Pituitary adenoma Flashcards
The normal pituitary is located below the hypothalamus in the _ ; and is about _ cm in length
The normal pituitary is located below the hypothalamus in the sella turcica ; and is about 1 cm in length
The pituitary gland is connected to the hypothalamus via the _
The pituitary gland is connected to the hypothalamus via the infundibulum
Another name for the anterior pituitary is the _
Another name for the anterior pituitary is the adenohypophysis
* Or sometimes called the pars distalis
Another name for the posterior pituitary is the _
Another name for the posterior pituitary is the neurohypophysis
* Sometimes called the pars nervosa
The anterior pituitary is connected to the hypothalamus via _
The anterior pituitary is connected to the hypothalamus via portal vessels
The (anterior/posterior) pituitary is an extension of the hypothalamic neuronal axons
The posterior pituitary is an extension of the hypothalamic neuronal axons
The anterior pituitary takes up about _ % of the pituitary gland
The anterior pituitary takes up about 80% of the pituitary gland
* Posterior is about 20%
The pars intermedia is a rudimentary structure in humans with a main function of producing _
The pars intermedia is a rudimentary structure in humans with a main function of producing melanocyte stimulating hormone (MSH)
What labs should be checked if you suspect hyperprolactinemia?
- Prolactin levels
- FSH, LH, testosterone, estrogen (due to decreased GnRH)
- TSH, T3, T4 (possible increase TRH)
Hyperprolactinemia causes GnRH to _ and manifests as _
Hyperprolactinemia causes GnRH to decrease and manifests as hypogonadotropic hypogonadism (low FSH, LH, estrogen, testosterone)
Primary hypothyroidism has what effect on prolactin?
Primary hypothyroidism –> high TRH –> increases prolactin
Dopamine antagonists (increase/decrease) prolactin levels
Dopamine antagonists increase prolactin levels
* Risperidone
* Haloperidol
* Fluphenazine
* Metoclopramide
Benign pituitary adenoma is a common cause of hyperprolactinemia; it involves proliferation of _ cells
Benign pituitary adenoma is a common cause of hyperprolactinemia; it involves proliferation of lactotrophs
Explain how a non-secreting pituitary adenoma can also increase prolactin levels
Non-secreting pituitary adenoma –> compression of infundibular stalk –> decreases dopamine –> decreases the inhibition of lactotrophs –> increases prolactin
Hyperprolactinemia may present as _ in females
Hyperprolactinemia may present as:
* Lack of ovulation
* Vaginal atrophy
* Infertility/amenorrhea
* Osteroporosis (estrogen protects bones)
Hyperprolactinemia may present as _ in men
Hyperprolactinemia may present as:
* Decreased spermatogenesis
* Galactorrhea (nipple discharge)
* Gynecomastia
Ichemia and infarction of the pituitary following delivery describes _ syndrome
Ichemia and infarction of the pituitary following delivery describes Sheehan syndrome
* Sheehan is one cause of hypopituitarism
Pregnancy causes the pituitary gland to swell due to _ ; this leaves it vulnerable to ischemia
Pregnancy causes the pituitary gland to swell due to production of lactotrophs ; this leaves it vulnerable to ischemia
* Postpartum hemorrhage –> pituitary infarct is known as Sheehan syndrome
Sheehan syndrome might present with lactation failure due to _ deficiency, bradycardia and weight gain due to _ deficiency, and DI due to _ deficiency
Sheehan syndrome might present with lactation failure due to prolactin deficiency, bradycardia and weight gain due to low TSH, and DI due lack of ADH
* Low ACTH, TSH, FSH/LH, GH, prolactin, ADH
Treatment for sheehan syndrome involves _
Treatment for sheehan syndrome is hormone replacement
* It is irreversible
Empty sella syndrome is caused by _
Empty sella syndrome is caused by enlargement of the sella turcica –> CSF leaks in –> compression of the pituitary
_ is associated with idiopathic intracranial HTN
Empty sella syndrome is associated with idiopathic intracranial HTN
In empty sella syndrome, the pituitary fossa is replaced by _ and will appear “empty” on head CT
In empty sella syndrome, the pituitary fossa is replaced by CSF and will appear “empty” on head CT
A sudden onset severe headache along with bitemporal hemianopia and AMS is suggestive of _
A sudden onset severe headache along with bitemporal hemianopia and AMS is suggestive of pituitary apoplexy
Pituitary apoplexy involves _
Pituitary apoplexy involves hemorrhage or infarction of pituitary, usually with a preexisting pituitary adenoma
Pituitary apoplexy will show _ on head CT
Pituitary apoplexy will show intrasellar mass with hemorrhage on head CT
We treat pituitary apoplexy with _ and possible surgery
We treat pituitary apoplexy with corticosteroids and possible surgery
_ is a benign tumor of Rathke’s pouch and is the most common childhood supratentorial tumor
Craniopharyngioma is a benign tumor of Rathke’s pouch and is the most common childhood supratentorial tumor
The most common hormonally active variant of pituitary adenoma produces _
The most common hormonally active variant of pituitary adenoma produces prolactin
Identify the anterior and posterior pituitary
Pituitary adenoma
Which is normal pituitary and which is adenoma?
Right is an adenoma; homogenous cells in sheets with little stroma
* They are “boring” to look at
A null cell adenoma is a _
A null cell adenoma is a non-functional neoplasm
_ is a neoplasm that arises from remnant cells of Rathke’s pouch (not from pituitary); they are most commonly suprasellar
Craniopharngioma is a neoplasm that arises from remnant cells of Rathke’s pouch (not from pituitary); they are most commonly suprasellar
* They are often benign and slow growing
Craniopharyngioma:
* Nests of stratified squamous cells
* Keratin, cholesterol rich cysts
* Fibrosis
* Calcification seen on x-ray
