pituitary 2

Question 1

adrenocorticotrophic hormone hyperfunction

Answer 1

Cushing disease

Question 2

adrenocorticotrophic hormone (ACTH) hypofunction

Answer 2

hypoadrenalism

Question 3

follicle stimulating hormone (FSH) luteinising hormone (LH) hyperfunction

Answer 3

usually silent, sometimes menstrual abnormalities, testicular enlargement, fertility issues

Question 4

FSH or LH hypo function

Answer 4

hypogonadism

Question 5

growth hormone hyper function

Answer 5

acromegaly

Question 6

growth hormone hypoofunction

Answer 6

decreased muscle mass, fatigue, some forms of dwarfism

Question 7

TSH hyperfunction

Answer 7

hyperthyroidism - but more often due to thyroid disease

Question 8

TSH hypofunction

Answer 8

hypothyroidism

Question 9

PRL hyperfunction

Answer 9

hyperprolactinaemia

Question 10

PRL hypofunction

Answer 10

isolated deficiency rare, causes lactation failure if breastfeeding

Question 11

plurihormonal hypofunction

Answer 11

panhypopituitarism

Question 12

vasopressin hyperfunction

Answer 12

SAIDH

Question 13

vasopressin hypofunction

Answer 13

diabetes insipidus

Question 14

oxytocin excess or deficiency

Answer 14

not associated with clinical disease

Question 15

hyperpituitarism

Answer 15

• excess secretion of pituitary hormones - anterior and posterior have different causes and effects

Question 16

causes of pituitary hyper function

Answer 16

• pituitary adenoma
• secondary hyperplasia (increased stimulation of the hypothalamus
• pituitary carcinoma (rare)

Question 17

pituitary adenoma

Answer 17

• slow growing tumours, benign, epithelial with neuroendocrine phenotype
• clinical proliferation of one type of pituitary cell
• arise in the anterior pituitary

Question 18

mass effect in pituitary adenomas

Answer 18

• raised intracranial pressure
• bony erosion
• local pressure on third ventricle, hypothalamus, optic chiasma (giving bi temporal hemianopia) or cranial nerves 3, 4, 5, 6

Question 19

altered hormonal secretion

Answer 19

• anterior, posterior or both
• hyperpituitarism - hormones produced by neoplastic cells
• hypopituitarism - normal pituitary compressed by tumour, becomes atrophic or ischaemic

Question 20

most common cause of hyperpituitarism

Answer 20

pituitary adenoma

Question 21

micro adenoma

Answer 21

<1cm

Question 22

macro adenoma

Answer 22

> 1cm

Question 23

pathological phenotypes of pituitary adenomas

Answer 23

1. immunohistochemical phenotype
2. H&E cell type (acidophil, basophil, chromophore adenoma)
3. ultrastructural phenotype based on size and morphology of granules

Question 24

functional (secretory) adenomas

Answer 24

• lactotroph/prolactinoma - amenorrhea, galatorrhoea, infertility, loss of libido
• somatotroph - gigantism, acromegaly
• corticotroph - Cushing’s disease
• plurihormonal -
• gonadotroph - secrete hormones inefficiently and variably, difficult to recognise, grow and have mass effects and paradoxical hypopituitarism
• thyrotroph

Question 25

non functional adenomas

Answer 25

null-cell adenomas

- these usually still express hormonal markers by immunohistochemistry

Question 26

other causes of hyperprolactinaemia

Answer 26

can occur due to physiological hyperplasia - pregnancy, lactation
head trauma or mass effect

Question 27

acromegaly/gigantism

Answer 27

• excess growth hormone
• enlargement of hands, thickening of the skin, skull bones, macroglossia, wide spaced teeth, hyperpigmentation, seborrhoea
• severe headache, arthritis, cardiomegaly, hepatic fibrosis, insulin resistance (T2D), renal failure

Question 28

acromegaly is when

Answer 28

• happens after growth plates are fused

Question 29

gigantism is when

Answer 29

happens before the growth plates are fused

Question 30

atypical adenoma and carcinoma

Answer 30

anterior pituitary

• rare, usually non-function
• invasive, high mitotic rate, pleomorphism

Question 31

craniopharyngioma

Answer 31

• mostly in childhood, early adulthood
• derived from rathke’s pouch remnants
• often large, 3-4cm, cystic, calcified
• history recapitulates enamel organ of tooth embedded in fibrous stroma
• usually benign but often locally invasive, difficult to treat

Question 32

secondary neoplasms in the pituitary

Answer 32

more common in the posterior pituitary, may present as diabetes insidious (breast and lung are commonest primary sites)