pituitary, hertz Flashcards
what is bitemporal hemianopsia
lose peripheral vision from pressure on optic chiasm
signs of cerebral edema
HA nausea and vomiting
what should optic nerve look like
sharply demarcated
women with white discharge from nipples and HA and elevate prolactin
pituitary adenoma
most common cause hyperpituitarism
adenoma in anterior lobe
what pituitary cell secretes prolactin
lactotroph
what pituitary cell secretes GH
somatotroph
what pituitary cell secretes prolactin and GH
mamosomatotroph
what secretes ACTH
corticotroph
what secretes FSH and LH
gonadotroph
what is the activating mutation in GH adenomas
GNAS
what is the activating mutation in pituitary carcinomas
HRAS
what germline inactivating mutation can occur in GH and prolactin adenomas
protein kinase A, regulatory subunit 1
cyclin D1 mutation means what for prognosis of pituitary adenoma
bad. very aggressive
MEN1 mutation can lead to what
GH prolactin, ACTH adenomas
you find a huge huge adenoma in pituitary, most likely?
non functional
the smaller ones are biologically active
pituitary usually has what type collagen in in
collagen IV- reticulin
what are local mass effects of hyperpituitarism
visual field abnormalities, signs and Sx of elevated intracranial P and hypopituitarism
What is pituitary apoplexy
stroke in pituitary can be caused by acute hemorrhage
what do high levels of prolactin cause
amennorhea, glactorrhea, loss of libido, infertility
why is pituitary adenoma more Dx in women
sensitivity of menses disruption between ages 20 and 40
see dense core granules on electrom microscopy
know from endocrine source
second most common type of functioning pituitary adenoma
somatotroph secreting GH
what causes gigantism and acromegaly
GH secreting adehoma
increased levels of GH cause what
stimulate secretion IGF-1
what is difference of gigantism and acromegaly
gigantism is before epiphysis closed.
What occurs in acromegaly
coarsening of facial features. enlarged soft tissues, large hnads and feet
what is hyperostosis
increase in bone desity
what is prognathism
enlargements of the jaw and protrusion of jaw
GH secreting tumor can lead to what other complications
DM, muscle weakness, HTN, arthritis, CHF, increased risk of GI cancers
how do we Dx GH adenoma
detect elevated IGF-1 and GH levels.
what is the most sensitive test for acromegaly
failure to suppress GH production with oral load of glucose
what are the effects of glucose on GH secretion
should decrease GH secretion
What is Cushing syndrome
hypercotisolism. escess ACTH
what do corticotroph adenomas look like histo
basophilic with dense granules and sometimes sparsely granulated
stain with PAS because have POMC
Gonadotroph adenomas are most frequently found in what population?
middle aged men and women when they become large enough to cause neurologic Sx like impaired vision, HA, diplopia or pituitary apoplexy
impaired secretion of LH can cause what in men and women
decreased energy and libido in men
amenorrhea in premenopausal women
Thyrotroph adenomas can cause what
hyperthyroidism
majority of pituitary tumors are what kind
nonfunctining
what Signs and Sx do you see in nonfunctioning pituitary adenomas
mass effects
2 distinct morphologic features of most adenomas
cellular monomorphism and absence of reticulin network
TsH increased?
hypothyroidism
primary cause of pituitary insufficiency
trauma, subarachnoid hemorrhage
what occurs with children who have GH deficiency
pituitary dwarfism
What occurs in TSH and ACTH deficiencies
hypothyroidism and hypoadrenalism
how come lose skin color in hypopituitarism
because loss of sitmulatory effects of MSH on melanocytes
What is DI
deficiency in ADH
excessive urination
What is SIADH
ADH excess causing hyponatremia
where does ADH work
collecting tubules of kidney
what tumor can cause SIADH
oat cell carcinoma or small cell carcinoma
what are differences of DI central vs nephrogenic
central is at level of ADH secretion, nephrogenic is response to ADH
if find tumor in pituitary and when aspirated find dark oil that comes out what is it and why is it dark?
craniopharyngioma
breakdown of keratin produces dark color with cholesterol breakdown
which cranipharyngioma demonstates calcifications
the adamantinomatous not papillary
what are spherule calcifications in epithelium called
psamomma bodies
prognosis of those with craniopharyngiomas
good survival, not recurrence if less than 5 cm
larger lesions still good prognosis but more invasive
