Week 4 - D - pathology of the pituitary and adrenal gland

Question 1

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Answer 1

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Question 2

What is the adenohypophysis and the neurohypophysis?

Answer 2

Adenohypophysis - anterior pituitary

Neurohypophysis - posterior pituitary

Question 3

In embryogenesis, what is the evagination at the roof of the developing mouth in front of the buccopharyngeal membrane that gives rise to the anterior pituitary (adenohypophysis)?

Answer 3

Rathke’s pouch

Question 4

What does the anterior pituitary secrete? Which hormones are trophic and non-trophic? What does the posterior pituitary secrete?

Answer 4

Anterior pituitary

• Trophic: TSH, ACTH, FSH, LH
• Non-trophic: GH and Prolactin

Posterior pituitary - ADH and oxytocin

Question 5

What are the two terms to describe the cells on histology of the anterior pituitary?

Answer 5

Acidophils and basophils

Question 6

Do the acidophils or basophils include the cells for trophic hormones?

Answer 6

Basophils include the cells which are for the trophic hormones

Question 7

What is the rare syndrome that can cause hypopituitarism due to ischaemic necrosis of the pituitary gland during childbirth?

Answer 7

Sheehan syndrome

During pregnancy, an increased amount of the hormone oestrogen in the body causes an increase in the size of the pituitary gland and the volume of blood flowing through it.

This makes the pituitary gland more vulnerable to damage from loss of blood.

If heavy bleeding occurs during or immediately after childbirth, there will be a sudden decrease in the blood supply to the already vulnerable pituitary gland.

This can cause tissue death and subsequent loss of pituitary function.

Question 8

Are pituitary adenomas derived from cells of the anterior or posterior pituitary?

Answer 8

Cells of the anterior pituitary

Question 9

Pituitary adenomas arise from the cells of the anterior pituitary What can side effects of large adenomas be?

Answer 9

Visual defects

Infarction can lead to panhypopituitarism

Question 10

What is the most common functional pituitary adenoma? What are common effects (women)?

Answer 10

Prolactinoma

Can cause infertility

Loss of sex drive

Amenorrhea

Question 11

What is the second most common functional pituitary adenoma that causes increase in Insulin Like Growth Factors (IGF) ? What condition can this adneoma cause?

Answer 11

Growth Hormone Secreting adenoma

Can cause acromegaly

Question 12

What inflammatory disorder can cause hypopituitarism?

Answer 12

Sarcoidosis

Question 13

a type of brain tumor derived from pituitary gland embryonic tissue? Derived from remnants of Rathke’s pouch

Answer 13

Craniopharyngioma

Question 14

What age groups are the ones affected (mostly) by craniopharyngiomas?

Answer 14

5-15years of age and 50-70

Excellent prognosis (especially if <5cm)

Question 15

In craniopharyngiomas, following radiation, what can rarely develop?

Answer 15

A squamous cell carcinoma

Question 16

What are the two types of diabetes insipidus?

Answer 16

1. Central.
2. Nephrogenic.

Question 17

What is the difference between central and nephrogenic diabetes insipidus?

Answer 17

Central - ADH deficiency

Nephrogenic - Renal resistance to ADH effects

Question 18

How many adrenal glands are there and what do they weigh?

Answer 18

Bilateral glands that weigh 4-5 grams each

Question 19

Where do the adrenal glands sit in relation to the kidneys? What are the two regions of the adrenal glands?

Answer 19

They sit superiomedially to the kidneys

They have the outer cortex and the inner medulla

Question 20

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Answer 20

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Question 21

Adrenocortical (cortex) hyperplasia can occur due to congenital and acquired factors What acquired conitions can cause adrenocortical hyperplasia?

Answer 21

Endogenous ACTH production - Pituitary adenoma (Cushing’s disease)

Ectopic ACTH

Paraneoplastic syndrome (small cell lung carcinoma)

Question 22

A deficiency in the enzyme that produces steroid hormones cortisol and aldosterone can cause congenital adrenocortical hyperplasia What is the enzyme name?

Answer 22

21-hydroxylase

Question 23

What can a 21-hydroxylase deficiency cause other than a congenital adrenocortical hyperplasia? What does the loss of cortisol negative feedback on ACTH secretion cause? (seen in the babies)

Answer 23

Hypotension due to the decrease in production of aldosterone which is required for salt/water reabsorption

Causes excess androgen production which gives the baby ambiguous genitalia

Question 24

Well circumscribed, encapsulated lesions Usually small – up to 2 to 3cm Yellow in colour What is this?

