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Endocrine 2 > Robbins - Pituitary > Flashcards

Robbins - Pituitary Flashcards

1
Q

Basophilic anterior pituitary hormones

A

B-FLAT - FSH, LH, ACTH, TSH

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2
Q

Acidophilic anterior pituitary hormones

A

Pink PiG - Prolactin, GH

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3
Q

Posterior pituitary hormones

A

ADH, oxytocin

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4
Q

PIT-1

A

Somatotrophs (GH)
Mammosomatotrophs (GH + prolactin)
Lactotrophs (prolactin)

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5
Q

GATA-2

A

Gonadotrophs (FSH, LH)

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6
Q

ADH and oxytocin - production

A

Hypothalamus

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7
Q

Headache, nausea, vomiting, bitemporal hemianopsia

A

Pituitary expanding mass

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8
Q

Which are bigger at Dx…functional or nonfunctional pituitary adenomas? Why?

A

Nonfunctional - no S/S until mass effect S/S

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9
Q

Majority of pituitary adenomas are what type?

A

Silent microadenomas (“incidentaloma”)

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10
Q

GNAS

Result?

A

Somatotroph (GH) adenomas (40%)

Deficient GTPase, excess active Gs-alpha, excess cAMP

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11
Q

PRKAR1A (PKA regulator)

Result?

A

Somatotroph (GH) or Lactotroph (prolactin) adenomas

Deficient PKA regulation, excess cAMP

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12
Q

Cyclin D1, TP53

Result?

A

Aggressive adenoma

Excess G1-S cell cycle transition

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13
Q

HRAS

Result?

A

Pituitary carcinoma

Cellular proliferation, survival, etc.

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14
Q

Role of cAMP

A

Promotes cellular proliferation and hormone synthesis/secretion

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15
Q

Most pituitary adenomas are (sporadic or genetic)?

A

Sporadic (95%)

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16
Q

Soft well-circumscribed mass in the cranial vault, compression of optic chiasm and cranial nerves

A

Typical pituitary adenoma

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17
Q

Soft un-encapsulated infiltrating mass in the cranial vault, infiltrating nearby sinuses, dura, etc.

A

Invasive pituitary adenoma

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18
Q

Invasive pituitary adenomas tend to be of the ____ type

A

Macroadenoma

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19
Q

Cranial mass, uniform (any of the 3 cell types) polygonal cells in sheets or cords, no reticulin or mitotic activity

A

Typical pituitary adenoma

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20
Q

How to distinguish a pituitary adenoma from normal parenchyma?

A

Normal - pleomorphic cell types, reticulin network

Adenoma - monomorphic cell population, little reticulin

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21
Q

Soft un-encapsulated infiltrating mass in the cranial vault, high mitotic activity, p53 expression

A

Atypical (aggressive/invasive) adenoma

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22
Q

Cranial mass, chromophobic cells, juxtanuclear PIT-1, psammoma bodies

A

Sparsely-granulated lactotroph adenoma

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23
Q

Cranial mass, acidophilic cells, diffuse cytoplasmic PIT-1, psammoma bodies

A

Densely-granulated lactotroph adenoma

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24
Q

Lactotroph adenomas have a propensity for _____

2 presentations of this?

A

Dystrophic calcification

Psammoma bodies, pituitary stones

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25
Q

Pituitary stone

A

Calcified lactotroph adenoma

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26
Q

Does prolactin level correlate w/ adenoma size?

A

YES

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27
Q

No menstrual periods, excessive lactation, loss of sexual drive, inability to become pregnant – what is it?

Then, mass on head CT

A

Prolactinemia - excessive production of prolactin

Lactotroph adenoma

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28
Q

Physiologic mechanisms of prolactinemia

A

Pregnancy, nipple stimulation (when lactating)

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29
Q

Pathologic (general) mechanism of prolactinemia - starts with what?

Causes?

A

Lactotroph hyperplasia (lost dopamine signaling)

Hypothalamus or pituitary stalk damage (head trauma), anti-dopamine drugs, suprasellar mass lesion

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30
Q

Treatment of lactotroph adenoma (2)

A

Bromocriptine (dopamine agonist) or surgery

31
Q

Child, abnormally large, overly long arms and legs

What to see on labs?

A

Gigantism

Excess GH and IGF-1

32
Q

Adult, overly large visceral organs, jaw protrusion, enlarged hands and feet, sausage fingers

What to see on labs?

A

Acromegaly

Excess GH and IGF-1

33
Q

Associated symptoms of GH excess (7)

A

Gonadal dysfunction, DM, weakness, HTN, arthritis, CHF, GI cancers

34
Q

Cranial mass, monomorphic acidophilic cells, strong GH reactivity

A

Densely-granulated somatotroph adenoma

35
Q

Cranial mass, pleomorphic chromophobic cells, focal weak GH reactivity

A

Sparsely-granulated somatotroph adenoma

36
Q

Cranial mass, monomorphic acidophilic cells, strong GH and prolactin reactivity

A

Mammosomatotroph adenoma

37
Q

Elevated GH level, does not decrease after oral glucose load

A

Acromegaly

38
Q

Treatment of somatotroph adenoma

A

Somatostatin analog, GH receptor antagonist, or surgery

39
Q

Cushings features, cranial mass

A

Corticotroph adenoma

40
Q

Small cranial mass, basophilic cells, PAS-positive

A

Densely-granulated corticotroph adenoma

41
Q

Small chromophobic mass, PAS-positive

A

Sparsely-granulated corticotroph adenoma

42
Q

Why is a corticotroph adenoma PAS-positive?

