs - PRL

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8
Q

What are the different types of basophils and what do they secrete?

A

Corticotrophs - ACTH
Thyrotrophs - TSH
Gonadotrophs - FSH/LH

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9
Q

What does the posterior pituitary look like histologically?

A

Non-myelinated axons of neurosecretory neurones

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10
Q

What can cause hyperfunction of the anterior pituitary?

A

Adenoma

Carcinoma

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11
Q

What can cause hypofunction of the anterior pituitary?

A 
Surgery/radiation
Sudden haemorrhage into the gland
Ischaemic necrosis - sheehan syndrome
Tumours extending into sella
Inflammatory conditions (sarcoid)
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12
Q

What are common pathologies of the posterior pituitary?

A

Diabetes insipidus

SAIDH

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13
Q

What can cause SIADH?

A

Ectopic secretion by tumours

Primary disorder of the pituitary

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14
Q

What causes diabetes insipidus?

A

Lack of ADH secretion

Life theratning dehydration

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15
Q

How are pituitary adenomas classed?

A 
By the cell type/ hormone produced: 
Prolacinoma (20-30%)
ACTH (10-15%)
FSH/LH (10-15%)
GH (5%) 
Hypo/non-functional (25-30%)
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16
Q

What other features can a large adenoma have?

A

Visual field defects
Pressure strophy of surrounding normal tissue
Infarction to panhypopituitarism

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17
Q

What will a prolactinoma cause?

A

Infertility
Lack of libido
Amenorrhoea

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18
Q

What will a GH secreting adnoma cause?

A

Growth of bone, cartilage and connective tissue causing gigantism or acromegaly

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19
Q

What will an ACTH secreting adenoma cause?

A

Cushings disease

Bilateral adrenocortical hyperplasia

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20
Q

What can cause panhypopituitarism?

A

Granulomatous inflammation - sarcoidosis
Infarction - sheehan’s syndrome
Primary or metastatic tumours

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21
Q

What is the origin of a craniopharyngioma?

A

Rathke’s pouch

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22
Q

What is the growth like of a craniopharyngioma?

A

Slow growing, cystic, calcification

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23
Q

What are the common symptoms of a craniopharyngioma?

A

Headaches and visual disturbances - children may have growth retardation

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24
Q

What are the different types of diabetes insipidus?

A

Central - ADH deficiency, trauma

Nephrogenic

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25
Q

Where does the adrenal gland sit?

A

Superior and medial to the upper pole of the kidneys

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26
Q

What is the adrenal gland composed of?

A

Outer cortex and central medulla

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27
Q

What can adrenal pathology be a manifestation of?

A

Pituitary disease

Shock/DIC

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28
Q

What can cause hyperfunction of the adrenal cortex?

A

Hyperplasia
Adenoma
Carcinoma

29
Q

What can cause hypofunction of the adrenal cortex?

A

Acute: waterhouse friderichsen
Chronic: addisons

30
Q

What is waterhouse friderichesen?

A

Adrenal gland failure due to bleeding into the adrenal glands, commonly caused by severe bacterial infection. Typically it is caused by Neisseria meningitidis

31
Q

What can congenital adrenocortical hyperplasia lead to?

A

Increased androgen production – masculinisation, precocious puberty

32
Q

What can cause endogenous ACTH production?

A 
Pituitary adenoma (cushings) 
Ectopic ACHT - paraneoplastic syndorme such as in small cell lung cancer
33
Q

What can cause acquire adrenocortical hyperplasia?

A

Endogenous ACTH production
Bilateral adrenal enlargement
Diffuse or nodular

34
Q

In what condition can an adrenocortical tumour occur in children?

A

Li-Fraumeni syndrome - germline mutation of p53

35
Q

What is the presentation of adrenocortical tumours?

A

Incidental finding
Hormonal effects
Mass lesion
Carcinomas with necrosis can cause fever

36
Q

What will an adrenocortical adenoma look like?

A

Well cirumscribed - encapsulated lesion
Small
Yellow/brown cute surface

37
Q

What will the cells look like in adrenocortical adenomas?

A

Cells resembling adrenocorticl cells

Well differentiated, small nuclei, rare mitoses

38
Q

Where will adrenocortical carinomas spread?

A

Localy - retroperitoneum, kidney
Metastasis - liver, lung and bone
Peritoneum and pleura
Regional lymph nodes

39
Q

What are the survival rates for adrenocortical carcinomas?

A

5 year survival is 20-35%

50% dead in 2 years

40
Q

What features suggest an adrenocortical tumour?

