Pituitary Pathology- Usera Flashcards by Danielle Hayes

Tropic hormones are hormones that have other (blank) as their target. Most tropic hormones are produced and secreted by the (blank) pituitary.

endocrine glands

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(blank) cells produce ADH and oxytocin. These hormones move down (blank) and are then secreted into the blood stream.

Neurosecretory

axons to axon endings

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Neurosecretory cells produce hypothalamic releasing and hypothalmic inhibiting hormones that secrete hormones into a (blank) system. Each type of hypothalamic hormone inhibit production and secretion of an anterior pituitary hormone.

portal

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What are the posterior pituitary hormones?

Oxytocin and ADH

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What are the anterior pituitary hormones?

Gonadotropic hormones
GH
Prolactin
ACTH
TSH

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Rathkes pouch grows down into the (blank)

pars nervosa (neurohypophysis)

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What are the three general appearances of cells of the anterior pituitary?

acidophils
basophils
chromophobes

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What is hyperpituitarism and what are examples of these?

-excess hormonal secretion

Examples: Adenomas, hyperplasia, carcinoma, non-pituitary tumors, hypothalamic disorders

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What is hypopituitarism? What are examples of this?

deficiency of trophic hormones

-ischemia, ablation, radiation

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What are the local mass effects of pituitary diseases?

visual field abnormalities
increased ICP
Pituitary apoplexy (hemorrhage into pituitary causing destruction)

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What hormones are secreted by corticotroph cells?
What are the tumor types associated with these cells?
What are the associated syndromes?

ACTH and other POMC-derived peptides
ACTH cell adenoma
Cushing syndrome and Nelson syndrome

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What hormone is secreted by a somatotroph?

What tumor is associated with this?

What are the associated syndromes?

GH
GH cell adenoma

-Gigantism (children)
Acromegaly (adults)

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What hormone is secreted by a lactotroph?

What tumor is associated with this?

What are the associated syndromes?

Prolactin

Prolactin cell adenoma

Galactorrhea and amenorrhea (in females) Decreased libido and headaches in males

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What hormone is secreted by a mammosomatroph?

What tumor is associated with this?

What are the associated syndromes?

Prolactin, GH

Mammosomtotroph

Combined features of GH and prolactin excess

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What hormone is secreted by a thyrotroph?

What tumor is associated with this?

What are the associated syndromes?

TSH

TSH cell adenoma

hyperthyroidism

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What hormone is secreted by a gonadotroph?

What tumor is associated with this?

What are the associated syndromes?

FSH, LH

gonadotroph, “null cell”, oncocytic adenoma

Hypogonadism, mass effects, and hypopituitarism

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Adenomas results in a hyperproliferation of a (blank) cell population. Are they functional or non functional?
What happens to the reticulin formation? When is the peak incidence of adenomas?

hyperproliferation of monomorphic cell population
Both
loss of reticulin formation
35-60 years

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(blank) percent of the population has subclinical microadenomas

14%

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What is the most common adenoma?

prolactinoma

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Hyperplasia can happen with things like pregnancy, how can you tell the difference between hyperplasia and an adenoma?

hyperplasia will have an intact reticular framework

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(blank) make up 30% of functional adenomas (most common)

prolactinomas

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Prolactinomas can be associated with (blank)

calcification/psammoma bodies (pituitary stones)

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(blank) secretion is proportional to tumor size.

prolactin

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What are the clinical features of prolactinomas?

amenorrhea
galactorrhea
loss of libido
infertility

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25% of cases of amenorrhea are associated with underlying (blank)

prolactinoma

(blank) men and women are less sensitive to the hormonal effects of hyperprolactinemia therefore tumors can reach larger size before clinical detection

