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Endocrine Exam > Pituitary Gland Pathology > Flashcards

Pituitary Gland Pathology Flashcards

1
Q

What is a primary disorder?

A
  • A problem with the endocrine organ itself
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2
Q

What is a secondary disorder?

A
  • A problem that affects the endocrine order
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3
Q

What regulates the posterior pituitary?

A
  • Direct release of hormone stimulation
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4
Q

What regulates the anterior pituitary?

A
  • Indirect control through release of regulatory hormones
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5
Q

What is the mass effect of pituitary lesions?

A
  • Masses will cause increased intracranial pressure
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6
Q

What is mass effect seen in?

A
  • Neoplasms

- Bleeds

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7
Q

What does the increased ICP cause in mass effect?

A
  • Headaches
  • N/V
  • HTN
  • Bradycardia
  • Shallow breathing
  • Papilledema
  • Visual field disturbances
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8
Q

What visual field disturbances may be present in mass effect?

A
  • Bilateral temporal hemianopsia due to compression of the optic chiasm
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9
Q

What is pituitary apoplexy?

A
  • Hemorrhage into adenoma which can compound the symptoms of mass effect
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10
Q

How can mass effect cause underproduction of pituitary hormones?

A
  • The mass can disturb the channel between the hypothalamus and the pituitary
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11
Q

What hormone may be overproduced due to mass effect?

A
  • Prolactin (hyperprolactinemia)
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12
Q

What is the size of a microadenoma?

A
  • Less than 1 cm
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13
Q

What is size of a macroadenoma?

A
  • 1-4 cm
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14
Q

What is the size of a giant adenoma?

A
  • Greater than 4 cm
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15
Q

What is different about the normal pituitary tissue in the presence of an adenoma?

A
  • There will be uniform, monotonous cells of whatever hormone secreting cell
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16
Q

What is the most common pituitary adenoma?

A
  • Lactotroph adenoma
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17
Q

What is the presentation of a lactotroph adenoma in females?

A
  • Menstrual irregularities
  • Galactorrhea
  • Diminished libido
  • Infertility
  • Mass effect
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18
Q

What is the presentation of a lactotroph adenoma in males?

A
  • Decreased libido
  • Decreased sperm count
  • Mass effect
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19
Q

What is seen in the progression of a lactotroph adenoma?

A
  • Stromal hyalinization with psammoma bodies (calcifications)
  • Dense calcification causing a pituitary stone
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20
Q

What is the treatment for a lactotroph adenoma?

A
  • Use dopamine agonists like bromocriptine or cabergoline
  • Surgery (transsphenoidal surgery)
  • Radiation therapy to dramatically reduce size
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21
Q

What are some other causes of hyperprolactinemia?

A
  • Pregnancy
  • Lactation/nipple stimulation
  • Loss of dopamine
  • Renal failure
  • Hypothyroidism
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22
Q

How is dopamine lost to cause hyperprolactinemia?

A
  • Damage to neurons (stroke, head trauma)
  • Drugs (Verapamil, Metoclopramide)
  • Mass
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23
Q

How does renal failure cause hyperprolactinemia?

A
  • Increased production and decreased clearance of PRL
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24
Q

How does hypothyroidism cause hyperprolcatinemia?

A
  • Increased TRH can stimulate PRL production
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25
Q

What are two predominant clinical presentations that occur?

A
  • Gigantism

- Acromegaly

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26
Q

What are some features of acromegly?

A
  • Enlargement of the face and hands
  • Protruding jaw
  • Enlarged nose
  • Thickened lips
  • Joint pain/limited mobility
  • Enlarged viscera
  • Shortened lifespan due to CV complications
27
Q

What is measured to see if there is excess GH?

A
  • Serum levels of IGH-1 which is the metabolite of GH that is secreted by the liver and is present in more stable, predictable amounts
28
Q

What is a normal inhibitor of GH?

A
  • Glucose

- Able to be used to test for elevated GH

29
Q

What is the treatment for elevated GH?

A
  • Somatostatin analogs
  • GH receptor antagonists
  • Surgical excision
30
Q

What are mammosomatotroph adenomas?

A
  • Adenomas that secrete both GH and PRL
31
Q

What do corticotroph adenomas secrete?

A
  • Secrete ATCH which induces hypercortisolism causing Cushing syndrome
32
Q

What is a special caveat about corticotroph adenomas?

A
  • Size can be misleading
  • Small tumors can be very functional
  • Need to know pathways
33
Q

What is Cushing disease?

A
  • Cushing syndrome that is due to a pituitary adenoma
34
Q

What is seen in Cushing syndrome?

A
  • Central obesity
  • Moon facies
  • Striae
  • Hirsutism
  • Thin skin
35
Q

What is the most common cause of Cushing syndrome?