A 
Large size 
Haemorrhage and necrosis
Frequent mitosis, atypical mitoses
Lack of clear cells
Capsualr or vascualr invasion
41
Q

What is primary hyperaldosteronism?

A

Conn’s syndrome

42
Q

What are the presenting features of conn syndrome?

A

Hypokalaemia - fatigue, numbness, increased urination, increased thirst, muscle cramps, muslce weakness

43
Q

What will an adenoma causing primary hyperaldosteronism look like?

A

Solitary, small, bright yellow
Buried within the gland
Spiranolacton bodies
Do not supress ACTH so adjacenet and contralateral adrenal tissue is not atrophic

44
Q

What are the different types of cushings syndrome?

A

Cushings disease

Endogenous - ACTH dependent, ACTH independent

45
Q

What can cause adrenocortical hypofunction?

A

Failure to simulate adrenal cortex - hypothalamic-pituitary disorder
Supression of adrenal cortex - treatment with steroids

46
Q

What causes acute primary adrenocortical insufficiency?

A

Rapid withdrawel of steroid treatment
Crisis in patients with chronic adrenocortical insufficiency due to stress - infection, no increasing dose of steroid treatment
Massive adrenal haemorrhage

47
Q

What can cause massive adrenal haemorrhage?

A

Newborn
Anticoagulant treatment
DIC
Septicaemic infection -waterhouse friderichsen

48
Q

What can cause chronic primary adrenocortical insufficiency?

A

Addison’s disease

49
Q

What can cause addisons disease/

A

Autoimmune
Infections - TB, fungal (histplasma), HIV (kaposi’s sarcoma)
Metastatic malignancy (lung, breast)
Amylid, sarcoid, haemachromatosis

50
Q

What are the symptoms of addisons disease?

A

Weakness, fatigue, anorexia, N+V, Wt loss, diarrhoea

Pigmentation (raised POMC)

51
Q

What biochemical signs will addisons show?

A

K+ retention
Na+ loss
Hyperkalaemia, hyponatraemia, volume depletion, hypotension
Hypoglycamia

52
Q

What will an addisonian crisis show?

A

Stress - infection, trauma or surgery

Vomiting, abdo pain, hypotension, shock and death

53
Q

What innervates the adrenal medulla?

A

Pre-synaptic fibres from the sympathetic nervous system

54
Q

What cells make up the adrenal medulla?

A

Neuroendocrine (chromaffin) cells

55
Q

What tumours affect the adrenal medullar?

A

Phaeochromocytoma

Neuroblastoma - paeds

56
Q

When are neuroblastomas commonly diagnosed?

A

18 months

57
Q

What causes a neurblastoma?

A

Amplification of N-myc and expression of telmoerase

58
Q

What is a phaeochroomocytoma?

A

Neoplasm derived from chromaffin cells of the adrenal medulla
Secrete catecholamines
Secondary hypertension

59
Q

What paroxyxsmal episodes of hypertension are common in a phaeo?

A

Stress, exericse, posture, palpation of tumour

60
Q

What are complications of a phaeochromocytoma?

A

Cardiac failure
Infarction
Arrhythmias
CVA

61
Q

What is the lab diagnosis of a phaechromocytoma?

A

Detection of urinary exretion of catecholamines and metaboltes

62
Q

Where will extre-adrenal phaeochromocytomas be?

A

Paragangliomas

Organs of zuckerkandl

63
Q

What is the rule of 10% of a phaeo?

A 
10% extra-adrenal
10% bilateral
10% biologically malignant
10% NOT associated with hypertension 
25% familal
64
Q

What is teh organ of zuckerkandl?

A

Chromaffin body derived form neural crest located at the bifurcation of the aorta or at the origin of the inferior mesenteric artery

65
Q

What will the adrenal gland look like if there is a phaeochromocytoma?

A

Yellow, red/brown to haemorrhagic and necrotic

66
Q

If the phaeochromocytoma is metastatic where will it commonly metastasize to?

A

Skeletal
Regional lymph nodes
Liver
Lung

67
Q

What is MEN2A?

A

Sipple syndrome;

Phaeochromocytoma, medullary thyroid carcinoma and parathyroid hyperplasia

68
Q

What is MEN2B?

A

Phaeochromocyoma, medullary htyroid carcinoma, neuroma or ganglioineuromas and marfanoid habitus

69
Q

What are the 3 zones of the adrenal cortex?

A

Zona glomerulosa - mineralocorticoids, aldosterone
Zona fasciculata- glucocorticocids, cortisol
Zone reticularis - sex steroids, glucorticoids

Endocrine (35 decks)

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