Pituitary adenoma

Question 1

The normal pituitary is located below the hypothalamus in the _ ; and is about _ cm in length

Answer 1

The normal pituitary is located below the hypothalamus in the sella turcica ; and is about 1 cm in length

Question 2

The pituitary gland is connected to the hypothalamus via the _

Answer 2

The pituitary gland is connected to the hypothalamus via the infundibulum

Question 3

Another name for the anterior pituitary is the _

Answer 3

Another name for the anterior pituitary is the adenohypophysis
* Or sometimes called the pars distalis

Question 4

Another name for the posterior pituitary is the _

Answer 4

Another name for the posterior pituitary is the neurohypophysis
* Sometimes called the pars nervosa

Question 5

The anterior pituitary is connected to the hypothalamus via _

Answer 5

The anterior pituitary is connected to the hypothalamus via portal vessels

Question 6

The (anterior/posterior) pituitary is an extension of the hypothalamic neuronal axons

Answer 6

The posterior pituitary is an extension of the hypothalamic neuronal axons

Question 7

The anterior pituitary takes up about _ % of the pituitary gland

Answer 7

The anterior pituitary takes up about 80% of the pituitary gland
* Posterior is about 20%

Question 8

The pars intermedia is a rudimentary structure in humans with a main function of producing _

Answer 8

The pars intermedia is a rudimentary structure in humans with a main function of producing melanocyte stimulating hormone (MSH)

Question 9

What labs should be checked if you suspect hyperprolactinemia?

Answer 9

1. Prolactin levels
2. FSH, LH, testosterone, estrogen (due to decreased GnRH)
3. TSH, T3, T4 (possible increase TRH)

Question 10

Hyperprolactinemia causes GnRH to _ and manifests as _

Answer 10

Hyperprolactinemia causes GnRH to decrease and manifests as hypogonadotropic hypogonadism (low FSH, LH, estrogen, testosterone)

Question 11

Primary hypothyroidism has what effect on prolactin?

Answer 11

Primary hypothyroidism –> high TRH –> increases prolactin

Question 12

Dopamine antagonists (increase/decrease) prolactin levels

Answer 12

Dopamine antagonists increase prolactin levels
* Risperidone
* Haloperidol
* Fluphenazine
* Metoclopramide

Question 13

Benign pituitary adenoma is a common cause of hyperprolactinemia; it involves proliferation of _ cells

Answer 13

Benign pituitary adenoma is a common cause of hyperprolactinemia; it involves proliferation of lactotrophs

Question 14

Explain how a non-secreting pituitary adenoma can also increase prolactin levels

Answer 14

Non-secreting pituitary adenoma –> compression of infundibular stalk –> decreases dopamine –> decreases the inhibition of lactotrophs –> increases prolactin

Question 15

Hyperprolactinemia may present as _ in females

Answer 15

Hyperprolactinemia may present as:
* Lack of ovulation
* Vaginal atrophy
* Infertility/amenorrhea
* Osteroporosis (estrogen protects bones)

Question 16

Hyperprolactinemia may present as _ in men

Answer 16

Hyperprolactinemia may present as:
* Decreased spermatogenesis
* Galactorrhea (nipple discharge)
* Gynecomastia

Question 17

Ichemia and infarction of the pituitary following delivery describes _ syndrome

Answer 17

Ichemia and infarction of the pituitary following delivery describes Sheehan syndrome
* Sheehan is one cause of hypopituitarism

Question 18

Pregnancy causes the pituitary gland to swell due to _ ; this leaves it vulnerable to ischemia

Answer 18

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

Question 19

Sheehan syndrome might present with lactation failure due to _ deficiency, bradycardia and weight gain due to _ deficiency, and DI due to _ deficiency

Answer 19

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

Question 20

Treatment for sheehan syndrome involves _

Answer 20

Treatment for sheehan syndrome is hormone replacement
* It is irreversible

Question 21

Empty sella syndrome is caused by _

Answer 21

Empty sella syndrome is caused by enlargement of the sella turcica –> CSF leaks in –> compression of the pituitary

Question 22

_ is associated with idiopathic intracranial HTN

Answer 22

Empty sella syndrome is associated with idiopathic intracranial HTN

Question 23

In empty sella syndrome, the pituitary fossa is replaced by _ and will appear “empty” on head CT

Answer 23

In empty sella syndrome, the pituitary fossa is replaced by CSF and will appear “empty” on head CT

Question 24

A sudden onset severe headache along with bitemporal hemianopia and AMS is suggestive of _

Answer 24

A sudden onset severe headache along with bitemporal hemianopia and AMS is suggestive of pituitary apoplexy

Question 25

Pituitary apoplexy involves _

Answer 25

Pituitary apoplexy involves hemorrhage or infarction of pituitary, usually with a preexisting pituitary adenoma

Question 26

Pituitary apoplexy will show _ on head CT

Answer 26

Pituitary apoplexy will show intrasellar mass with hemorrhage on head CT

Question 27

We treat pituitary apoplexy with _ and possible surgery

Answer 27

We treat pituitary apoplexy with corticosteroids and possible surgery

Question 28

_ is a benign tumor of Rathke’s pouch and is the most common childhood supratentorial tumor

Answer 28

Craniopharyngioma is a benign tumor of Rathke’s pouch and is the most common childhood supratentorial tumor

Question 29

The most common hormonally active variant of pituitary adenoma produces _

Answer 29

The most common hormonally active variant of pituitary adenoma produces prolactin

Question 30

Identify the anterior and posterior pituitary

Answer 30

Question 31

Answer 31

Pituitary adenoma

Question 32

Which is normal pituitary and which is adenoma?

Answer 32

Right is an adenoma; homogenous cells in sheets with little stroma
* They are “boring” to look at

Question 33

A null cell adenoma is a _

Answer 33

A null cell adenoma is a non-functional neoplasm

Question 34

_ is a neoplasm that arises from remnant cells of Rathke’s pouch (not from pituitary); they are most commonly suprasellar

Answer 34

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

Question 35

Answer 35

Craniopharyngioma:
* Nests of stratified squamous cells
* Keratin, cholesterol rich cysts
* Fibrosis
* Calcification seen on x-ray