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PATHOANATOMY > TUMORS OF PITUITARY GLAND > Flashcards

TUMORS OF PITUITARY GLAND Flashcards

1
Q

WHAT IS HYPERPITUITARISM?

A

over secretion of one or more of pituitary hormones

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2
Q

OUTLINE PIT. GLAND HORMONES?

A 
TSH
PROLACTIN 
FSH 
LH 
ACTH
GH 
ADH
OXYTOCIN
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3
Q

WHAT IS HYPOPITUITARISM

A

Deficiency of one or more pituitary hormone

TSH - hypothyroidism
ACTH - adrenal insufficiency
GH - dwarfism
LH + FSH - amenorrhea

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4
Q

WHAT IS ACROMEGALY

A

> IN ADULTS

EXCESSIVE PRODUCTION OF GH IN ADULTS AFTER CLOSURE OF EPIPHYSEAL PLATE IN BONE GROWTH

> increased growth of extremities - hands + feet
coarse facial features

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5
Q

ETIOLOGY OF ACROMEGALY

A

ADENOMA OF PIT. GLAND

tumors or somatotropin cells in anterior pit. gland

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6
Q

WHAT IS GIANTISM

A

> IN CHILDREN

EXCESSIVE SECRETION OF GH IN CHILDREN PRIOR TO CLOSURE OF EPIPHYSEAL PLATE IN BONE GROWTH

> enlargement + thickening of long bones
increased height + enlarged thoracic cage

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7
Q

WHAT IS CUSHING DISEASE

A

EXCESSIVE SECRETION OF ACTH > INCREASES CORTISOL SECRETION OF ADRENAL CORTEX

> Bilateral adrenal cortical hyperplasia
increased level of ACTH

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8
Q

ETOILOGY OF CUSHINGS DISEASE

A

> Lesion in pit. gland
corticotrophin adenoma
multiple micro adenomas

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9
Q

CLINICAL FEATURES OF CUSHINGS DISEASE

A 
> obesity + round belly 
> increased protein break down 
> systemic hypertension 
> impaired glucose tolerance > diabetes 
> hump back > adipocyte deposition 
> increased hair growth 
> moon round face
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10
Q

DESCRIBE GROSS ANATOMY OF PIT. GLAND ADENOMA

A

> 10mm to few cm in diameter
spherical
soft
encapsulated > BENING

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11
Q

DESCRIBE HISTOLOGY OF PIT. GLAND ADENOMA

A

3 PATTERN TYPES:
> DIFFUSE
polygonal cells arranged in sheets w/ scanty storm

> PAPILLARY
columnar/ fusiform cells arranged in papillae

> SINUSOIDAL
columnar/ fusiform cells w/ fibrovascular stroma

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12
Q

WHAT IS PITUITARY DWARFISM?

A

SEVERE DEFICIENCY OF GH IN CHILDREN BEFORE GROWTH IS COMPLETED
> retarded growth
> pituitary dwarfism

INHERITED AUTOSOMAL RECESSIVE DISORDER

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13
Q

CLINICAL FEATURE OF PITUITARY DWARFISM

A 
> proportionate retardation growth in bones 
> normal mental state of age 
> poorly developed genital 
> delayed puberty 
> episodes of hypoglycaemia
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14
Q

WHAT IS ADIPOSE GENITAL DYSTROPHY/ FROHLICH SYNDROME

A

> DECREASED LEVEL OF GONADOTROPIC RELEASING HORMONE
results > low FSH + LH

CAUSE:
> lesion in hypothalamus/ ant. pit. gland 
> craniopharyngioma
> adenoma 
> glioma
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15
Q

CLINICAL SYMPTOMS OF ADIPOSE-GENITAL DYSTROPHY/ FROHLICH SYNDROME

A

> disturbed growth
obesity
arrested sexual developement
mentally subnormal

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16
Q

WHAT IS SHEEHAN SYNDROME

A

> severe blood loss in female during birth labour
hypoxic damage to pit. gland
postpartum pituitary necrosis
enlarged pit. gland during pregnancy can be followed by hypotensive shock after birth > leading to necrosis

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17
Q

CLINICAL MANIFESTATION OF SHEEHAN SYNDROME?

A 
> failure of lactation following delivery > prolactin deficiency 
> loss axillary + pubic hair 
> amonerrhea 
> sterility 
> loss of libido
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18
Q

WHAT IS DIABETES INSIPIDUS

A

DEFICIENCY OF ADH DUE TO INFLAMMATION OR NEOPLASTIC LESIONS IN HYPOTHALAMIC-HYPOPHYSEAL AXIS

CAUSE:
> surgery lesions
> radiation therapy

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19
Q

CLINICAL FEATURES OF DIABETES INSIPIDUS

A

ADH acts on collecting duct to reabsorb water
Low ADH > no reabsorption of water > water loss

> large volume of urine 
> polyuria 
> polydipsia 
> dehydration 
> hypotension
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20
Q

WHAT IS CRANIOPHARYNGIOMA

A

BENING TUMOR ARISING FROM REMENANTS OF RATHKES POUCH

> MC : CHILDREN + YOUNG ADULTS

> BENING TUMOR > compresses against adjacent structures

GROSS: 
encapsulated
adherent to surrounding structures
cystic
reddish-grey mass

HISTOLOGICALLY:
resembles ameloblastoma of jaw
stratified squamous epithelium
solid ameloblastous areas

HYDROCEPHALUS > build up of fluid > increased intra-cranial pressure > HEADACHE

DEFICIENCY IN HORMONE:
> GH
> GONADOTROPIN

21
Q

DEFINE GOITRE?

