Endo path

Question 1

which transcription factor is expressed in pluripotent cells of rathke’s pouch that eventually become lactotroph

Answer 1

PIT-1

Question 2

which transcription factor is expressed in pluripotent cells of rathke’s pouch that eventually become gonadotroph

Answer 2

SF1 and GATA2

Question 3

which transcription factor is expressed in pluripotent cells of rathke’s pouch that eventually become somatotroph

Answer 3

PIT1

Question 4

stimulus for oxytocin secretion

Answer 4

cervix dilation, nipple stimulation

Question 5

oxytocin effects on end organ

Answer 5

uterine SM contract, parturition, lactation

Question 6

stimulus for ADH secretion

Answer 6

hypovolemia, dehydration, increased plasma osmotic pressure

Question 7

where are the baroreceptors located that fire to cause ADH secretion

Answer 7

cardiac atria, carotids

Question 8

whats the earliest clinical manifestation of mass effect with pituitary adenoma

Answer 8

sellar expansion, bony erosion (radiograph detected)

Question 9

clinical manifestation of mass effect with pituitary adenoma due to increased intracranial pressure

Answer 9

headache, nausea, vomitting

Question 10

visual manifestation of mass effect with pituitary adenoma

Answer 10

bitemporal hemianopsia

Question 11

most common cause of hyperpituitarism

Answer 11

adenoma (anterior pituitary)

Question 12

most common gene mutations leading to pituitary adenoma

Answer 12

gprotein

Question 13

somatotroph adenomas have this gene mutation 40% of the time

Answer 13

GNAS (Galpha)

Question 14

aggressive adenomas likely have acquired what gene mutation

Answer 14

RB or cyclin D1 or TB53

Question 15

HRAS is a gene mutated in what form of cancer

Answer 15

pituitary carcinoma (rare)

Question 16

young GH adenoma patients (<35 yo) likely have what familial predisposition

Answer 16

mutation in AIP

Question 17

if a patient has both adrenal glands removed due to Cushing syndrome and then an ACTH secreting adenoma arises what do we call this

Answer 17

nelson syndrome

Question 18

what types of adenomas can be classified as densely or sparsely granulated

Answer 18

somatotroph, corticotroph, lactotroph

Question 19

macroadenomas are more likely to be invasive into cavernous and sphenoid sinuses, dura, or brain and this is possible thanks to what feature of the tumor

Answer 19

not grossly encapsulated

Question 20

normal pituitary tissue that becomes an adenoma loses what (this causes the tumor to be soft/gelatinous)

Answer 20

reticulin (connective tissue between cells)

Question 21

this neurosurgical emergency occurs when a pituitary adenoma acutely hemorrhages into itself and can cause sudden death

Answer 21

pituitary apoplexy

Question 22

most common hyperfunctioning pituitary adenoma

Answer 22

lactotroph adenoma (women 20-40)

Question 23

most common histology for a lactotroph adenoma

Answer 23

juxtanuclear PIT1 localization, chromophobic cells (sparsely granulated)

Question 24

lactotroph adenomas have a propensity to undergo ___ which can be isolated psmmoma bodies or can include the whole tumor

Answer 24

dystrophic calcification

Question 25

serum prolactin levels are elevated to what degree when there is a lactotroph adenoma

Answer 25

correlate with size of tumor

Question 26

prolactinemia (elevated PRL in blood) leads to what sx

Answer 26

amenorrhea, galactorrhea, low libido, infertility

Question 27

aside from lactotroph adenoma what can cause prolactinemia

Answer 27

pregnancy, loss of DA inh (damage to hypothalamus, pituitary stalk, mass effect of other adenoma, drugs), renal failure, hypothyroid

