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endocrine > pituitary and adrenal pathology > Flashcards

pituitary and adrenal pathology Flashcards

1
Q

describe the anterior pituitary gland

A

Adenohypophysis
Derived from Rathke’s pouch
Secretes trophic and non-trophic hormones
Trophic: TSH, ACTH, FSH, LH
Non-trophic: GH and Prolactin

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2
Q

describe the posterior pituitary gland

A

Neurohypophysis
Extension of neural tissue consists of modified glial cells and axonal processes
Secretes ADH (vasopressin) and oxytocin

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3
Q

what are the pathologies of anterior pituitary hyperfunction?

A

adenoma
carcinoma

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4
Q

what are the pathologies of anterior pituitary hypofunction?

A

Surgery/radiation
Sudden Haemorrhage into gland
Ischaemic necrosis
Sheehan Syndrome
Tumours extending into sella
Inflammatory conditions (Sarcoidosis)

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5
Q

what are the pathologies of the posterior pituitary?

A

Posterior Pituitary
Diabetes Insipidus
Lack of ADH secretion
Can lead to life threatening dehydration

Syndrome of Inappropriate ADH secretion (SIADH)
Ectopic secretion of ADH by tumours
Primary disorder in the pituitary

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6
Q

what are the most common functional pituitary adenomas?

A

prolactinoma - Infertility, lack of libido, amenorrhea
growth hormone secreting - increase in insulin-like growth factors, stimulates growth of bone, cartilage and connective tissue, causes gigantism or acromegaly
ACTH secreting - cushing’s disease, usually micro adenoma, bilateral adrenocortical hyperplasia

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7
Q

describe craniopharyngioma

A

Derived from remnants of Rathke’s pouch
1 – 5% of intracranial tumours
Slow growing, often cystic, may calcify
Some arise within the sella but most suprasellar
good prognosis

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8
Q

what are the symptoms of craniopharyngioma?

A

headaches and visual disturbances (children may have growth retardation)

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9
Q

describe the adrenal gland

A

Bilateral Glands ~ 4 - 5 grams each

Sit superior and medial to upper pole of kidneys

Composed of an outer cortex and a central medulla

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10
Q

what are the 3 zones of the adrenal gland cortex?

A

Zona Glomerulosa –
Mineralocorticoids
Aldosterone

Zona Fasciculata –
Glucocorticoids
Cortisol

Zona Reticularis –
Sex Steroids + Glucocorticoids

GFR

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11
Q

describe the medulla of the adrenal gland

A

Central core of the adrenal – distinct from the cortex
Innervated by pre-synaptic fibres from sympathetic nervous system
Neuroendocrine (chromaffin) cells - secrete catecholamines

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12
Q

what is the usual presentation of adrenocortical tumours?

A

Incidental finding (radiology, autopsy)
Hormonal effects
Mass lesion
Carcinomas with necrosis can cause fever

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13
Q

describe adrenocortical adenoma

A

Well circumscribed, encapsulated lesions
Usually small – up to 2 to 3cm
Yellow / yellow brown cut surface (lipid)
Composed of cells resembling adrenocortical cells
Well differentiated, small nuclei, rare mitoses
Can be functional, but more likely not

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14
Q

describe adrenocortical carcinoma

A

Rare
More likely to be functional - virilising tumours usually malignant
Can closely resemble adenoma

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15
Q

how do adrenocortical carcinomas spread?

A

Local invasion – retroperitoneum, kidney
Metastasis – usually vascular (liver, lung and bone)
Peritoneum and pleura
Regional lymph nodes
poor prognosis- 5 year survival rate 20-35%

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16
Q

what features are suggestive of adrenocortical carcinoma?

A

Large size (>50g, often >20cm)
Haemorrhage and necrosis
Frequent mitoses, atypical mitoses
Lack of clear cells
Capsular or vascular invasion

17
Q

describe primary hyperaldosteronism

A

Conn’s syndrome
Usually associated with diffuse or nodular hyperplasia of both adrenal glands
35% have adenoma, rarely carcinoma
glucocorticoid remediable

18
Q

describe secondary hyperaldosteronism

A

Increased renin
Decreased renal perfusion, hypovolaemia, pregnancy

19
Q

describe hypercortisolism

A

Cushing’s syndrome or disease
Exogenous or endogenous
Exogenous – iatrogenic (steroid therapy)
Endogenous-
ACTH dependent- ACTH secreting pituitary adenoma (70%) - Cushing’s disease
Ectopic ACTH (10%) - Small cell lung cancer
Gives rise to adrenal hyperplasia
ACTH independent
Adrenal adenoma (10%) or carcinoma (5%)
Non-lesional adrenal gland atrophies

20
Q

describe secondary adrenocortical hypofunction

A

Failure to stimulate adrenal cortex
Hypothalamic-pituitary disorder
Hypopituitarism
Suppression of adrenal cortex
Treatment with steroids

21
Q

describe primary adrenocortical hypofunction

A

can be acute or chronic and has many causes

22
Q

describe acute primary adrenocortical insufficiency

A

Rapid withdrawal of steroid treatment
Crisis in patient’s with chronic adrenocortical insufficiency – due to stress e.g. infection or not increasing dose of steroid treatment
Massive adrenal haemorrhage - Newborn, Anticoagulant treatment, DIC, Septiceamic infection – Waterhouse Friderichsen

23
Q

describe chronic primary adrenocortical insufficiency (addison’s disease)

A

-addison’s disease
-3 common causes - infection, metastatic malignancy, autoimmune adrenalitis
-shows signs once >90% of gland is destroyed

24
Q

when does addison’s disease manifest itself?

A

manifests once there are significant decreases in glucocorticoid and mineralocorticoid levels

25
Q

what are the symptoms of addison’s disease?

A

vague-
-weakness, fatigue, anorexia, weight loss, vomiting, diarrhoea
-pigmentation (not seen in hypopituitarism)

26
Q

what are the 2 main types of adrenal medullary tumours?

A

phaeochromocytoma & neuroblastoma

27
Q

describe adrenal medullary neuroblastoma

A

Composed of primitive appearing cells but can show maturation and differentiation towards ganglion cells
Age and stage important for prognosis
Amplification of N-myc & expression of telomerase predict a poor outcome

28
Q

describe phaeochromocytoma

A

A neoplasm derived from chromaffin cells of the adrenal medulla
Secrete catecholamines
Rare cause of secondary hypertension

29
Q

what are the effects phaeochromocytoma can cause?

A

hypertension-paroxysmal episodes
complications- cardiac failure, infarction, arrhythmias

30
Q

what are the 10%s of phaeochromocytoma?

A

10% are extra adrenal
10% are bilateral
10% are biologically malignant
10% are not associated with hypertension
(25% are familial)

31
Q

what is the average size of a phaeochromocytoma?

A

100g (can range from 1g to >2kg)

32
Q

what genetic condition is phaeochromocytoma associated with?

A

multiple endocrine neoplasia type 2 (men2)

33
Q

what is the treatmnet of phaeochromocytoma?

A

surgery- prepare for surgery by
full alpha and beta blockade.
alpha first using a-blockers phenoxybenzamide
then beta using b-blockers e.g. propanolol

fluid and/ or blood replacement
careful anaesthetic asessment

34
Q

how do you diagnose phaeochromocytoma?

A

identify catecholamine excess
MRI abdomen, full body
PET scan

endocrine (25 decks)

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