A

ENLARGEMENT OF THYROID GLAND DUE TO HYPERPLASIA OF FOLLICULAR EPITHELIUM IN RESPONSE TO DEFICIENCY OF THYROID HORMONES

> swelling of thyroid gland > seen as lump in neck

MAIN ETIOLOGY:
Thyroid gland becomes hyper plastic due to deficiency of thyroid hormone + tries to compensate the deficiency
main reason for deficiency: LOW IODINE DIET

22
Q

EXPLAIN HOW DEFICIENCY THYROID HORMONE CAUSES HYPERPLASIA OF THYROID GLAND?

A 
> deficiency thyroid hormone 
> activating negative feedback loop
> causing excessive secretion of TSH
> TSH act on thyroid glands
> hyperplasia of follicular epithelium 
> formation of new follicular cells
> enlarged/ swollen thyroid glands > GOITRE \
23
Q

WHAT IS ENDEMIC GOITRE?

A

When significant proportion of population in area (more than 10%) has palpable/ obvious enlarged thyroid gland/ goitre

> usually due to IODINE DEFICIENCY
CHINA + AFRICA

24
Q

WHAT IS SPORADIC/ NON-ENDEMIC GOITRE?

A 
Nothing to do with epidemiology
> due to low iodine diet 
> genetic factors 
> dietary goitrogens ( substances in food that cause dysfunction of thyroid - unable to produce T-hormones)
> hereditary defect
25
Q

OUTLINE MORPHOLOGICAL FORMS OF GOITRE?

A 
SIMPLE GOITR
> enlargement of thyroid gland is:
- moderate 
- symmetric
- diffuse 
- cut surface > gelatinous + brown 
> HISTOLOGY:
- large follicles distended by colour + lined by flattened epithelium

NODULAR GOITRE
> asymmetric + extreme enlargement of thyroid gland
- nodular with poor encapsulation
- scarring
- haemorrhages
- cystic degeneration
- focal calcification
> HISTOLOGY:
- partial/ incomplete encapsulation of nodules
- small to large follicles > vary in size
- follicles lined with flat to high epithelium
- areas with haemorrhages, microcyst and calcification

26
Q

WHAT IS HYPERTHYROIDISM

A

THYROTOXICOSIS/ GRAVES DISEASE
> BASEDOW’S DISEASE
> hyper metabolic + biochemical state due to excessive production of thyroid hormones

TRIAD FEATURES:
> hyperthyroidism
> diffuse thyroid enlargement
> ophtalmopathy

MOST COMMON IN FEMALES 30-40 y/o

27
Q

WHAT IS GRAVES DISEASE

A

AUTOIMMUNE DISORDER > EXCESSIVE PRODCUTION OF THYROID HORMONES

> auto antibodies against thyroid antigens found in serum
Ab:
- TSH receptor antibodies
- Thyroid microsomal antibodies

28
Q

GROSS ANATOMY OF THYROID IN GRAVES DISEASE

A

MODERATLEY, DIFFUSLEY + SYMMETRICALLY ENLARGED

CUT SURFACE:
- parenchyma is homogeneous + red brown + meaty

29
Q

HISTOLOGY OF THYROID IN GAVES DISEASE

A

> epithelial hyperplasia
increased heigh of follicular lining cells
formation of papillary inholdings into lumina of follicles
colloid diminished + watery + vacuolated
stroma shows increase vascularity + accumulation of lymphoid cells

30
Q

WHAT IS HYPOTHYROIDISM?

A

HYPOMETABOLIC CLINICAL STATE DUE TO INSUFFICIENCY PRODUCTION OF THYROID HORMONES FOR PROLONGED PERIODS

2 TYPES OF CLINICAL MANIFESTATION:
> CRETINISM
> MYXOEDEMA

31
Q

OUTLINE 2 CLINICAL TYPES OF HYPOTHYROIDISM?

A
  1. CRETISM

2. MYXOEDEMA

32
Q

EXPLAIN CRETINISM HYPOTHYROIDISM?

