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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
What are two predominant clinical presentations that occur?
- Gigantism | - Acromegaly
26
What are some features of acromegly?
- 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
What is measured to see if there is excess GH?
- 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
What is a normal inhibitor of GH?
- Glucose | - Able to be used to test for elevated GH
29
What is the treatment for elevated GH?
- Somatostatin analogs - GH receptor antagonists - Surgical excision
30
What are mammosomatotroph adenomas?
- Adenomas that secrete both GH and PRL
31
What do corticotroph adenomas secrete?
- Secrete ATCH which induces hypercortisolism causing Cushing syndrome
32
What is a special caveat about corticotroph adenomas?
- Size can be misleading - Small tumors can be very functional - Need to know pathways
33
What is Cushing disease?
- Cushing syndrome that is due to a pituitary adenoma
34
What is seen in Cushing syndrome?
- Central obesity - Moon facies - Striae - Hirsutism - Thin skin
35
What is the most common cause of Cushing syndrome?
- Iatrogenic (glucocorticoid administration)
36
What is checked first when suspecting Cushing syndrome?
- Check ACTH levels to see if it is an adrenal source or a tumor in pituitary or ectopic
37
How can corticotroph adenomas be differentiated from ACTH-secreting tumors as the source of hypercortisolism?
- Dexamethasone suppression test - Corticotroph adenomas show suppression of ACTH - ACTH-secreting tumors are stubborn and do not suppress ACTH
38
What is a method of blood testing to help differentiate the source of hypercorisolism?
- Sticking a catheter into the inferior petrosal sinus will help determine if the source of ACTH is coming from the pituitary
39
How do you treat corticotroph adenomas?
- Somatostatin analogs (they express both dopamine and somatostatin receptors) - Bromocriptine - Surgical excision
40
What is Nelson syndrome?
- 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
What does a thyrotroph adenoma cause?
- Secondary hyperthyroidism
42
How do gonadotroph adenomas present?
- Rarely present with minimal function | - Usually present with mass effect
43
What are some common mutations seen in somatic mutations?
- GNAS | - USP8 - Corticotroph
44
What are some common mutations seen in familial mutations?
- AIP (FIPA)
45
What does mutation of GNAS cause?
- Makes the alpha subunit of Gs lose its GTPase activity | - GTP will initiate cascade with cGMP-driven cell proliferation
46
What are adenomas like?
- Well circumscribed - Can erode bone - Can bleed
47
What are aggressive adenomas like?
- Poorly circumscribed - Can invade brain - More likely as the adenomas get bigger
48
What are pituitary carcinomas like?
- Rare | - Can metastasize or spread through the brain
49
What is Rathke's cleft cyst?
- 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
What kind of craniopharyngioma is seen in children?
- Adamantinomatous craniopharyngiomas | - Will see growth retardation from hypopituitarism
51
What kind of craniopharyngioma is seen in adults?
- Papillary craniopharyngiomas | - Signs of increased intracranial pressure or hypopituitarism
52
What needs to be considered when we see hypopituitarism?
- Tumors/mass lesions/cysts - Traumatic brain injury/hemorrhage - Surgery/radiation - Apoplexy - Ischemic necrosis/Sheehan syndrome - Inflammatory disorders - Genetic defects
53
What is primary empty sella syndrome?
- CSF leaks into the sella and compresses the pituitary
54
What is secondary empty sella syndrome?
- Pituitary expands and infarcts within the sella, leaving an empty space
55
What lobe is affected in empty sella syndrome?
- Anterior lobe
56
What is Sheehan syndrome?
- Postpartum necrosis of the anterior pituitary
57
How does Sheehan syndrome occur?
- 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
What is a main presenting symptom of Sheehan syndrome in postpartum women?
- Lack of lactation
59
What is diabetes insipidus?
- Insufficient ADH secretion causing decreased reclaimed free water from renal collecting system
60
What is seen in diabetes insipidus?
- Increased serum osmolality, hypernatremia - Dilute, excessive urine - Polyuria
61
How do you tell the difference between central and nephrogenic diabetes insipidus?
- Administer DDVAP - Look to see if the kidney responds with increased water retention and increased urine sodium/osmolality (if so, means central DI)
62
What is syndrome of inappropriate ADH syndrome (SIADH)?
- Increased reclaimed free water from renal collecting system
63
What are some causes of SIADH?
- Small cell carcinoma of the lung - Traumatic brain injury/subarachnoid hemorrhage - Drugs (SSRIs)
64
What is seen in SIADH?
- Decreased serum osmolality (hyponatremia) - Concentrated urine (hypernatremia) - Mental status changes, muscle weakness, seizures

Endocrine Exam (11 decks)

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