Pituitary+parathyroid Flashcards
parathyroid hyperplasia morphology
typically multigland, affecting all glands
loss of normal adipocytes, though some fat remains
ssimilar to adenomas, but no rim of normal gland
second most common pituitary tumor
presentation
Growth hormone cell adenoma
gigantism or acromegaly
Asrenocortical adenoma morphology
small, encapsulated, unilateral
predominantly fasiculata cells
most are non functional
alveolar architecture and lipid rich cells
parathyroid adenoma morphology
typically solitary, unilateral mass
primarily chief cells with islands of oxyphil cells
loss of normal adipocytes within tumor
typically rim of compressed normal parathyroid at periphery
Adrenal cortex morphology - zona fasciculata
clear cells
Pheochromocytoma =
neoplasms of adrenal medulla chromafin cells
synthesize and secrete catecholamines > HTN
pituitary adenoma morpholohy
uniform cells in sheets or cords
supporting reticulin network is lost
Li-fraumeni syndrome =
inherted cause of
inherited cause of adrenocortical carcinoma
mutant p53 alelle
(also breast CA, sarcoma, leukemia, brain CA)
causes of hypopituitarism
Pituitary tumors - mass effect
Pituitary adenoma
Cranipharyngioma
Sheenhan Syndrome
Iatrogenic (surgery or radiation)
Rathke Cleft Cyst
Sheehan syndrome
pospartum necrosis caused by ischemia or pituitary gland
adrenal medulla morphology
chromaffin cells with rich vascular network
Conn Syndrome =
hyperaldosteronism caused by adrenal cortical adenoma
most common finding in endogenous cushings
bilateral hyperplasia
causes of hypercortisolism (and mechanism)
Cortical atrophy - exogenous gluccocorticoid (dec ACTH)
Bilateral hyperplasia - endogenous hypercortisolism, ZF hyperplasia (inc ACTH)
Adrenocortical adenoma - endogenous secretion of cortisol (ACTH independent)
Adrenocortical carcinoma - (ACTH independent)
Beckwith-Wiedmann syndrome =
genetic cause of ___
genetic cause of Adrenocortical carcinoma
genomic imprinting of ch11 at WT2 locus
enlargement of body organs or body segments
(also Wilm’s tumor, hepatoblastoma, rhabdomyosarcoma, pancreatic tumors)
relative distribution of primary hyperparathyroidism
Parathyroid adenoma
hyperplasia
carcinoma
80% adenoma
15% hyperplasia
5% carcinoma
Craniopharyngioma morphology
bening suprasellar or sellar tumors arising from Rathke Pouch
nests and cords of squamous columnar cells in loose stroma, often cystic an associated with calcification
parathyroid carcinoma morphology
firm lesion
adheres to surrounding tissue (infiltration)
very high calcium
dx based on invasion or metatasis
Rule of 10s for Pheochromocytoma
10% familial (MEN-2A, MEN-2B, type 1 neurofibromatosis, on Hippel Lindau, Sturge Weber)
10% extra adrenal = paragangliomas
10% bilateral
10% malignant - more frequent in extra-adrenal
large pituitary tumors can cause
bilatemporal hemianopsia
pituitary adenomas are classified based on
immunohistochemistry stains regardless of fxnl stus
pheochromocytoma morphology
small nests of zellnallen chromafin cells with rich vascular network
cytoplasm typically granular and basophilic
pleomorphic nuclei
adrenocortical hyperplasia morphology
bilateral thickening of adrenal cortex
predominantly fasciculata cells
diffuse with relatively even thickening
OR
nodular with multiple bilateral nodules separated by thickened cortex
Fat
aside from prolactin cell adenoma, hyperprolactinemia can be associated with
Rx (methyl-dopa, reserpine) that interfere with DA
Stalk effect from regional tumors preventing hypothalamic inhibition
pregnancy
most common cause of primary hyperparathyroidism
parathyroid adenoma
brown tumors of hyperparathyroidism, morphology
aggregates of osteoclasts, giant cells, and hemorrhagic debris
2 cell types of parathyoid gland
general morphology
cheif cells
oxyphil cell
consists of lobules with intervening adipocytes
adrenocortical carcinoma is dx by finding
invasion or metastases
osteoitisfibrosacystica
caused by hyperparathyroidism
cystic lesiosn caused by bone resoprtion leading to
thinned cortex and
marrow fibrosis with
cystic degeneration
bone manifestations of hyperparathyroidism result from _____ and include ___ and ____
result from osteoclast activation
include osteitisfibrosacystica and brown tumors
Rathke cleft cyst
cysts lined by ciliated cuboidal cells with scattered goblet cells and anterior pituitary cells
a cause of hypopituitarism
adrenocortical carcinoma morphology
large size with invasion
lymph node mettases common
compact cells, nuclear atypia, necrosis
most common pituitary tumor
prolactin cell adenoma
