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Year 2 > Pathology of the pituitary and the adrenal gland > Flashcards

Pathology of the pituitary and the adrenal gland Flashcards

1
Q

What is the adenohypophysis?

A

Anterior pituitary

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2
Q

What is the neurohypophysis?

A

Posterior pituitary

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3
Q

What trophic hormones does the anterior pituitary secrete?

A

Adrenocorticotrophic hormone
Follicular stimulating hormone
Luteinizing hormone
Thyroid stimulating hormone

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4
Q

What non-trophic hormones does the anterior pituitary secrete?

A

Growth hormone

Prolactin

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5
Q

What is a trophic hormone?

A

Hormones that act upon endocrine glands

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6
Q

What does the posterior pituitary secrete?

A

Anti-diuretic hormone/vasopressin

Oxytocin

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7
Q

What colour do acidic cells show up on H&E staining? What about alkaline cells?

A

Acidic - pink

Alkaline - purple

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8
Q

Are the cells which secrete the non trophic hormones acidic or alkaline?

A

Acidic (i.e pink)

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9
Q

Which pathologies of the anterior pituitary gland can cause hyperfunction?

A

Adenoma

Carcinoma

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10
Q

Which pathologies of the anterior pituitary gland can cause hypofunction?

A 
Surgery
Radiation
Sheehan syndrome/ischaemic necrosis
Haemorrhage
Tumours
Sarcoidosis (& other inflammatory conditions)
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11
Q

List some common pathologies of the posterior pituitary

A

Diabetes insipidus

Syndrome of inappropriate ADH secretion (SIADH)

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12
Q

What extra-pituitary cause is there for SIADH?

A

Paraneoplastic/ectopic production

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13
Q

What is diabetes insipidus?

A

Insufficient ADH secretion causing dehydration

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14
Q

Is pituitary adenoma associated with MEN1 or MEN2?

A

MEN1

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15
Q

How are pituitary adenomas classified?

A

Cell type/hormone produced

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16
Q

Which types of pituitary adenomas can you develop?

A 
Prolactinoma
ACTH-oma
GH-oma
FSH/LH-oma
TSH-oma
Mixed
Hypofunctioning/non-functioning
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17
Q

Is it possible to have a pituitary adenoma with subclinical hormone production levels?

A

Yes

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18
Q

What are the mass effects of large pituitary adenomas?

A

Bitemporal hemianopsia
Pressure atrophy
Infarction –> panhypopituitarism

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19
Q

What is the most common functional pituitary adenoma?

A

Prolactinoma

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20
Q

How does a prolactinoma present?

A

Lack of libido
Amenorrhoa
Infertility

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21
Q

Growth hormone causes the production of which substance?

A

Insulin like growth factor 1

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22
Q

How does a growth hormone producing adenoma present?

A

Increased growth of bone, cartilage and connective tissue:

  • Acromegaly (adults)
  • Gigantism (children)
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23
Q

How does an ACTH producing adenoma present?

A

Cushing’s syndrome

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24
Q

What are the two commonest causes of Cushing’s syndrome?

A

Bilateral adrenal hyperplasia

ACTH secreting pituitary adenoma

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25
Q

Are pituitary carcinomas most commonly functional or non-functional?

A

Functional

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26
Q

List some possible causes of panhypopituitarism

A 
Rathke cleft cysts
Traumatic brain injury
Subarachnoid haemorrhage
Surgery
Radiation
Granulomatous inflammatory disease (sarcoidosis, TB)
Sheehan's syndrome 
Apoplexy/bleeding from internal organ
Hypothalamic tumours
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27
Q

How might a pituitary apoplexy present?

A 
Headache
Diplopia 
Hypopituitarism
Cardiovascular collapse
Loss of consciousness
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28
Q

Why might diplopia result in a pituitary apoplexy?

A

Haemorrhage puts pressure on the oculomotor nerve

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29
Q

Apart from panhypopituitarism what else might hypothalamic tumours cause?

A

Diabetes insipidus

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30
Q

What is a cricopharyngioma derived from?

