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Endo > SM_173b: Hypothalamus-Pituitary Histology / Pathology > Flashcards

SM_173b: Hypothalamus-Pituitary Histology / Pathology Flashcards

1
Q

____ plays a central role in modulating the endocrine system along with the hypothalamus

A

Pituitary plays a central role in modulating the endocrine system along with the hypothalamus

  • Pituitary connected to hypothalamus via pituitary stalk, confined by sella turcica and sellar diaphragm
  • Activity intimately related to the hypothalamus via hypothalamic-hypophyseal portal venous system (anterior pituitary) and direct axonal projections (posterior pituitary)
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2
Q

_____, _____, _____, and _____ of the hypothalamus control the anterior pituitary

A

Arcuate nucleus, paraventricular nucleus, ventromedial nucleus, and dorsal nucleus of the hypothalamus control the anterior pituitary

  • Arcuate nucleus: GHRH, dopamine, GnRH
  • Paraventricular nucleus: TRH, CRH, GnRH, somatostatin
  • Ventromedial nucleus: TRH, GnRH
  • Dorsal nucleus: TRH, GnRH
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3
Q

____ and ____ of the hypothalamus control the posterior pituitary

A

Supraoptic and paraventricular nuclei of the hypothalamus control the posterior pituitary

  • Oxytocin and vasopressin
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4
Q

Pituitary consists of the ____, ____, and ____

A

Pituitary consists of the anterior pituitary (adenohypophysis), posterior pituitary (neurohypophysis), and pars intermedia

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5
Q

Anterior pituitary is populated by ____ and cells are compartmentalized into ____

A

Anterior pituitary is populated by epithelial cells containing trophic hormones and cells are compartmentalized into small acini by a reticulin network

  • Many different cell types
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6
Q

Posterior pituitary is populated by ____ and ____ and axons are supported by ____

A

Posterior pituitary is populated by axons and axon terminals and axons are supported by specialized glial cells termed “pituicytes”

  • Originate in neurons in the supraoptic and paraventricular nuclei of hypothalamus
  • Axonal expansions visible as finely granular rounded to ellipsoidal structures (Herring bodies)
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7
Q

____ and ____ are histological features present the posterior pituitary

A

Herring bodies and pituicytes are histological features present the posterior pituitary

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8
Q

_____ is the likely site of Rathke’s cleft cysts

A

Pars intermedia is the likely site of Rathke’s cleft cysts

  • Cystic change common
  • Vestigial
  • At interface of adenohypophysis and neurohypophysis
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9
Q

Anterior lobe of pituitary blood supply is primarily ____

A

Anterior lobe of pituitary blood supply is primarily the low pressure portal venous circulation from hypothalamus

  • Facilitates delivery of hypothalamic releasing hormones to anterior pituitary target cells
  • Low pressure renders the anterior lobe vulnerable to ischemic insults (hypotension, elevated ICP)
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10
Q

Posterior lobe of pituitary receives blood mainly from ____

A

Posterior lobe of pituitary receives blood mainly from direct branches of inferior hypophyseal arteries

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11
Q

Pituitary has ____ origins

A

Pituitary has dual ectodermal origins

  • Anterior pituitary: from oral ectoderm (Rathke’s pouch, an extension of the developing oral cavity)
  • Neurohypophysis: from neural ectoderm (ventral outgrowth of the hypothalamic floor)
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12
Q

____ are the most common cause of hyperpituitarism

A

Pituitary adenomas are the most common cause of hyperpituitarism

  • Most common tumors of anterior pituitary
  • Pathogenesis uncertain in most cases: few cases associated with MEN-1
  • Manifestations related to secretion of excess hormone, hypopituitarism, mass effect
  • Pathological classification based on immunohistochemical profile and other selected morphological features
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13
Q

Describe general morphological features of pituitary adenomas

A

General morphological features of pituitary adenomas

  • Cytoplasm of constituent cells is monomorphous compared to non-neoplastic gland
  • Paucity of reticulin network
  • Low mitotic activity
  • Atypical adenomas: ki-67 labeling index > 3%
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14
Q

Describe the types of pituitary adenoma

A

Types of pituitary adenoma

  • Prolactin
  • Growth hormone
  • ACTH
  • Gonadotropin
  • Thyrotroph
  • Nonfunctioning
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15
Q

Prolactin-producing adenomas cause ____ in women and ____ in men

A

Prolactin-producing adenomas cause amenorrhea / galactorrhea in women and impotence / loss of libido in men

  • Microadenomas or macroadenomas
  • Most common variant
  • Usually diagnosed earliest in women of reproductive age
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16
Q