older

What are other ways other than a prolactinoma that can cause hyperprolactinemia?

``` Physiologic -pregnancy -nipple stimulation Pathologic -Lactotroph hyperplasia ```

What are the causes of hyperprolactinemia?

- hypothalamic prolactin stimulation - medications (neuroleptics, antihypertensive, psychotropic agents, anti-ulcer agents, opiates) - neurogenic - physiologic causes (pregnancy) - reduce prolactin elimination - abnormal molecules - increased prolactin production

What are the causes for increased prolactin production?

Polycystic ovarian syndrome, adenomas, hypothalamic stalk interruption, hypophysitis (inflammation)

What are the causes for reduced prolactin elimination?

renal failure | hepatic insufficiency

What are the physiologic causes of increased prolactin secretion?

pregancy-> estrogen-> prolactin

What are the neurogenic causes of increased prolactin?

chest wall injury, breast stimulation, breastfeeding-> causes dopamine inhibition and increased prolactin

What are the medications that cause increased prolactin?

neuroleptics, antihypertensives, psychotropic agents, anti-ulcer agents, opiates-> decreased dopamine -> increased prolactin

How do you get hypothalamic PRL stimulation?

primary hypothyroidism or adrenal insufficiency which leads to increase TRH-> increased Prolactin

An adenoma of other trophic cells (not lactotrophs) can still cause hyperprolactinemia due to mass effect on the infundibilum, preventing normal (blank) inhibition

dopamine-mediated

What is the 2nd most common functional adenoma?

Somatotroph adenoma (growth hormone producing)

Somatotroph adenomas have symptoms mediated by (blank)

Hepatic IGF-1 secretion

How do you diagnose somatotroph adenomas?

- documentation of persistently elevated GH and IGF-1 | - failure to suppress GH secretion following oral glucose

What are the 2 major diseases that somatotroph adenomas cause?

gigantism and acromegaly

What is this: - elevated GH before closure epiphyses - generalized increase in size, long arms and legs

gigantism

What is this: elevated GH after closure of epiphyses Growth is skin, soft tissues, viscera (including heart), bones of face, hands and feet

Acromegaly

How can you tell someone is taking GH? Can this be fixed?

they have gaps in their teeth? | yes, when control of GH levels is restored then tissue overgrowth may recede

What does a corticotroph adenoma do?

causes excess ACTH causing hypersecretion of cortisol by adrenals

corticotroph adenoma causes cushing syndrome and cushing disease. What is each of them?

Cushing syndrome: stigmata ass. w/ excess cortisol secretion | Cushing disease: due to a pituitary corticotroph adenoma

Adrenalectomy can lead to (blank)

corticotroph adenoma

Adrenalectomy can lead to a corticotroph adenoma called (blank) syndrome

nelson's syndrome

Why does an adrenalectomy lead to a corticotroph adenoma?

loss of inhibitory feedback on inhibitory pre-existing microadenoma

Elevated (blank) and (blank) secretion can lead to hyperpigmentation

ACTH and POMC

(blank) is difficult to recognize = inefficient and variabe secretion.

Gonadatroph adenoma (LH or FSH producing)

Gonadatrophic adenoma can lead to what symptoms?

LH deficiency, decreased libido in men, amenorrhea in women

Who does gonadatrophic adenomas present in? | What are the symptoms usually due to and what are these symptoms?

-older and middle aged people -mass itself: diplopia (tumor on optic chiasm), headache (increased ICP), pituitary apoplexy, other hormone def.

(blank) percent of pituitary adenomas are non functioning adenomas

25-30%

Non functioning adenomas present due to mass effects which are...? They can disturb (blank) function leading to (blank)

diplopia, headaches, visual field disturbances - anterior pituitary function - hypopituitarism

(blank) is a TSH producing hormone that causes hyperthyroidism

thyrotroph

What is a pituitary carcinoma and how common is it? what are the most common types?

a malignant adenoma that demonstrates craniospinal or systemic metastases. less than 1% Prolactin and ACTH most common

What causes dwarfism? What causes Amenorrhea and infertility in women? What causes decreased libido, impotence, loss of axillary and pubic hair? What causes addison's disease (decreased ACTH)? What causes pallor?

``` GH deficiency LH/FSH deficiency LH/FSH deficiency Hypoadrenalism MSH deficinecy or ACTH deficiency (not creating POMC) ```

What are the causes of hypopituitarism?

``` tumors and mass lesion (mets etc) TBI Surgery or radiation Pituitary apoplexy Sheehan syndrome Rathke cleft cyst empty sella syndrome Inflammatory or infections conditions (sarcoidosis, TB) ```

What is the msot common metastatic tumor that hits the hypopituitary?

Breast cancer

How can a TBI cause hypopituitarism?

can disrupt hypothalamic input and cause destruction of stalk

What is a pituitary apoplexy?

sudden hemorrhage, often in an adenoma

What are the common infections or inflammatory conditions that can cause hypopituitarism?

sarcoidosis and TB

What is sheehan syndrome?

During pregnancy, the anterior pituitary can double in size without a corresponding increase in vascularity--> reduction in blood volume by obstretric hemorrhage can lead to post-partum ischemic necrosis

Other than sheehan syndrome, pituitary necrosis can be caused by other systemic diseases such as...?

DIC, sickle cell, shock

What are the symptoms of sheehan syndrome?

lack of lactation, headache, and obtundation.

What is the difference between apoplexy and sheehan syndrome?

apoplexy is caused by hemorrhage resulting in ischemic necrosis whereas sheehan is caused by a lack of blood flow causing ischemia

What is empty sella syndrome and who is it common in?

defect in diaphragm sella that allows herniation of arachnoid mater, compressing the normal pituitary. Multiparous obese women

What are secondary causes of empty sella syndrome?

adenoma, surgery etc

What is a rathke cleft cyst? | What is it derived from?

fluid filled cysts located in the posterior aspect of the anterior pituitary -Rathke's pouch

What is the type of epithelium that lines rathke cleft cysts?

ciliated cuboidal epithelium with occasional goblet cells

What can rathkes cleft cyst impinge on and cause?

impinge on posterior pituitary causing diabetes insipidous

What causes diabetes insipidus?

ADH deficiency

What are the symptoms of diabetes inspidous?

excess urination and dilute urine | excessive thirst and polydipsia

What can diabetes insipidus result from?

trauma, tumors, inflammatory disorders, surgeries, or spontaneous

What are the 2 types of diabetes inspidius?

central -primary ADH deficiency | Nephrogenic- unresponsiveness of renal tubules

What is SIADH?

excessive secretion of ADH resulting in excess retention of water causing severe hyponatremia and cerebral edema

What are the causes of SIADH?

- ectopic secretion by malignant tumors (small cell CA of lung is most common) - drugs (cyclophosphamide, narcotics, phenothiazines) - infection - trauma

What is the most common malignant tumor that can cause SIADH?

small cell CA of lung

What are the drugs that can cause SIADH?

- cyclophosphamide (chemo drug) - narcotics - phenothiazines

What is the the total body water like in SIADH? the blood volume? Is there peripheral edema?

- increased - remains normal - no peripheral edema (instead diffuse generalized edema)

What are the 2 suprasellar tumors?

- optic nerve gliomas | - craniopharyngioma

What can an opic nerve glioma occur with?

neurofibromatosis

What is a craniopharyngioma derived from? How common is it? What are the characteristics of a craniopharyngioma?

vestigial remnants of rathke's pouch - 1-5% of intracranial tumors - slow growing, benign

When do people commonly get suprasellar tumors?

bimodal incidence 5-15 yrs adults > 65 years

What causes a craniopharyngioma?

abnormalities of WNT signaing (activating beta-catenin mutations)

Histologically how does a craniopharyngioma look?

stellate cells and wet keratin