A

Rathke’s pouch remnants

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31
Q

Are most cricopharyngiomas sellar or suprasellar in location?

A

Suprasellar

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32
Q

Which age groups do cricopharyngiomas present in?

A

Young*

Old

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33
Q

How do cricopharyngiomas present?

A

Headaches
Visual disturbances (nerve palsies, etc)
Growth retardation

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34
Q

How are cricopharyngiomas treated?

A

Radiation

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35
Q

What are the possible causes of central diabetes insipidus?

A

Trauma
Iatrogenic
Inflammatory disorders
Tumours

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36
Q

What is the cause of nephrogenic diabetes insipidus?

A

Renal resistance

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37
Q

What is the most common underlying cause behind syndrome of inappropriate ADH secretion?

A

Paraneoplastic syndrome

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38
Q

Where do the adrenal glands sit in relation to the kidneys?

A

Superior and medial

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39
Q

What are the two parts of the adrenal glands?

A

Outer cortex

Inner medulla

40
Q

What type of hormone does the cortex secrete?

A

Steroid

41
Q

What type of hormone does the medulla secrete?

A

Catecholamines

42
Q

What are the three zones of the adrenal cortex?

A

Zona glomerulosa, fasiculata and reticularis (Get Fucked Robyn)

43
Q

What do the zones of the adrenal cortex secrete?

A

Glomerulosa - mineralocorticoids
Fasiculata - glucocorticoids
Reticularis - sex steroids

44
Q

Name a mineralocorticoid and a glucocorticoid

A

Aldosterone

Cortisol

45
Q

Which type of cells secrete catecholamines?

A

Neuroendocrine/chromaffin

46
Q

What is the adrenal medulla innervated by?

A

Pre-synaptic sympathetic nerve fibres

47
Q

Which conditions not affecting the adrenals directly can affect adrenal functioning?

A

Pituitary disease
Shock
Disseminated intravascular coagulation

48
Q

Is congenital adrenal hyperplasia autosomal dominant?

A

No autosomal recessive

49
Q

How does congenital adrenal hyperplasia cause adrenal pathology?

A

Altered enzyme pathways cause an increase in androgen production
Reduced cortisol stimulates ACTH release and hyperplasia

50
Q

How does congenital adrenal hyperplasia present?

A

Masculinisation

Precocious puberty

51
Q

What are the underlying causes behind acquired adrenal hyperplasia?

A 
Pituitary adenoma (cushing's)
Ectopic ACTH (paraneoplastic)
52
Q

What is the difference between nodular and diffuse acquired adrenal hyperplasia in terms of ACTH?

A

Diffuse usually ACTH dependent

Nodular usually ACTH independent

53
Q

Which age group gets adrenal tumours?

A

Adults

54
Q

In which condition do children get adrenal tumours?

A

Li-Fraumeni syndrome

55
Q

How do adrenal tumours present?

A

Hormonal effects
Mass effects
Fever of unknown origin (carcinoma w/ necrosis)
Incidental

56
Q

Are adrenal adenomas typically functional?

A

No

57
Q

How common is adrenal cancer?

A

Rare

58
Q

Are adrenal cancers typically functional?

A

Yes (virilising)

59
Q

How does adrenal cancer typically spread?

A

Local
Vascular metastases
Peritoneum
Regional lymph nodes

60
Q

What are the features of an adrenal mass that would suggest cancer?

A

Large >20cm
Haemorrhage +/- necrosis
Capsular or vascular invasion
Histological signs

61
Q

What pathology of the adrenal glands is primary aldosteronism (conn’s) associated with?

A

Bilateral hyperplasia (common)
Adenoma
Glucocorticoid remediable

62
Q

What is glucocorticoid remediable primary aldosteronism an is it ACTH linked?

A

Rare genetic disorder and yes

63
Q

What is the underlying mechanism behind secondary aldosteronism?

A

Increased renin

64
Q

What causes secondary aldosteronism?

A

Decreased renal perfusion
Pregnancy
Hypovolaemia

65
Q

Hypercortisolism is endogenous. T/F

A

False - non specific term which can refer to endogenous or exogenous pathologies

66
Q

What is the cause of exogenous hypercortisolism?