A
  • Iatrogenic (glucocorticoid administration)
36
Q

What is checked first when suspecting Cushing syndrome?

A
  • Check ACTH levels to see if it is an adrenal source or a tumor in pituitary or ectopic
37
Q

How can corticotroph adenomas be differentiated from ACTH-secreting tumors as the source of hypercortisolism?

A
  • Dexamethasone suppression test
  • Corticotroph adenomas show suppression of ACTH
  • ACTH-secreting tumors are stubborn and do not suppress ACTH
38
Q

What is a method of blood testing to help differentiate the source of hypercorisolism?

A
  • Sticking a catheter into the inferior petrosal sinus will help determine if the source of ACTH is coming from the pituitary
39
Q

How do you treat corticotroph adenomas?

A
  • Somatostatin analogs (they express both dopamine and somatostatin receptors)
  • Bromocriptine
  • Surgical excision
40
Q

What is Nelson syndrome?

A
  • Adrenal glands are removed to deal with Cushing syndrome effects
  • ACTH is still in excess and is metabolized to a-MSH which causes patients to become pigmented
41
Q

What does a thyrotroph adenoma cause?

A
  • Secondary hyperthyroidism
42
Q

How do gonadotroph adenomas present?

A
  • Rarely present with minimal function

- Usually present with mass effect

43
Q

What are some common mutations seen in somatic mutations?

A
  • GNAS

- USP8 - Corticotroph

44
Q

What are some common mutations seen in familial mutations?

A
  • AIP (FIPA)
45
Q

What does mutation of GNAS cause?

A
  • Makes the alpha subunit of Gs lose its GTPase activity

- GTP will initiate cascade with cGMP-driven cell proliferation

46
Q

What are adenomas like?

A
  • Well circumscribed
  • Can erode bone
  • Can bleed
47
Q

What are aggressive adenomas like?

A
  • Poorly circumscribed
  • Can invade brain
  • More likely as the adenomas get bigger
48
Q

What are pituitary carcinomas like?

A
  • Rare

- Can metastasize or spread through the brain

49
Q

What is Rathke’s cleft cyst?

A
  • Cystic mass derived from Rathke’s pouch
  • Can expand and compress normal pituitary
  • Can rupture and result in inflammation of the pituitary or meningitis
50
Q

What kind of craniopharyngioma is seen in children?

A
  • Adamantinomatous craniopharyngiomas

- Will see growth retardation from hypopituitarism

51
Q

What kind of craniopharyngioma is seen in adults?

A
  • Papillary craniopharyngiomas

- Signs of increased intracranial pressure or hypopituitarism

52
Q

What needs to be considered when we see hypopituitarism?

A
  • Tumors/mass lesions/cysts
  • Traumatic brain injury/hemorrhage
  • Surgery/radiation
  • Apoplexy
  • Ischemic necrosis/Sheehan syndrome
  • Inflammatory disorders
  • Genetic defects
53
Q

What is primary empty sella syndrome?

A
  • CSF leaks into the sella and compresses the pituitary
54
Q

What is secondary empty sella syndrome?

A
  • Pituitary expands and infarcts within the sella, leaving an empty space
55
Q

What lobe is affected in empty sella syndrome?

A
  • Anterior lobe
56
Q

What is Sheehan syndrome?

A
  • Postpartum necrosis of the anterior pituitary
57
Q

How does Sheehan syndrome occur?

A
  • Delicate anterior pituitary, mostly dependent on venous blood supply, is uniquely sensitive to compression during pregnancy
  • Ischemia/infarction can occur during labor and delivery
58
Q

What is a main presenting symptom of Sheehan syndrome in postpartum women?

A
  • Lack of lactation
59
Q

What is diabetes insipidus?

A
  • Insufficient ADH secretion causing decreased reclaimed free water from renal collecting system
60
Q

What is seen in diabetes insipidus?

A
  • Increased serum osmolality, hypernatremia
  • Dilute, excessive urine
  • Polyuria
61
Q

How do you tell the difference between central and nephrogenic diabetes insipidus?

A
  • Administer DDVAP
  • Look to see if the kidney responds with increased water retention and increased urine sodium/osmolality (if so, means central DI)
62
Q

What is syndrome of inappropriate ADH syndrome (SIADH)?

A
  • Increased reclaimed free water from renal collecting system
63
Q

What are some causes of SIADH?

A
  • Small cell carcinoma of the lung
  • Traumatic brain injury/subarachnoid hemorrhage
  • Drugs (SSRIs)
64
Q

What is seen in SIADH?

A
  • Decreased serum osmolality (hyponatremia)
  • Concentrated urine (hypernatremia)
  • Mental status changes, muscle weakness, seizures

Endocrine Exam (11 decks)

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