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Block 10 week 1 > Pituitary Pathology- Usera > Flashcards

Pituitary Pathology- Usera Flashcards

1
Q

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

A

endocrine glands

anterior

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2
Q

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

A

Neurosecretory

axons to axon endings

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3
Q

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.

A

portal

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4
Q

What are the posterior pituitary hormones?

A

Oxytocin and ADH

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5
Q

What are the anterior pituitary hormones?

A 
Gonadotropic hormones
GH
Prolactin
ACTH
TSH
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6
Q

Rathkes pouch grows down into the (blank)

A

pars nervosa (neurohypophysis)

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7
Q

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

A

acidophils
basophils
chromophobes

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8
Q

What is hyperpituitarism and what are examples of these?

A

-excess hormonal secretion

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

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9
Q

What is hypopituitarism? What are examples of this?

A

deficiency of trophic hormones

-ischemia, ablation, radiation

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10
Q

What are the local mass effects of pituitary diseases?

A
  • visual field abnormalities
  • increased ICP
  • Pituitary apoplexy (hemorrhage into pituitary causing destruction)
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11
Q

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

A
  • ACTH and other POMC-derived peptides
  • ACTH cell adenoma
  • Cushing syndrome and Nelson syndrome
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12
Q

What hormone is secreted by a somatotroph?

What tumor is associated with this?

What are the associated syndromes?

A
  • GH
  • GH cell adenoma

-Gigantism (children)
Acromegaly (adults)

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13
Q

What hormone is secreted by a lactotroph?

What tumor is associated with this?

What are the associated syndromes?

A

Prolactin

Prolactin cell adenoma

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

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14
Q

What hormone is secreted by a mammosomatroph?

What tumor is associated with this?

What are the associated syndromes?

A

Prolactin, GH

Mammosomtotroph

Combined features of GH and prolactin excess

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15
Q

What hormone is secreted by a thyrotroph?

What tumor is associated with this?

What are the associated syndromes?

A

TSH

TSH cell adenoma

hyperthyroidism

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16
Q

What hormone is secreted by a gonadotroph?

What tumor is associated with this?

What are the associated syndromes?

A

FSH, LH

gonadotroph, “null cell”, oncocytic adenoma

Hypogonadism, mass effects, and hypopituitarism

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17
Q

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?

A
  • hyperproliferation of monomorphic cell population
  • Both
  • loss of reticulin formation
  • 35-60 years
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18
Q

(blank) percent of the population has subclinical microadenomas

A

14%

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19
Q

What is the most common adenoma?

A

prolactinoma

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20
Q

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

A

hyperplasia will have an intact reticular framework

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21
Q

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

A

prolactinomas

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22
Q

Prolactinomas can be associated with (blank)

A

calcification/psammoma bodies (pituitary stones)

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23
Q

(blank) secretion is proportional to tumor size.

A

prolactin

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24
Q

What are the clinical features of prolactinomas?

A
  • amenorrhea
  • galactorrhea
  • loss of libido
  • infertility
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25
Q

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

A

prolactinoma

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26
Q

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

A

older

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27
Q

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

A 
Physiologic 
-pregnancy
-nipple stimulation
Pathologic
-Lactotroph hyperplasia
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28
Q

What are the causes of hyperprolactinemia?

A
  • hypothalamic prolactin stimulation
  • medications (neuroleptics, antihypertensive, psychotropic agents, anti-ulcer agents, opiates)
  • neurogenic
  • physiologic causes (pregnancy)
  • reduce prolactin elimination
  • abnormal molecules
  • increased prolactin production
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29
Q

What are the causes for increased prolactin production?

A

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

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30
Q

What are the causes for reduced prolactin elimination?

A

renal failure

hepatic insufficiency

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31
Q

What are the physiologic causes of increased prolactin secretion?

A

pregancy-> estrogen-> prolactin

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32
Q

What are the neurogenic causes of increased prolactin?

A

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

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33
Q

What are the medications that cause increased prolactin?

A

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

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34
Q

How do you get hypothalamic PRL stimulation?

A

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

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35
Q

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

A

dopamine-mediated

36
Q

What is the 2nd most common functional adenoma?

A

Somatotroph adenoma (growth hormone producing)

37
Q

Somatotroph adenomas have symptoms mediated by (blank)

A

Hepatic IGF-1 secretion

38
Q

How do you diagnose somatotroph adenomas?

A
  • documentation of persistently elevated GH and IGF-1

- failure to suppress GH secretion following oral glucose

39
Q

What are the 2 major diseases that somatotroph adenomas cause?