A

Steroid therapy (iatrogenic)

67
Q

How can the endogenous causes of hypercortisolism be divided?

A

ACTH dependent

ACTH independent

68
Q

What is cushing’s disease?

A

A ACTH secreting pituitary adenoma

69
Q

What is the most common source of ectopic ACTH production?

A

Small cell lung cancer

70
Q

What are the ACTH dependent mechanisms of hypercortisolism?

A

Cushing’s

Ectopic production

71
Q

What are the ACTH independent mechanisms of hypercortisolism?

A

Adrenal adenoma
Adrenal carcinoma
Non-lesional atrophy

72
Q

How can primary causes of adrenal insufficiency be divided?

A

Acute

Chronic

73
Q

What are the acute causes of adrenal insufficiency?

A

Withdrawal of steroid treatment
Crisis induced in chronic insufficiency patients (e.g infeciton)
Adrenal haemorrhage

74
Q

What are the causes of adrenal haemorrhage?

A

Newborn babies
Septicaemia –> waterhouse-fruderuchsen syndrome
Anticoagulation treatment
Disseminated intravascular coagulation

75
Q

What are the chronic causes of adrenal insufficiency?

A 
Addison's disease/autoimmune adrenalitis
Infection (TB, fungal, HIV)
Metastatic malignancy
Amyloidosis
Sarcoidosis
Haemochromatosis
76
Q

Does addison’s disease develop fast or slow?

A

Slowly

77
Q

How does Addison’s disease present?

A 
Weakness
Fatigue
Anorexia
Vomiting
Weight loss
Diarrhoea 
Palmer pigmentation
78
Q

Why does palmer pigmentation result in addison’s disease and no hypopituitarism?

A

Raised proopiomelanocortin only occurs in addison’s

79
Q

What is the effect of decreased mineralocorticoids in addison’s disease?

A

Potassium retention
Sodium loss
Volume depletion
Hypotension

80
Q

What is the effect of decreased glucocorticoids in addison’s disease?

A

Hypoglycaemia

81
Q

How does an addison’s crisis present?

A 
Inducted by stress (infection, trauma, surgery, etc)
Vomiting
Abdominal pain
Hypotension
Shock
82
Q

When is a neuroblastoma diagnosed?

A

Children and infants

83
Q

Where do neuroblastomas arise?

A

Adrenal medulla

Sympathetic chain

84
Q

How is the prognosis of a neuroblastoma affected by age?

A

The younger the patient the better the prognosis

85
Q

What is a phaeochromocytoma derived from?

A

Chromaffin cells of the adrenal medulla

86
Q

What do phaeochromocytomas secrete and what can this cause?

A

Catecholamines

Secondary hypertension

87
Q

How does a phaeochromocytoma present?

A

(Paroxysmal) hypertension (younger patients)
Aggravated by exercise, posture, stress
Micturation (bladder involvement)

88
Q

What are the complications of phaeochromocytoma?

A

Heart failure
MI
Arrhythmia
CVA

89
Q

How is phaeochromocytoma diagnosed?

A

Catacholeamines in urine

90
Q

Why is phaeochromocytoma called the 10% tumour?

A 
Bilateral
Extra-adrenal
Familial
Malignant
Not associated with hypertension
91
Q

What are extra-adrenal phaeochromocytomas called and where are they found?

A

Paraganglioma

Carotid body

92
Q

Where do cancerous phaeochromocytomas usually metastasise to?

A

Bone (common)
Lymph nodes
Liver
Lung

93
Q

What are the two classifications of multiple endocrine neoplasia type 2?

A

Type 2A - Sipple syndrome

Type 2B

94
Q

What mutation is multiple endocrine neoplasia type 2 associated with?

A

RET

95
Q

What are the features of sipple sydrome?

A

Phaeochromocytoma
Medullary thyroid cancer
Parathyroid hyperplasia

96
Q

What are the features of MENT2B?

A

Phaeochromocytoma
Medullary thyroid cancer
Marfinoid habitus
Neuroma/ganlioneuroma

Year 2 (72 decks)

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