A

Carbohydrates in POMC, the ACTH precursor

43
Q

Corticotroph adenoma…immunoreactive stainings?

A

POMC, ACTH, Beta-endorphin

44
Q

A patient with Cushings has his adrenals removed surgically. Later, he presents with headache, visual disturbances, and dark spots on his skin

A

Nelson syndrome - large destructive pituitary adenoma due to loss of negative feedback from adrenals

45
Q

Nelson syndrome - why the hyperpigmentation?

A

POMC = common precursor for ACTH and melanin

46
Q

Middle age, headaches, double vision, SF-1 and GATA-2 positive

A

Gonadotroph adenoma

47
Q

Gonadotroph adenomas usually secrete more ____

A

FSH than LH

48
Q

Thyrotroph adenomas are ____, and cause ____

A

RARE, hyperthyroidism

49
Q

Headache, double vision, hypopituitarism, cranial mass

A

Nonfunctioning pituitary adenoma

50
Q

Cranial mass, craniospinal or other metastases

Usually secrete what?

A

Pituitary carcinoma

Prolactin or ACTH

51
Q

How much of the anterior pituitary must be dysfunctional for effects to be seen?

A

75%

52
Q

Hypofunction of anterior and posterior pituitary

A

Hypothalamus dysfunction

53
Q

Causes of anterior pituitary hypofunction (11)

A
  • Mass lesion
  • Subarachnoid hemorrhage, TBI
  • Pituitary surgery or radiation
  • Pituitary apoplexy
  • Ischemic necrosis of pituitary
  • Rathke cleft cyst
  • Empty sella syndrome
  • Hypothalamic lesion
  • Sarcoidosis
  • TB meningitis
  • PIT-1 congenital deficiency
54
Q

Sudden excruciating headache, double vision, hypopituitary S/S

Evidence of what?

A

Pituitary apoplexy - hemorrhage into the gland

Rapid enlargement of an adenoma

55
Q

Pregnant woman begins bleeding from the vagina and is rushed to the ER. She is stabilized, but begins showing signs of hypopituitarism

A

Sheehan syndrome - enlarged pituitary from pregnancy (w/o appropriate blood supply) becomes ischemic after acute blood loss

56
Q

A patient at autopsy shows a small, fibrous mass attached to the wall of the sella turcica - what is it?

Causes? (5)

A

Pituitary ischemic necrosis

DIC, sickle cell, elevated ICP, traumatic injury, shock

57
Q

Mass filled w/ proteinaceous fluid and lined w/ ciliated cuboidal epithelium, goblet cells, and anterior pituitary cells

Danger?

A

Rathke cleft cyst

Hypopituitarism via expanding mass lesion

58
Q

Primary empty sella syndrome

A

Defect in diaphragma sella, herniation of arachnoid mater and CSF into sella turcica

59
Q

Secondary empty sella syndrome

A

Pituitary mass removed or infarcted, causing loss of function

60
Q

Overweight woman, multiple pregnancies, hypopituitarism

A

Primary empty sella - diaphragma sella defect

61
Q

Hypothalamic lesions that cause hypopituitarism

A
  • Craniopharyngioma

- Metastatic breast or lung carcinoma

62
Q

Hypopituitarism, polyuria, polydipsia, headache, stiff neck, apical lung mass

A

TB meningitis - infection of hypothalamus

63
Q

Short stature, fatigue, inability to lactate, weight gain, always cold, hair loss

Explain

A

PIT-1 mutation

Deficient GH, prolactin, and TSH

64
Q

Polyuria, always thirsty, polydipsia, dilute urine, hypernatremia. Responds to ADH therapy

A

Central diabetes insipidus - lack of ADH

65
Q

Non-spontaneous causes of central diabetes insipidus

A

Head trauma, tumors, inflammation of the brain, surgery

66
Q

Hyponatremia, cerebral edema, neurologic dysfunction

Causes?

A

SIADH

Ectopic ADH (small cell lung carcinoma), drugs, CNS infections, CNS trauma

67
Q

2 most common hypothalamus tumors that cause pituitary deficit

A
  • Gliomas

- Craniopharyngiomas

68
Q

Hypothalamus mass, vestigial remnants of Rathke pouch

A

Craniopharyngioma

69
Q

Child or older adult, headaches, visual issues, growth retardation (child)

A

Craniopharyngioma

70
Q

WNT mutations, beta-catenin mutations

A

Craniopharyngioma

71
Q

Child, cystic, multiloculated mass with stratified squamous epithelium within a spongy reticulum, palisading of squamous epithelium at the edge, compact lamellar keratin

A

Adamantinomatous craniopharyngioma

72
Q

Lamellar keratin, dystrophic calcification, fibrosis, inflammatory background

A

Adamantinomatous craniopharyngioma

73
Q

Adult, cranial mass with sheets and papillae lined by well-differentiated epithelium. No palisading, reticulum, keratin, calcification, or cysts

A

Papillary craniopharyngioma

74
Q

Craniopharyngioma - prognosis?

A

Excellent

Endocrine 2 (12 decks)

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