w3 - parthology of pituitary and adrenal glands

Question 1

the anterior pituitary gland (adenohypophysis) is derived from Rathke’s pouch, and secretes trophic and non-trophic hormones, what does trophic mean? examples of each

Answer 1

trophic - causes growth

• TSH
• ACTH
• FSH
• LH

non-trophic
GH
Prolactin

Question 2

posterior pituitary (neurohypophysis) is an extension of neural tissue, consists of modified glial cells and axonal processes. what does it secrete?

Answer 2

ADH - vasopressin

Oxytocin

Question 3

prolactinoma is the most common functional tumour. what does it cause

Answer 3

infertility
lack of libido
amenorrhea - absence of menstruation

Question 4

growth hormone is 2nd most common, leads to gigantism or acromegaly through increasing conc of ___

Answer 4

Insuline like Growth Factors (IGF)

Question 5

pituitary hypofunction (panypopituitarism - affects multiple hormones) is caused by 3

Answer 5

granulomatous inflammation - sarcoidosis
infarction - sheehan’s syndrome
primary/metastatic tumours

Question 6

diabetes insipidus originates in the

Answer 6

posterior pituitary
central - ADH deficiency/trauma
nephrogenic - renal resistance to ADH effects

Question 7

3 causes of adrenal phyperfunction

Answer 7

hyperplasia
adenoma
carcinoma

Question 8

acute and chronic cause of adrenal hypofunction

Answer 8

acute - Waterhouse-Fridherichsen

chronic - Addisons disease

Question 9

adrenocortical hyperplasoa can congential, with altered biosynthesis leading to incr androgen production (masculinisation + precocious puberty) and also reduced cortisol. what does this cause

Answer 9

stimulates ACTH release and cortical hyperplasia (10-15x normal weight

Question 10

acquired adrenocortical hyperplasia can be either due to endogenous ACTH (2 examples), bilateral adrenal adrenal enlargement (how much in g), and either diffuse or nodular (which is ACTH driven)

Answer 10

endogenous ACTH

• pituitary adenoma (Cushings)
• ectopic ACTH (paraneoplastic syndrome - small cell lung carcinoma)

up to 30g

diffuse = ACTH driven

Question 11

presentation of adrenocortical tumours

Answer 11

mainly adults (M=F) 
incidental finding - radiology, autopsy 
hormonal effects
mass lesion 
carcinomas + necrosis can cause fever

Question 12

t/f adrenocortical adenomas are more likely to be functional

Answer 12

false

can be, but unlikely

Question 13

which is more common, adrenocortical adenoma or carcinoma

Answer 13

adenoma

Question 14

for adrenocortical tumours what is the definite criterion for malignancy

Answer 14

metastasis only

Question 15

`features suggesting adrenocortical carcinom

Answer 15

large >50g/20cm 
haemorrhage and necrosis 
frequent/atypical  mitoses
lack of clear cells 
capsular/vascular invasion

Question 16

acute primary adrenocortical insufficiency occurs duue to rapid withdrawal of ___ ___/ patients with chronic insufficiency due to stress or not increasing __ of __ __/ or due to massive haemorrhage (newborns, ___ treatment, DIC, or ___ infection - waterhouse friderichsen)

Answer 16

steroid treatment

dose streroid treatment

anticoagulant treatment

septicaemic infection

Question 17

give examples of chronic primary arrenocortical insufficiency

Answer 17

addisons disease
autoimmune adrenalitis
infections (TB, fungal, GIV)
metastatic- lung,breast

Question 18

addisons disease causes drops in glucocorticod and mineralocorticoid levels. outline effect of each

Answer 18

decreased mineralocorticoids

• K+ retention, Na+ loss
• volume depletion
• hypotension

dec. gluco
- hypoglycaemia

Question 19

addisons disease has vague symptoms (weakness, fatigue, anorexia, nausea, WL, diarrhoea, ppigmentation) but due to the effects on corticoid levels, itcan cause crisis. outline this

Answer 19

stress- infection,trauma, surgery -> vomiting, Ab pain, hypotension, shock and death

Question 20

the medulla iis the central core of the adrenal, distinct from the cortex, it is innervated by ____ __ from ___ nervous system and has neuroendocrine (__) cells which secrete ___

Answer 20

pre-synaptic

chromaffin
catecholamines

Question 21

adrenal medullary tumours are either neuroblasyomas or phaeochromocytoma, outline eac h

Answer 21

neuroblastoma

• primitive appearing, but mature/differentiate towards ganglion cellls
• 1/7000 live births
• 40% arise in medulla, remainder along sympathetic chain

phaeochromocytoma

• neoplasm from chromaffin cells of adrenal medula
• secretes catecholamines

Question 22

how is phaeochromocytoma diagnosed

Answer 22

excretion of catecholamines and metabolites

Question 23

the cortex of the adrenal gland is organised into 3 zones, name each and purpose

Answer 23

zona gloomerulosa

• mineralocorticoids
• aldosterone

zona fasciculata

• glucocorticoids
• cortisol

zona reticularis

• sex steroids
• glucocorticoids