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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
Pituitary stone
Calcified lactotroph adenoma
26
Does prolactin level correlate w/ adenoma size?
YES
27
No menstrual periods, excessive lactation, loss of sexual drive, inability to become pregnant -- what is it? Then, mass on head CT
Prolactinemia - excessive production of prolactin Lactotroph adenoma
28
Physiologic mechanisms of prolactinemia
Pregnancy, nipple stimulation (when lactating)
29
Pathologic (general) mechanism of prolactinemia - starts with what? Causes?
Lactotroph hyperplasia (lost dopamine signaling) Hypothalamus or pituitary stalk damage (head trauma), anti-dopamine drugs, suprasellar mass lesion
30
Treatment of lactotroph adenoma (2)
Bromocriptine (dopamine agonist) or surgery
31
Child, abnormally large, overly long arms and legs What to see on labs?
Gigantism Excess GH and IGF-1
32
Adult, overly large visceral organs, jaw protrusion, enlarged hands and feet, sausage fingers What to see on labs?
Acromegaly Excess GH and IGF-1
33
Associated symptoms of GH excess (7)
Gonadal dysfunction, DM, weakness, HTN, arthritis, CHF, GI cancers
34
Cranial mass, monomorphic acidophilic cells, strong GH reactivity
Densely-granulated somatotroph adenoma
35
Cranial mass, pleomorphic chromophobic cells, focal weak GH reactivity
Sparsely-granulated somatotroph adenoma
36
Cranial mass, monomorphic acidophilic cells, strong GH and prolactin reactivity
Mammosomatotroph adenoma
37
Elevated GH level, does not decrease after oral glucose load
Acromegaly
38
Treatment of somatotroph adenoma
Somatostatin analog, GH receptor antagonist, or surgery
39
Cushings features, cranial mass
Corticotroph adenoma
40
Small cranial mass, basophilic cells, PAS-positive
Densely-granulated corticotroph adenoma
41
Small chromophobic mass, PAS-positive
Sparsely-granulated corticotroph adenoma
42
Why is a corticotroph adenoma PAS-positive?
Carbohydrates in POMC, the ACTH precursor
43
Corticotroph adenoma...immunoreactive stainings?
POMC, ACTH, Beta-endorphin
44
A patient with Cushings has his adrenals removed surgically. Later, he presents with headache, visual disturbances, and dark spots on his skin
Nelson syndrome - large destructive pituitary adenoma due to loss of negative feedback from adrenals
45
Nelson syndrome - why the hyperpigmentation?
POMC = common precursor for ACTH and melanin
46
Middle age, headaches, double vision, SF-1 and GATA-2 positive
Gonadotroph adenoma
47
Gonadotroph adenomas usually secrete more ____
FSH than LH
48
Thyrotroph adenomas are ____, and cause ____
RARE, hyperthyroidism
49
Headache, double vision, hypopituitarism, cranial mass
Nonfunctioning pituitary adenoma
50
Cranial mass, craniospinal or other metastases Usually secrete what?
Pituitary carcinoma Prolactin or ACTH
51
How much of the anterior pituitary must be dysfunctional for effects to be seen?
75%
52
Hypofunction of anterior and posterior pituitary
Hypothalamus dysfunction
53
Causes of anterior pituitary hypofunction (11)
- 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
Sudden excruciating headache, double vision, hypopituitary S/S Evidence of what?
Pituitary apoplexy - hemorrhage into the gland Rapid enlargement of an adenoma
55
Pregnant woman begins bleeding from the vagina and is rushed to the ER. She is stabilized, but begins showing signs of hypopituitarism
Sheehan syndrome - enlarged pituitary from pregnancy (w/o appropriate blood supply) becomes ischemic after acute blood loss
56
A patient at autopsy shows a small, fibrous mass attached to the wall of the sella turcica - what is it? Causes? (5)
Pituitary ischemic necrosis DIC, sickle cell, elevated ICP, traumatic injury, shock
57
Mass filled w/ proteinaceous fluid and lined w/ ciliated cuboidal epithelium, goblet cells, and anterior pituitary cells Danger?
Rathke cleft cyst Hypopituitarism via expanding mass lesion
58
Primary empty sella syndrome
Defect in diaphragma sella, herniation of arachnoid mater and CSF into sella turcica
59
Secondary empty sella syndrome
Pituitary mass removed or infarcted, causing loss of function
60
Overweight woman, multiple pregnancies, hypopituitarism
Primary empty sella - diaphragma sella defect
61
Hypothalamic lesions that cause hypopituitarism
- Craniopharyngioma | - Metastatic breast or lung carcinoma
62
Hypopituitarism, polyuria, polydipsia, headache, stiff neck, apical lung mass
TB meningitis - infection of hypothalamus
63
Short stature, fatigue, inability to lactate, weight gain, always cold, hair loss Explain
PIT-1 mutation Deficient GH, prolactin, and TSH
64
Polyuria, always thirsty, polydipsia, dilute urine, hypernatremia. Responds to ADH therapy
Central diabetes insipidus - lack of ADH
65
Non-spontaneous causes of central diabetes insipidus
Head trauma, tumors, inflammation of the brain, surgery
66
Hyponatremia, cerebral edema, neurologic dysfunction Causes?
SIADH Ectopic ADH (small cell lung carcinoma), drugs, CNS infections, CNS trauma
67
2 most common hypothalamus tumors that cause pituitary deficit
- Gliomas | - Craniopharyngiomas
68
Hypothalamus mass, vestigial remnants of Rathke pouch
Craniopharyngioma
69
Child or older adult, headaches, visual issues, growth retardation (child)
Craniopharyngioma
70
WNT mutations, beta-catenin mutations
Craniopharyngioma
71
Child, cystic, multiloculated mass with stratified squamous epithelium within a spongy reticulum, palisading of squamous epithelium at the edge, compact lamellar keratin
Adamantinomatous craniopharyngioma
72
Lamellar keratin, dystrophic calcification, fibrosis, inflammatory background
Adamantinomatous craniopharyngioma
73
Adult, cranial mass with sheets and papillae lined by well-differentiated epithelium. No palisading, reticulum, keratin, calcification, or cysts
Papillary craniopharyngioma
74
Craniopharyngioma - prognosis?
Excellent

Endocrine 2 (12 decks)

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