2: Pathology of pituitary and adrenal glands

Question 1

Pituitary pathologies are caused by what two types of abnormal function?

Answer 1

Hyperfunction

Hypofunction

Question 2

Which recess of the middle cranial fossa is the pituitary gland found in?

Answer 2

Sella turcica

Question 3

What membrane of dura mater covers the pituitary gland?

Answer 3

Diaphragm sellae

Question 4

Which structure connects the pituitary to the hypothalamus?

Answer 4

Pituitary stalk

Question 5

Which pituitary gland is

a) an extension of the neural aspect of the hypothalamus?
b) anterior?

Answer 5

a) posterior

b) anterior

Question 6

What is the anterior pituitary also known as?

Answer 6

Adenohypophysis

Question 7

Which hormones does the anterior pituitary secrete?

Answer 7

Trophic: TSH, ACTH, LH and FSH

Non-trophic: GH and PRL

Question 8

Which hormones does the posterior pituitary secrete?

Answer 8

ADH

Oxytocin

Question 9

What is the posterior pituitary also known as?

Answer 9

Neurohypophysis

Question 10

On histology of the pituitary gland, all the cells look different - why is this?

Answer 10

Loads of different cells which produce different hormones

Question 11

What causes anterior pituitary hyperfunction?

Answer 11

Pituitary tumours

Adenomas and carcinomas

Question 12

What causes anterior pituitary hypofunction?

Answer 12

Surgery, radiation

Haemorrhage into gland

Tumours

Inflammatory conditions

Question 13

What is Sheehan syndrome?

What kind of abnormal pituitary function does it cause?

Answer 13

Ischaemic necrosis of pituitary gland following childbirth

Pituitary hypofunction

Question 14

What are two notable conditions associated with the posterior pituitary?

Answer 14

Diabetes insipidus

SIADH

Question 15

What is a benign tumour of the anterior pituitary known as?

Answer 15

Pituitary adenoma

Question 16

What genetic syndrome are numerous pituitary adenomas a presentation of?

Answer 16

MEN1

multiple endocrine neoplasia

Question 17

Pituitary adenomas are classified by the type of ___ they produce.

Answer 17

hormone

Question 18

Can pituitary adenomas produce more than one hormone?

Answer 18

Yes

Question 19

Do pituitary adenomas have to produce hormone?

Answer 19

No, similarly to thyroid, some are non-functional

Question 20

Why may large pituitary adenomas cause visual field defects?

Answer 20

Compression of optic chiasm

Question 21

What disease involves multiple hormone deficiencies of the pituitary gland?

Answer 21

Panhypopituitarism

Question 22

Why may large pituitary adenomas cause hypopituitarism?

Answer 22

(Infarction due to) compression

Question 23

What are three types of pituitary adenoma and which diseases will they cause?

Answer 23

Prolactinoma - hyperprolactinaemia (galactorrhoea, infertility, loss of libido, amenorrhoea)

GHoma - acromegaly

ACTHoma - Cushing’s disease

Question 24

What are three causes of panhypopituitarism?

Answer 24

Tumours (primary or metastatic)

Granulomatous disease e.g sarcoidosis

Sheehan syndrome

Question 25

The anterior pituitary gland is a remnant of which embryological structure?

Answer 25

**Rafke's pouch**

Question 26

Which rare, benign tumour is most commonly seen in children and arises from Rafke's pouch during development?

Answer 26

**Craniopharyngioma**

Question 27

What are two important posterior pituitary syndromes?

Answer 27

**Diabetes insipidus** **SIADH**

Question 28

Production of **ectopic** hormone e.g ADH, ACTH may be caused by what?

Answer 28

**Functioning tumours elsewhere e.g small cell carcinomas of the lung** "Paraneoplastic syndrome"

Question 29

What are the two parts of the adrenal gland?

Answer 29

**Cortex** **Medulla**

Question 30

The adrenal medulla is an extension of the ___ nervous system.

Answer 30

**sympathetic**

Question 31

What hormones do the adrenal a) cortex b) medulla produce?

Answer 31

**Adrenal cortex** - cortisol (glucocorticoids), aldosterone (mineralocorticoids), androgens (sex hormone) **Adrenal medulla** - adrenaline and noradrenaline (catecholamines)

Question 32

Again, what two types of abnormal adrenal function are there?

Answer 32

**Hyperfunction** **Hypofunction**

Question 33

Adrenal disease can be caused by which other endocrine gland?

Answer 33

**Pituitary gland**

Question 34

What are three causes of **adrenal cortex hyperfunction**?

Answer 34

**Hyperplasia** (too much ACTH stimulation) ## Footnote **Adenoma, carcinoma**

Question 35

What are diseases causing **acute** and **chronic** **adrenal cortex hypofunction?**

Answer 35

**Acutely -** Waterhouse-Friederichsen disease **Chronic** - Addison's disease (the important one)

Question 36

What is Waterhouse-Friderichson syndrome?

Answer 36

**Adrenal hypofunction** caused by bleeding secondary to infection usually Neisseria meningitidis

Question 37

What causes adrenal cortex hyperplasia?

Answer 37

**Overstimulation by ACTH**

Question 38

**Which diseases are associated with overproduction of ACTH?** **Which adrenal pathology is associated with this?**

Answer 38

**Cushing's DISEASE** **2ndary hyperaldosteronism** **Ectopic ACTH production** e.g small cell carcinoma of lungs **Androgen excess** ADRENAL HYPERPLASIA

Question 39

Why are adrenal cortex adenomas yellow?

Answer 39

**Lipid content**

Question 40

How do adrenocortical carcinomas tend to spread?

Answer 40

**Locally** - to retroperitoneum, kidneys **Haematogenously** - to liver, lungs and bone

Question 41

What syndromes do overproduction of a) aldosterone b) cortisol by the adrenal cortex tumours produce?

Answer 41

**a) Conn's syndrome** **b) Cushing's syndrome** mind that pituitary ACTH excess causing symptoms would be Cushing's **disease** and **secondary hyperaldosteronism**

Question 42

Problems with which axis can cause secondary adrenocortical hypofunction?

Answer 42

**Hypothalamic-pituitary-adrenal axis**

Question 43

Which type of drug **suppresses** the adrenal cortex?

Answer 43

**Steroids**

Question 44

What is the name given to chronic adrenocortical insufficiency?

Answer 44

**Addison's disease**

Question 45

Addison's disease is a type of **(primary / secondary)** adrenocortical insufficiency.

Answer 45

**primary adrenocortical insufficiency**

Question 46

Which part of the nervous system innervates the adrenal medulla?

Answer 46

**Sympathetic**

Question 47

Which cells in the adrenal medulla secrete catecholamines?

Answer 47

**Neuroendocrine / Chromaffin cells**

Question 48

What are two types of tumour found in the adrenal medulla?

Answer 48

**Phaeochromocytoma** **Neuroblastoma**

Question 49

Which type of endocrine tumour is common in infancy?

Answer 49

**Neuroblastoma** **Craniopharyngioma**

Question 50

What is a neoplasm of neuroendocrine cells called?

Answer 50

**Phaeochromocytoma**

Question 51

What cardiovascular disease does phaeochromocytoma cause?

Answer 51

**Hypertension** | (secondary)

Question 52

What is a lab sign of phaeochromocytoma?

Answer 52

**Urinary excretion of catecholamines** makes sense cuz you're overproducing them

Question 53

Phaeochromocytoma is known as the \_\_% tumour.

Answer 53

10% tumour ## Footnote **10% extra-adrenal** **10% bilateral** **10% malignant** **10% familial (think MEN2A)** **10% DON'T cause hypertension**