A

gigantism and acromegaly

40
Q

What is this:

  • elevated GH before closure epiphyses
  • generalized increase in size, long arms and legs
A

gigantism

41
Q

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

A

Acromegaly

42
Q

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

A

they have gaps in their teeth?

yes, when control of GH levels is restored then tissue overgrowth may recede

43
Q

What does a corticotroph adenoma do?

A

causes excess ACTH causing hypersecretion of cortisol by adrenals

44
Q

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

A

Cushing syndrome: stigmata ass. w/ excess cortisol secretion

Cushing disease: due to a pituitary corticotroph adenoma

45
Q

Adrenalectomy can lead to (blank)

A

corticotroph adenoma

46
Q

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

A

nelson’s syndrome

47
Q

Why does an adrenalectomy lead to a corticotroph adenoma?

A

loss of inhibitory feedback on inhibitory pre-existing microadenoma

48
Q

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

A

ACTH and POMC

49
Q

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

A

Gonadatroph adenoma (LH or FSH producing)

50
Q

Gonadatrophic adenoma can lead to what symptoms?

A

LH deficiency, decreased libido in men, amenorrhea in women

51
Q

Who does gonadatrophic adenomas present in?

What are the symptoms usually due to and what are these symptoms?

A

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

52
Q

(blank) percent of pituitary adenomas are non functioning adenomas

A

25-30%

53
Q

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

A

diplopia, headaches, visual field disturbances

  • anterior pituitary function
  • hypopituitarism
54
Q

(blank) is a TSH producing hormone that causes hyperthyroidism

A

thyrotroph

55
Q

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

A

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

56
Q

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?

A 
GH deficiency
LH/FSH deficiency
LH/FSH deficiency
Hypoadrenalism
MSH deficinecy or ACTH deficiency (not creating POMC)
57
Q

What are the causes of hypopituitarism?

A 
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)
58
Q

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

A

Breast cancer

59
Q

How can a TBI cause hypopituitarism?

A

can disrupt hypothalamic input and cause destruction of stalk

60
Q

What is a pituitary apoplexy?

A

sudden hemorrhage, often in an adenoma

61
Q

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

A

sarcoidosis and TB

62
Q

What is sheehan syndrome?

A

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

63
Q

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

A

DIC, sickle cell, shock

64
Q

What are the symptoms of sheehan syndrome?

A

lack of lactation, headache, and obtundation.

65
Q

What is the difference between apoplexy and sheehan syndrome?

A

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

66
Q

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

A

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

Multiparous obese women

67
Q

What are secondary causes of empty sella syndrome?

A

adenoma, surgery etc

68
Q

What is a rathke cleft cyst?

What is it derived from?

A

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

69
Q

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

A

ciliated cuboidal epithelium with occasional goblet cells

70
Q

What can rathkes cleft cyst impinge on and cause?

A

impinge on posterior pituitary causing diabetes insipidous

71
Q

What causes diabetes insipidus?

A

ADH deficiency

72
Q

What are the symptoms of diabetes inspidous?

A

excess urination and dilute urine

excessive thirst and polydipsia

73
Q

What can diabetes insipidus result from?

A

trauma, tumors, inflammatory disorders, surgeries, or spontaneous

74
Q

What are the 2 types of diabetes inspidius?

A

central -primary ADH deficiency

Nephrogenic- unresponsiveness of renal tubules

75
Q

What is SIADH?

A

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

76
Q

What are the causes of SIADH?

A
  • ectopic secretion by malignant tumors (small cell CA of lung is most common)
  • drugs (cyclophosphamide, narcotics, phenothiazines)
  • infection
  • trauma
77
Q

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

A

small cell CA of lung

78
Q

What are the drugs that can cause SIADH?

A
  • cyclophosphamide (chemo drug)
  • narcotics
  • phenothiazines
79
Q

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

A
  • increased
  • remains normal
  • no peripheral edema (instead diffuse generalized edema)
80
Q

What are the 2 suprasellar tumors?

A
  • optic nerve gliomas

- craniopharyngioma

81
Q

What can an opic nerve glioma occur with?

A

neurofibromatosis

82
Q

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

A

vestigial remnants of rathke’s pouch

  • 1-5% of intracranial tumors
  • slow growing, benign
83
Q

When do people commonly get suprasellar tumors?

A

bimodal incidence
5-15 yrs
adults > 65 years

84
Q

What causes a craniopharyngioma?

A

abnormalities of WNT signaing (activating beta-catenin mutations)

85
Q

Histologically how does a craniopharyngioma look?

A

stellate cells and wet keratin

Block 10 week 1 (4 decks)

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