Describe prolactinoma histology

A

Prolactinoma histology

  • Sparsely granulated
  • Dystrophic calcification (pituitary stone)
  • Elevated prolactin levels due to tumor secretion must be distinguished from stalk effect: levels < 150 ng/MI may represent stalk effect
  • Most response to bromocriptine and related drugs (cabergoline)
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17
Q

Describe growth hormona (somatotroph cell) adenomas

A

Growth hormona (somatotroph cell) adenomas

  • Most are macroadenoma
  • Sparsely granulated (fibrous bodies) or densely granulated
  • Prolactin reactivity often present
  • Elevated IGF-1 leads to gigantism and acromegaly
18
Q

This is a ____ adenoma

A

This is a densely granulated growth hormone adenoma

19
Q

This is a ____ adenoma

A

This is a sparsely granulated growth hormone adenoma

20
Q

This is a ____ adenoma with ____

A

This is a sparsely granulated growth hormone adenoma with fibrous bodies

21
Q

Describe ACTH-producing adenomas

A

ACTH-producing adenomas

  • Usually microadenomas
  • Basophilic, densely granulated, strongly PAS and ACTH-reactive
  • Associated with hypercortisolism
    • Cushing syndrome: hypercorticism regardless of cause
    • Cushing disease: hypercorticism due to ACTH adenoma
    • Nelson syndrome: enlargement of ACTH adenoma after removal of both adrenal glands
22
Q

This is an ____ adenoma

A

This is an ACTH corticotroph cell adenoma

23
Q

Describe gonadotroph (FSH-LH) cell adenoma

A

Gonadotroph (FSH-LH) cell adenoma

  • Macroadenomas
  • Many occur in the setting of hypogonadism
  • Symptoms usually referable to mass effect
  • Elevated alpha-subunit common
24
Q

____ are usually macroadenomas and a rare cause of hyperthyroidism

A

Thyrotroph (TSH) cell adenomas are usually macroadenomas and a rare cause of hyperthyroidism

25
Q

Describe nonfunctioning pituitary adenomas

A

Nonfunctioning pituitary adenomas

  • Null cell adenomas or silent variants
  • Most often present as macroadenomas
  • Symptoms usually referable to mass effect and/or hypopituitarism
  • Synaptophysin and chromogranin reactive
26
Q

This is a ____ adenoma

A

This is a null cell adenoma

27
Q

Describe pituitary carcinoma

A

Pituitary carcinoma

  • Defined by presence of metastases and / or craniospinal dissemination
  • Poor correlation with cytological atypia
  • Most hormonally active
  • Extremely rare
28
Q

Describe causes of hypopituitarism

A

Hypopituitarism causes

  • Neoplasms: pituitary adenoma, others
  • Rathke’s cleft cysts: originate from remnants of the Rathke’s pouch
  • Sheehan’s syndrome: ischemic necrosis, postpartum
  • Pituitary apoplexy: sudden hemorrhage into pituitary, often into an adenoma, emergency
  • Inflammatory diseases and infections: lymphocytic hypophysitis, sarcoidosis, tuberculous meningitis
29
Q

Rathke’s cleft cyst has ____ epithelium

A

Rathke’s cleft cyst has ciliated cuboidal epithelium

30
Q

Lymphocytic hypophysitis is ____ and is most common during ____

A

Lymphocytic hypophysitis is symmetrical enlargement of pituitary accompanied by anterior pituitary insufficiency and is most common during pregnancy / postpartum

  • Autoimmune, both cellular and humoral
  • May have autoimmune infiltrates in other endocrine organs
31
Q
A
32
Q

CNS sarcoidosis is often associated with ____, preferentially affects the ____, and produces ____

A

CNS sarcoidosis is often associated with systemic sarcoidosis, preferentially affects the suprasellar region, and produces non-caseating granulomatous inflammation with multinucleated giant cells

33
Q

This is ____

A

This is CNS sarcoidosis

34
Q

Posterior pituitary syndromes affect ____ release

A

Posterior pituitary syndromes affect ADH release

35
Q

Diabetes insipidus is ____ or ____

A

Diabetes insipidus is central or nephrogenic

  • Central: primary, neoplasms, infections, inflammatory diseases
36
Q

____ may be caused by extra-CNS disorders such as small cell carcinoma

A

Inappropriate ADH secretion may be caused by extra-CNS disorders such as small cell carcinoma

37
Q

_____ and _____ are hypothalamic suprasellar tumors

A

Craniopharyngiomas and germ cell tumors are hypothalamic suprasellar tumors

38
Q

This is a ____

A

This is a grade I adamamntinomatous craniopharyngioma

39
Q

This is a ____

A

This is a grade I papillarycraniopharyngioma

40
Q

This is a ____

A

This is a germinoma

Endo (25 decks)

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