Answer 24

Adrenocortical adenoma

Question 25

A rare, likely to be functional adrenal growth Can closely resemble an adrenocortical adenoma however 50% die within two years What is this?

Answer 25

Adrenocortical carcinoma

Question 26

What are features suggestive of an adrenocortical carcinoma?

Answer 26

Large size (\>50g, often \>20cm) Haemorrhage and necrosis Frequent mitoses, atypical mitoses Lack of clear cells Capsular or vascular invasion

Question 27

What disorder of aldosterone secretion is characterized by • Increased total body sodium, ECF volume, plasma volume, BP, and pH; decreased potassium, renin and AT II activity; no edema?

Answer 27

Primary hyperaldosteronism (Conn syndrome) - due to an adrenal adenoma producing aldosterone

Question 28

When is cushing's syndrome known as cushing's disease?

Answer 28

When the hypercortisolism is caused by an ACTH secreting pituitary adenoma

Question 29

Primary adrenal insufficency can be acute or chronic, What syndrome can cause it acutely?

Answer 29

Waterhouse–Friderichsen syndrome (WFS)

Question 30

Presents with: Adrenal hemorrhage, hypotension, DIC (disseminated intravascular coagulation) and meningitis

Answer 30

Waterhouse-Friderichsen syndrome (meningococcemia) Waterhouse–Friderichsen syndrome (WFS) is defined as adrenal gland failure due to bleeding into the adrenal glands, commonly caused by severe bacterial infection. The bacterial infection leads to massive bleeding into one or (usually) both adrenal glands.

Question 31

Which bacteria typically causes waterhouse friderichson syndrome? What is the treatment of the disease?

Answer 31

Neisseria meningitidis Typically IV ceftriaxone to treat the meningitis and IV hydrocortisone for addrenal support

Question 32

Addison's disease is an Insidious onset manifest once significant decreases in glucocorticoid and mineralocorticoid levels What happens to the glucose, potassium and sodium levels in the blood?

Answer 32

Hypoglycaemia Hyperkalaemia Hyponatraemia

Question 33

What happens to a patients blood pressure in addison's disease?

Answer 33

Due to decreased mineraloccorticoid causing decreased aldosterone an therefore decreased sdoium (and water) reabsorption, the ECF volume decreases and patient can become hypotensive

Question 34

What are the two adrenal medullary tumours?

Answer 34

Pheochromocytoma and neuroblastoma

Question 35

Usually diagnosed 18 months Cancer cells form in nerve tissue of the adrenal gland, neck, chest, or spinal cord What adrenal tumour is this?

Answer 35

Neuroblastoma

Question 36

In neuroblastoma, the amplification of what proto-oncogene and the expression of which protein indicated a poor prognosis?

Answer 36

Amplification of N-myc & expression of telomerase predict a poor outcome

Question 37

A neoplasm derived from chromaffin cells of the adrenal medulla that secretes catecholamines What is this and what can it cause?

Answer 37

Pheochromocytoma Can cause hypertension, sweating and anxiety

Question 38

What percentage of people with pheochromocytoma get hypertenison? What is the most appropriate initial test when suspecting pheochromocytoma?

Answer 38

90% Tests 24 hr urinary collection of metanephrines (sensitivity 97%\*) this has replaced a 24 hr urinary collection of catecholamines (sensitivity 86%)

Question 39

What is the 10% rule in the pheochromocytoma?

Answer 39

10% are extra-adrenal 10% are bilateral 10% are biologically malignant 10% are NOT associated with hypertension 10% familial 10% found in kids

Question 40

A certain labratory test can be carried out in which a chemical will turn tumour dark brown due to oxidation of catecholamines in tumour cells in a pheochromocytoma What is this chemical?

Answer 40

Potassium dichromate K₂Cr₂O₇

Question 41

Phaeochromocytoma is a feature of multiple endocrine neoplasia (MEN2a and MEN2b) Does MEN2a or 2b involve parathyroid cancers and marfinoid habitus?

Answer 41

MENN2a has parathyroid cancers MEN2b has people appear wth a marfinoid habitus

Question 42

What are the three layers of the adrenal cortex?What do they produce? (mnemonic - Go Find Rex, Make Good, Sex)

Answer 42

* Zona Glomerulosa (outer Mineralocorticoids -\> Aldosterone * Zona Fasciculata – Glucocorticoids -\> Cortisol * Zona Reticularis – Sex Steroids + Glucocorticoids (Go Find Rex= glomerulosa, fascicularis, reticularis Make Good Sex= mineralocorticoid, glucoortoicoid, sex)

Question 43

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Answer 43

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