Pituitary Pathology

Question 1

The pathology of underlying hyperfunction is usually either ______ or ______

Answer 1

Hyperplasia (inc. number of secretory cells)

Neoplasm (Autonomous Secretory Cells)

Question 2

The pathology of underlying hypofunction is usually either _____________ or _______________

Answer 2

Atrophy (dec. number of secretory cells)

Necrosis (ischemia, autoimmune destruction, etc.)

Question 3

Due to large reserve capacity, hypofunction does not occur until roughly _________% of the gland tissue is gone

Answer 3

80-90

Question 4

Adenomas are (benign/malignant) neoplastic transformations and are (more/less) common in Endocrine cancers

Answer 4

Benign; more

Question 5

Adenocarcinomas are (benign/malignant) neoplastic transformations

Answer 5

Malignant

Question 6

Endocrine neoplasias can be (functional/nonfunctional) where they produce tons of hormone

Answer 6

Functional

Question 7

Endocrine neoplasias can be (functional/nonfunctional) where they are silent, but can have mass effect and impinge on neighbors

Answer 7

Nonfunctional

Question 8

Histopathology of benign vs. malignant endocrine tumors is often similar, so diagnosis is usually based on…

Answer 8

Metastases (best)

Local Vascular/neural invasion

Question 9

MEN

Answer 9

Multiple Endocrine Neoplasia

Question 10

How might Autoantibodies affect endocrine function

Answer 10

Stimulate–> hyperfunction
Block–> hypofunction
WBC mediated destruction–> hypofunction

Question 11

Special name for the Anterior Pituitary

Answer 11

Adenohypophysis (and Pars Distalis)

Question 12

Special name for the Posterior Pituitary

Answer 12

Neurohypophysis (and Pars Nervosa)

Question 13

The (Anterior/Posterior) Pituitary has tightly packed clusters of secretory cells with RICH vasculature; cells are named based on staining properties (acidophils, basophils, chromophobes) and secretory product (Lactotrophs, Thyrotrophs, etc.)

Answer 13

Anterior

Question 14

The cells in the Anterior Pituitary are named by what conventions?

Answer 14

Staining properties (Acidophils, Basophils, Chromophobes)
Secretory product (Lactotrophs, Thyrotrophs, etc.)

Question 15

Which Pituitary secretory cells and its products are Acidophilic (2 total)

Answer 15

Somatotrophs –> GH

Lactotrophs –> Prolactin

Question 16

Which Pituitary secretory cells and its products are Basophilic (4 total)

Answer 16

Thyrotrophs –> TSH
Corticotrophs –> ACTH
Gonadotrophs –> FSH & LH

Question 17

The (Anterior/Posterior) Pituitary is composed of nervous tissue (axons and glial cells).

Answer 17

Posterior

Question 18

The cell bodies of the neurons in the Posterior Pituitary are located where?

Answer 18

Hypothalamus

Question 19

Mass effect is a consequence of….

Answer 19

space-occupying issue

Question 20

Pituitary adenomas arise from the (Anterior/Posterior) lobe

Answer 20

Anterior

Question 21

Pituitary neoplasm; usually arises from Anterior lobe; histologically has homogenous sheets of cells with LITTLE stroma; usually are monoclonal (involves inc. secretion of one hormone like Prolactin or ACTH)

Answer 21

Pituitary Adenoma

Question 22

Neoplasm; BENIGN and SLOW growing; usually either seen in CHILDREN or adults >65 yo; arises from remnant of Rathke’s pouch (so not from pituitary); usually SUPRAsellar; can be CYSTIC and calcified

Answer 22

Craniopharyngioma

Question 23

Histologic features of Craniopharyngioma

Answer 23

Cysts with Calcifications

Question 24

Vascular lesion of Pituitary; usually due to Postpartum Hypotension, DIC, Shock or Sickle Cell; most common form is “Sheehan Syndrome.”

Answer 24

Ischemic Necrosis

Question 25

Most common type of Pituitary Ischemic Necrosis; occurs postpartum; the majority of blood supply of anterior lobe is venous (low bp) --> anterior lobe enlarges during pregnancy --> uterine hemorrhage during delivery --> hypotension --> ischemia & necrosis

Answer 25

Sheehan Syndrome

Question 26

Pituitary Vascular lesion; SUDDEN expanding hemorrhage in adenoma leads to destruction of adjacent pituitary cells; hypopituitarism can clinically occur

Answer 26

Pituitary Apoplexy

Question 27

"to occur suddenly"

Answer 27

Apoplexy

Question 28

Lesion of the Pituitary due to the destruction of part or all of the Pituitary; due to surgery, radiation or congenital defect

Answer 28

Empty Sella Syndrome

Question 29

What can cause Empty Sella Syndrome

Answer 29

Surgery Radiation Congenital Defects (CSF has leaked into the sella turcica, putting pressure on the pituitary. This causes the gland to shrink or flatten)

Question 30

Most POSTERIOR Pituitary pathology is the result of...

Answer 30

- Mass effect (impingement) | - Necrosis/destruction (infarcts, hemorrhage, surgery, etc.)

Question 31

a set of conditions characterized by autoimmune disease that causes multiple endocrine deficiencies, which affect the hormone-producing (endocrine) glands

Answer 31

Autoimmune Polyglandular Syndromes (APS) * Polyglandular endocrinopathies

Question 32

Pituitary gland is connected to hypothalamus by

Answer 32

infundibulum

Question 33

Pituitary enlargement can lead to impingement on pituitary itself. This can cause

Answer 33

panhypopituitarism

Question 34

Pituitary enlargement can lead to impingement on optic chiasm. This can cause

Answer 34

Bitemporal hemianopia

Question 35

Pituitary enlargement can lead to impingement on optic cavernous sinuses. This can cause

Answer 35

CN 3, 4, 5, 6 palsies

Question 36

Pituitary enlargement can lead to impingement on CSF. This can cause

Answer 36

headache due to increased pressure

Question 37

What size of pituitary neoplasms usually cause mass effects?

Answer 37

Macroadenoma (>= 1 cm) *Microadenoma (<= 1 cm) usually cause no mass effects

Question 38

Diagnosis of pituitary neoplasms are made by

Answer 38

immunohistochemistry

Question 39

Empty sella syndrome and mass lesion (causing impingement of pituitary) usually involve both anterior and posterior lobes. Clinical presentation of this is

Answer 39

panhypopituitarism

Question 40

a condition in which the production and secretion of all hormones by the pituitary gland (both ant. and post.) is reduced

Answer 40

panhypopituitarism

Question 41

Clinical presentation of posterior pituitary lesions

Answer 41

Central diabetes insipidus (low/lack of ADH)