Pathology of the Pituitary Gland (Handorf)

Question 1

What bony landmarks surround the pituitary?

Answer 1

sella turcica

ant. and post. clinoid processes

Question 2

Why is an MRI better for viewing the pituitary than a CT?

Answer 2

no bony artifact

Question 3

The 50% of cells in the pituitary secrete what hormone?

Answer 3

GH

Question 4

Cells secreting ____ have the largest secretory granule diameter.

Answer 4

PRL

Question 5

How can you tell if you are looking at a histological image of the anterior pituitary (rather than the posterior)?

Answer 5

high vascularization in anterior pituitary

Question 6

What are common causes of hypopituitarism?

Answer 6

1. post-srx
2. post-radiation
3. cysts
4. tumors
5. ischemia or hemorrhage
6. inflmm
7. empty sella syndr
8. gene deficit

Question 7

Which lobe is often affected by an infarction?

Answer 7

anterior

Question 8

What percentage of the lobe must be lost due to infarction before symptoms occur? Why?

Answer 8

75%; the lobe has a greater capacity than is actually needed for function

Question 9

What are common causes of pituitary infarction?

Answer 9

DM
CVA
Increased intracranial pr
hypoperfusion
Sheehan's
Pituitary apoplexy

Question 10

When does Sheehan’s present?

Answer 10

~1 month postpartum

Question 11

What inflammatory lesions may cause hypopituitarism?

Answer 11

1. acute inflammation (sinusitis, osteomyelitis)
2. granulomatous inflmm (TB, sarcoid, fungal, giant cell)
3. lymphocytic (autoimmune)

Question 12

What anatomic location does granulomatous inflammation favor?

Answer 12

base of brain (i.e. where the pituitary is located!)

Question 13

What are common causes of hyperpituitarism?

Answer 13

1. hyperplasia
2. pituitary adenoma
3. ectopic secretion by nonpituitary tumor
4. hypothalamic disorder

Question 14

What would pituitary hyperplasia look like histologically?

Answer 14

nodular or diffuse pattern of gland involvement, with increased cell number

Question 15

Epidemiology of pituitary adenomas

Answer 15

30-50 y/o

Question 16

What would affect how quickly a pituitary adenoma was detected?

Answer 16

if it is functional or nonfunctional

Question 17

What is a possible serious symptom of pituitary adenomas?

Answer 17

with increased size, it can compress on the optic chiasm

Question 18

What is the most common type of pituitary adenoma?

Answer 18

prolactin cell adenoma

Question 19

What is notable about the frequency of GH cell adenomas?

Answer 19

~50% of the cells in the pituitary produce GH, but they only account for 5% of pituitary adenomas

Question 20

Gross morphology of pituitary adenomas?

Answer 20

well circumscribed, macro or micro lesion; if large enough, may extend into suprasellar region

Question 21

Histology of pituitary adenomas?

Answer 21

sheet-like growth pattern with relative cellular monomorphism and loss of reticular network

note: functional status cannot be predicted from routine histo appearance

Question 22

How can you confirm that a tumor is a pituitary adenoma?

Answer 22

immunohistochemical stains

Question 23

He didn’t cover a ton of slides.

Answer 23

Can we assume we aren’t responsible?