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Endo > Pituitary Pathology > Flashcards

Pituitary Pathology Flashcards

1
Q

How do the following signals from the hypothalamus affect the Pituitary gland?

  • TRH
  • Dopamine
  • CRH
  • GHRH
  • Somatostatin
  • GnRH
A
  • TRH → TSH
  • Dopamine (-) → Prolactin
  • CRH → ACTH
  • GHRH → GH
  • Somatostatin (-) → GH
  • GnRH → FSH/LH
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2
Q

What types of appearance/staining will be effective in the anterior pituitary?

A

Acidophilic, Basophilic, Chromophobic

Special immunostains used for specific hormones

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3
Q

What types of cells are found in the posterior pituitary; what is secreted?

A

Contains pituicytes and axons; secretes ADH and oxytocin

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4
Q

What are some differences in appearance between the anterior and posterior pituitary?

A

Anterior pituitary is more cellular and has small clusters of cells that are held together by reticulin

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5
Q

Pituitary adenomas

Gender preference:

Age:

A

Gender preference: Women > Men

Age: 3rd - 6th decades

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6
Q

What type of hormone secretion is most common in a pituitary adenoma? What types of cells are present? How are they stained?

A

Prolactin (approx. 30%) - Lactotrophs - Chromophobic staining

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7
Q

How are pituitary adenomas removed?

A

Trans-sphenoidal resection

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8
Q

How can a pituitary adenoma be distinguished from a normal pituitary?

A

Adenomas have destruction of normal patterns of reticulin and express only one cell type

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9
Q

What are some potential causes of a prolactin adenoma?

A
  • Associated with medications that interfere with dopamine
  • Stalk effect - other regional tumors may disturb the hypothalamic inhibition of prolactin secretion
  • Pregnancy
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10
Q

What is Sheehan syndrome?

A

Postpartum ischemic necrosis of the pituitary gland - pituitary enlarges during pregnancy and is susceptible to ischemia

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11
Q

What are Rathke Cleft Cysts? How do they appear?

A

Cysts lined by ciliated cuboidal cells with scattered goblet cells and anterior pituitary cells - Remnant of rathke’s pouch

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12
Q

What is a craniopharyngioma and where can it be located?

A

A benign tumor usually located suprasellar

May also be within sella, third ventricle or (rarely) pineal region

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13
Q

Craniopharyngioma characteristics

  • Age peaks:
  • Presenting symptoms:
  • Types (2):
A
  • Age peaks: 5-14 y/o; 65-74 y/o
  • Presenting symptoms: Visual abnormalities (chiasm) and hypopituitarism
  • Types (2): Adamantinomatous type and Papillary type
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14
Q

What are appearances and characteristics of the adamantinomatous type of craniopharyngioma?

A
  • Cysts filled with dark brown fluid and cholesterol crystals
  • Basally palisading squamous epithelium
  • Abdant keratin
  • Local invasion of brain with chronic inflammation
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15
Q

What is the appearance of the papillary type of craniopharyngioma?

A

Papillary architecture with no keratin formation

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16
Q

Large pituitary adeonmas can cause bitemporal ___________

A

Hemianopsia (no vision in half of visual field)

17
Q

The parathyroid develops from…

A
  • Pharyngeal pouches
    • Inferior portion & thymus - 3rd pouch
    • Superior portion - 4th pouch
18
Q

Describe the appearance of a normal parathyroid (color, cell type, distinguishing features)

A
  • Yellow, brown ovoid nodule composed primarily of chief cells and oxyphil cells
  • Large amount of intervening stromal fat in adults - adipocytes serve as a key distinguishing feature
19
Q

Hormone secretions from the parathyroid are controlled by levels of…

A

free calcium

20
Q

What types of disorders cause hyperfunctioning of the parathyroid? Hypofunctioning?