A

CONGENITAL HYPOTHYROIDISM
> severe deficiency in thyroid hormones in new borns
> impaired neurological functions: deaf mutism, spasticity, mental deficiency
> stunted growth
> physical deformities - thyroid agenesis
> fetal exposure to antithyroid drugs + iodides
> impaired skeletal growth
> dwarfism
> round face
> narrow forehead
> widely set eyes
> flat broad nose

33
Q

EXPLAIN MYXOEDEMA HYPOTHYROIDISM?

A

SEVERELY ADVANCED HYPOTHYROIDISM

> non pitting edema due to accumulation of hydrophilic mucopolysaccharides in intercellular substance of dermis + other tissue

CAUSE:

  • ablation of thyroid by surgery/ radiation
  • autoimmune thyroiditis

CLINICAL FEATURES:

  • cold intolerance
  • mental + physical lethargy
  • constipation
  • slow of speech
  • intellectual function
  • puffiness of face
  • loss of hair
  • altered texture of skin
34
Q

OUTLINE TYPES OF TUMORS OF THYROID GLAND

A

BENING:
- Follicular Adenoma

MALIGNANT:
- Thyroid carcinoma

35
Q

DESCRIBE GROSS ANATOMY OF THYROID ADENOMA

A

> most adenoma - asymptomatic with cold nodule
some hyperthyroidism with hot nodule - producing excessive thyroid hormones

> small + spherical shape 
> cut surface:
- grey-white to red brown colour 
- focal area w/ calcification 
- haemorrhage + cyst formation

> solitary nodule - well define + round
complete encapsulation
clearly distinct inside + outside
compression of thyroid parenchyma

36
Q

DESCRIBE HISTOLOGICAL APPEARANCE OF THYROID ADENOMA

A

BENING FOLLICULAR EPITHELIAL CELLS ARRANGED IN 4 TYPES:

1) Normofollicular - simple
2) Macrofollicular - colloid
3) Microfollicular - fetal
4) Trabecular - embryonal

37
Q

WHAT DO YOU CALL MALIGNANT TYPE OF THYROID CANCER?

A

THYROID CARCINOMAS

38
Q

TYPES OF THYROID CARCINOMAS

A
  1. PAPILLARY CARCINOMA
  2. FOLLICULAR CARCINOMA
  3. ANAPLASTIC CARCINOMA
  4. MEDULLARY THYROID CARCINOMA
  • SQUAMOUS CELL CARCINOMA
  • MUCOEPIDERMOID CARCINOMA
  • MUCINOUS CARCINOMA
39
Q

EXPLAIN HYPERPARATHYROIDISM?

A

Excessive production of parathyroid hormone

TYPES:

  • primary
  • secondary
  • tertiary
40
Q

ETIOLOGY, BIOCHEMICAL TEST AND CLINICAL FEATURE OF PRIMARY HYPERPARATHYROIDISM

A 
ETIOLOGY:
> postmenopausal women 
> adenomas 
> carcinomas 
> hyperplasia 
BIOCHEMICAL TESTS:
> increased parathyroid hormone 
> hypercalcemia 
> hypophophatemia 
> hypercalcuria

CLINICAL FEATURE:
> lithiasis
> nephrocalcinosis
> metastatic calcification in blood vessels, kidneys, stomach, lungs

41
Q

ETIOLOGY, BIOCHEMICAL TEST AND CLINICAL FEATURE OF SECONDARY HYPERPARATHYROIDISM

A

ETIOLOGY:
> chronic renal failure
> vitamin D deficiency
> malabsorption syndromes

BIOCHEMICAL TESTS:
> hypocalcemia

CLINICAL FEATURE:
> renal osteodystrophy 
> osteoporosis 
> osteomalacia 
> osteosceloriss
42
Q

ETIOLOGY OF TERTIARY HYPERPARATHYROIDISM

A

Hyperplastic autonomous

43
Q

WHAT IS HYPOPARATHYROIDISM?

A

DEFICIENCY OF PARATHYROID HORMONE

44
Q

TYPES OF HYPOPARATHYROIDISM?

A

Primary hypoparathyroidism

Pseudohypoparathyroidism

Pseudo-pseudohypoparathydoisim

45
Q

RISK FACTORS FOR PARATHYROID ADENOMA

A

> any age
males + female equally
later age

46
Q

CLINICAL FEATURE OF PARATHYROID ADENOMA

A

HYPERPARATHYROIDISM

47
Q

GROSS ANATOMY OF PARATHYROID ADENOMA

A

> less than 5cm in diameter
yellow/ brown
round
encapsulated

48
Q

MICRO DESCRIPTION OF PARATHYROID ADENOMA

A

> chief cells arranged in sheets/ cords
oxyphil cells + water clear cells
parathyroid parenchyma external to capsule

> > helps to differentiate adenoma from diffuse hyperplasia

49
Q

DESCRIBE GROSS AND MICRO ANATOMY OF PARATHYROID CARCINOMA

A

> rate tumor
severe hyperparathyroidism

GROSS:

  • irregular shape
  • adherent to surrounding tissue

MICRO:
- well differentiated adenocarcinoma

PATHOANATOMY (7 decks)

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