Pituitary Pathology

Question 1

What six hormones are produced by the anterior pituitary?

Answer 1

GH
ACTH
TSH
LH
FSH
Prolactin

Question 2

Which anterior pituitary hormone is under inhibitory control? What inhibits it?

Answer 2

Prolactin

Dopamine

Question 3

Which hormones are produced by acidophils? Basophils?

Answer 3

Acidophils: GH, PL
Basophils: FSH, LH, ACTH, TSH (BFLAT)

Question 4

What hormones are released by the posterior pituitary?

Answer 4

Oxytocin, ADH

Question 5

What is the role of Oxytocin?

Answer 5

Labor, milk let-down

Cuddling, monogamy, trust

Question 6

What are five causes of hyperpituitarism? Which is the most common?

Answer 6

Pituitary adenoma (MOST COMMON)
Destruction of end organs
Hypothalmic disorders
Hyperplasia of anterior lobe
Carcinoma of anterior lobe

Question 7

What are considered “Mass effects” of pituitary adenomas?

Answer 7

Visual deficits, increased ICP, HYPOpituitarism

Question 8

What genetic endocrine disorder oftentimes sees pituitary adenoma?

Answer 8

MEN I

Question 9

Who most often gets pituitary adenomas?

Answer 9

Adults

Question 10

When is a pituitary adenoma a neurosurgical emergency?

Answer 10

When it bleeds

Question 11

What do pituitary adenomas look like on microscopy?

Answer 11

Sheets/cords
Uniform cells of one type
May be pleomorphic
May have mitoses

Question 12

What is the most common hormone produced by a pituitary adenoma? Least common?

Answer 12

Most common: Prolactin

Least common: TSH

Question 13

What proteins are often mutated in pituitary adenomas?

Answer 13

GNAS1
MEN1
RAS/cMYC

Question 14

What type of protein does GNAS code?

Answer 14

G3 protein, leads to increased cAMP

Question 15

How do men present with a prolactinoma? Women?

Answer 15

Men: Decreased libido and headache
Women: Amenorrhea, galactorea

Question 16

How do you treat prolactinomas?

Answer 16

Dopamine receptor agonists:
Bromocryptine
Cabergoline

Question 17

What do people who present with a GH adenoma before adulthood look like? After?

Answer 17

Before: Zach Fredman
After: Andre the Giant

Question 18

Other than being huge, what can GH adenoma manifest as?

Answer 18

Diabetes
Hypertension
Arthritis
GI carcinoma

Question 19

What are common lab findings for a GH adenoma?

Answer 19

Increased GH
Increased IGF-1
GH unresponsive to glucose

Question 20

How do you treat a GH adenoma?

Answer 20

Octreotide
GH receptor antagonists
Surgery

Question 21

What disease does an ACTH adenoma result in?

Answer 21

Cushing Disease

Question 22

What is Nelson Syndrome?

Answer 22

Take away adrenal glands’ negative feedback (remove cortisol)
Leads to super growth of pituitary adenoma

Question 23

What are two causes of adrenal Cushing syndrome?

Answer 23

Tumor

Nodular hyperplasia

Question 24

What is paraneoplastic Cushing Syndrome?

Answer 24

ACTH producing nonendocrine cancer (SCC of Lung)

Question 25

What is iatrogenic Cushing syndrome?

Answer 25

Cushing syndrome from long term use of corticosteroids

Question 26

What are causes of Hypopituitarism?

Answer 26

``` Pituitary destruction Ischemic necrosis Empty sella syndrome Pituitary apoplexy Hypothalmic lesions ```

Question 27

How can the pituitary be destroyed?

Answer 27

Big pituitary adenoma | Surgery or radiation

Question 28

What are the events leading up to ischemic necrosis of the pituitary?

Answer 28

Pituitary gets BIG (Pregnancy, e.g.) Hemorrhage (delivery) causes hypotension Pituitary becomes necrotic

Question 29

What syndrome is Pituitary Ischemic Necrosis after pregnancy known as?

Answer 29

Sheehan syndrome

Question 30

How does Sheehan syndrome present?

Answer 30

Poor lactition Loss of pubic hair Fatigue

Question 31

What events lead to Empty Sella Syndrome?

Answer 31

Arachnoid or CSF herniation | Pituitary compression

Question 32

What is Pituitary Apoplexy and what are the symptoms?

Answer 32

Sudden infarction of adenoma | Meningeal symptoms

Question 33

What hormone is affected first in hypopituitarism?

Answer 33

GH | then FSH/LH, TSH, ACTH

Question 34

What are signs of decreased GH?

Answer 34

Pituitary dwarfism, muscle weakness

Question 35

What are signs of decreased FSH/LH?

Answer 35

Loss of libido | Menstrual abnormalities

Question 36

What are signs of decreased PL?

Answer 36

Inability to lactate

Question 37

What are signs of decreased TSH?

Answer 37

Hypothyroidism

Question 38

What are signs of decreased ACTH?

Answer 38

Adrenal insufficiency

Question 39

What hormone is decreased in central Diabetes Insipidus?

Answer 39

ADH

Question 40

What happens to serum osmolality as a result of DI?

Answer 40

Serum osmolality increases

Question 41

What happens to serum osmolality in SIADH?

Answer 41

Serum osmolality decreases

Question 42

What are some causes of SIADH?

Answer 42

SCC of Lung CNS trauma Pulmonary infection Drugs (Cyclophosphamide)

Question 43

How do you treat SIADH?

Answer 43

Demeclocycline