A
  • Hyperfunction
    • Parathyroid Hyperplasia
    • Parathyroid Adenoma
    • Parathyroid Carcinoma
  • Hypofunction
    • Congenital (DiGeorge syndrome)
    • Iatrogenic (surgical)
    • Familial
    • Autoimmune
21
Q

Which type of hyperfunctioning abnormality of the parathyroid is most common?

A

Adenoma (75-80%)

Hyperplasia is second most common

22
Q

What types of bone diseases are found in hyperparathyroidism? (3)

A
  • Osteitis fibrosis cystica - erosion of bone by osteoclasts; grossly thinned cortex; fibrosis of marrow with hemorrhage and cyst formation
  • Brown tumor - osteoclasts, reactive giant cells, hemorrhage
  • Osteoporosis
23
Q

Which type of hyperfunctioning abnormality of the parathyroid is a solitary mass that presents with proliferation of chief cells and a rim of normal parathyroid at the periphery?

A

Parathyroid adenoma

24
Q

How is parathyroid hyperplasia different than a parathyroid adenoma?

A
  • In parathyroid hyperplasia, clasically all four glands are involved (vs. one with adenoma)
  • Loss of normal fat cells
  • No normal parathyroid along the edge
25
Q

What are some distinguishing features of Parathyroid carcinomas?

A
  • Mitotic activity
  • Fibrous bands
  • Caspsular vascular invasion
26
Q

Why are parathyroid carcinomas difficult to treat?

A
  • Usually not diagnosed until they become invasive or metastatic
  • Hard to remove from surrounding structures due to fibrous adhesions
27
Q

What are some pathologies of the adrenal cortex?

What are some pathologies of the adrenal medulla?

A
  • Adrenal cortex:
    • Adrenocortical hyperplasia
    • Adenoma
    • Carcinoma
  • Adrenal medulla
    • Pheochromocytoma
28
Q

How does adrenocortical hyperplasia appear?

Which layer is predominantly hyperplastic?

A

Bilateral thickening of the adrenal cortex, predominantly the zona fasciculata (clear cells)

Can be diffuse or nodular (picture)

29
Q

Adrenocortical adenoma

  • Color:
  • Predominate zone affected:
  • Solitary vs multiple:
  • Characteristic type of cell:
A
  • Color: Yellow (encapsulated)
  • Predominate zone affected: fasciculata
  • Solitary vs multiple: solitary
  • Characteristic type of cell: lipid rich cells
30
Q

What distinguishes adrenocortical carcinoma from adrenocortical adenoma?

A

Adrenocortical carcionomas are rare and usually > 5cm in diameter

  • Invasive with effacement of normal structures
  • Necrosis and hemorrhage
  • Well to poorly differentiated (pleomorphism)
  • Lymph node metastasis
31
Q

What type of adrenocortical carcinoma is shown in this image?

A

Well differentiated

32
Q

What type of adrenocortical carcinoma is shown in this image?

A

Poorly differentiated

33
Q

What are some causes of hypercortisolism?

A
  • Exogenous glucocorticoids
  • Increased ACTH
  • ACTH independent hypercortisolism (adenoma/carcinoma)
  • Congenital adrenal hyperplasia
34
Q

What is Conn syndrome?

A

Hyperaldosteronism: Adrenal cortical adenoma

35
Q

What is the classic triad of symptoms associated with pheochromocytoma?

A

Headaches, palpitations, diaphoresis

36
Q

What is the rule of 10s that is associated with pheochromocytomas?

A
  • 10% associated with familial syndromes
  • 10% extra adenal (paragangliomas)
  • 10% bilateral
  • 10% are malignant
37
Q

What is a distinguishing feature of pheochromocytomas?

A

Zellballen: small nests of chromaffin cells with abundant granular, basophilic cytoplasm

38
Q

How are the chromaffin cells in a pheochromocytoma stained?

A

Stained with neuroendocrine markers (chromogranin, synaptophysin)

39
Q

What are the common sites of paragangliomas?

A
  • Jugulotympanic
  • Carotid body
  • Vagal
  • Aorticopulmonary

Endo (18 decks)

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