Question 28

tx for lactotroph adenoma

Answer 28

bromocriptine (DA-R agonist), surgery

Question 29

second most common hyperfunctioning pituitary adenoma

Answer 29

somatotroph GH adenoma

Question 30

a bihormonal adenoma that stains positive for both GH and prolactin

Answer 30

mammosomatotroph

Question 31

histology of densely granulated somatotroph adenoma

Answer 31

strong GH cytoplasm staining, acidophilic cells

Question 32

histology of sparsely granulated somatotroph adenoma

Answer 32

chromophobe cells with focal weak GH positivity on immunohistochemical stain

Question 33

mammosomatotroph histology

Answer 33

look like densely granulated somatotroph plus positive staining for prolactin

Question 34

consistent elevation of GH causes release of what from the liver

Answer 34

IGF-1

Question 35

somatotroph adenoma that presents in kid before growth plate closure whats the outcome

Answer 35

gigantism (long arms and legs)

Question 36

somatotroph adenoma that presents in an adult whats the outcome

Answer 36

acromegaly (thyroid, liver, heart, adrenals, skin, bones of face, hands and feet)

Question 37

GH excess can cause what sxs other than acromegaly/gigantism

Answer 37

DM, gonadal dysfunction, weak mm, HTN, arthritis, CHF, GI cancer

Question 38

how to detect somatotroph adenoma

Answer 38

serum GH and IGF elevated, glucose suppression test (very sensitive!)

Question 39

tx somatotroph adenoma

Answer 39

surgery, somatostatin analog, or GH-R antagonist

Question 40

when are corticotroph adenomas usually detected

Answer 40

microadenoma stage (bc of cushing syndrome)

Question 41

histo stain for corticotroph adenoma

Answer 41

PAS (it stains POMC- ACTH precursor)

Question 42

Which hormone is most commonly secreted from a gonadotroph adenoma

Answer 42

FSH

Question 43

What is required to make the rare diagnosis of pituitary carcinoma

Answer 43

Mets (craniospinal or systemic)

Question 44

Pituitary carcinomas are usually functional secreting one of these hormones

Answer 44

Prolactin, ACTH

Question 45

Sudden onset HA, diploplia, hypopituitarism

Answer 45

Pituitary apoplexy

Question 46

Postpartum necrosis of anterior pituitary

Answer 46

Sheehan syndrome

Question 47

When arachnoid mater and csf herniate into sella leading to hypopituitarism

Answer 47

Primary empty sella syndrome

Question 48

Pt population for primary empty sella

Answer 48

Obese female after multiple pregnancies

Question 49

What causes secondary empty sella

Answer 49

Enlargement of pituitary leads to infarction or surgical removal

Question 50

Most likely outcome of hypothalamic lesion

Answer 50

DI

Question 51

Which cancers metastesize to hypothalamis

Answer 51

Reast, lung carcinoma

Question 52

Adh deficiency leads to what

Answer 52

DI (polyuria, polydipsia)

Question 53

What happens to serum osmolality and serum sodium in a patient with DI

Answer 53

Increase

Question 54

Biggest consequence of SIADH

Answer 54

hyponatremia, cerebral edema

Question 55

What causes SIADH

Answer 55

Usually ectopic secretion by small cell lung carcinoma

Question 56

Most common supracellar tumor in adults

Answer 56

Glioma

Question 57

Most common supracellar tumor in kids

Answer 57

Craniopharyngioma

Question 58

Origin of craniopharyngeal tumor

Answer 58

Rathke pouch

Question 59

Molecular genetic pattern of craniopharyngiomas

Answer 59

WNT signalling abn, beta catenin mutation

Question 60

Craniopharyngiomas often bulge into what adjacent structure

Answer 60

Third ventricla

Question 61

Adamantinomatous craniopharyngioma more pften occur in kids and have what defining features

Answer 61

Calcifications, periferal palisading, compact lamellar “wet” keratin

Question 62

Craniopharyngioma more likely found in adult overn65

Answer 62

Papillary

Question 63

Describe cysts of adamantinomatous craniopharyngioma

Answer 63

Cholesterol rich fluid looks like machine oil