Pathology of the pituitary gland

Question 1

Which lobe of the pituitary is more vascularized and why? This confers what kind of susceptibility?

Answer 1

Anterior- distribution of hormones
Posterioris more neuronal in nature.

Therefore, the anterior lobe is more likely to suffer with profound hypotension.

Question 2

3 cell types of the pars distalis

Answer 2

chromophobes, acidophils, basophils

Question 3

T or F All granules secreted from the anterior pituitary, no matter the hormone, are the same size.

Answer 3

False. There is some correlation between size of granule and hormone secreted

Question 4

What color are basophils?

Answer 4

blue

Question 5

Embryological development of ant pit?#

Answer 5

Develop from invagination of oral ectoderm call ed pouch of Rathke.

Question 6

Embryological development of post pit#

Answer 6

Forms from neuroectoderm derived from hypothalamus. Fuses with pouch of rathke.

Question 7

Causes of hypopituitarism? Which of these is most common?

Answer 7

Surgery, radiation, cysts, tumors, ischemia/hemorrhage, inflammation, empty sella syndrome, gene defect

Tumor is most common, most commonly adenoma

Question 8

About ____% of anterior lobe must be lost for symptoms to occur post infarction.

Answer 8

75– We have more endocrine capacity than we need

Question 9

Which lobe is usually affected by infarction?

Answer 9

Anterior

Question 10

There is damage to the pituitary stalk affected anterior and posterior pituitary. What is the only hormone that will have increased secretion?#

Answer 10

Prolactin

Question 11

Causes of pituitary infarction

Answer 11

DM, CVA, ICP, hypoperfusion of any cause, sheehan’s, pituitary apoplexy

Question 12

What is pituitary apoplexy?#

Answer 12

Sudden hemorrhage into the gland usually due to adenoma

Question 13

Histologically, what will infarct of the pituitary look like?

Answer 13

Loss of nuclei, ghost cells

Question 14

How can pituitary adenomas cause hypopituitarism?#

Answer 14

mass effect or pituitary apoplexy

Question 15

What happens to the pituitary gland in pregnancy?#

Answer 15

doubles in size without a significant increase in blood supply

Question 16

What inflammatory lesions can cause pituitary damage?

Answer 16

Acute inflammation (sinusitis, osteomyelitis), granulomatous (TB, fungal, sarcroid, idiopathic giant cell granuloma), lymphocytic (autoimmune)

Question 17

Granulomas tend to affect the _____.

Answer 17

skull base (pituitary)

Question 18

Describe sarcoidosis affecting the pituitary.

Answer 18

Rule of TB. Tx with steroids. 
#Look for Shaumann bodies and asteroid bodies withing giant cells. Remember GRAIN (gammaglobulinemia, RF, ACE increase, Interstitial fibrosis, Noncaseating granuloma).  Produce elevated 1,25 (OH2)VD--> hypercalciuria +/- hypercalcemia

Question 19

Things causing hyperpituitarism

Answer 19

hyperplasia, pituitary adenoma, ectopic secretion, hypothalamic disorder

Question 20

Is pituitary hyperplasia common?

Answer 20

No

Question 21

Addison’s is an example of ____ hyperplasia.

Answer 21

ACTH

Question 22

Pituitary adenomas make up ___% of intracranial neoplasms.

Answer 22

10

Question 23

What age groups sees more pituitary adenomas?

Answer 23

30-50

Question 24

Are pituitary adenomas usually isolated or associated with other syndromes?

Answer 24

Usually isolated

Question 25

What kind of pituitary adenomas are detected early on?

Answer 25

Functioning

Question 26

What symptoms are caused by pituitary adenoma mass effect?#

Answer 26

bitemporal hemianopsia, hypopituitarism, headache

Question 27

Most common functional pituitary adenoma

Answer 27

prolactin adenoma

Question 28

Histopathology of pituitary adenoma

Answer 28

Sheet like growth pattern, relative monomorphism, loss of typical reticular fiber network, functional status cannot be predicted from histo appearance, immunohistochemical stain can be confirmatory

Question 29

What is a craniopharygioma?#

Answer 29

Congenital tumor arising from remnants of Rathke pouch. Most common cause of hypopituitarism in children.

Question 30

What does craniopharyngioma look like histologically? (wiki)

Answer 30

nesting squamous epithelium, calcium deposits, cystic spaces. Can be papillary or adamantinomatous,