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E2T1 > Endocrine Path 1: Pituitary > Flashcards

Endocrine Path 1: Pituitary Flashcards

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1
Q

organs

A
  • pituitary gland
  • thyroid gland
  • parathyroid gland
  • pancreas
  • adrenal glands
  • pineal gland
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2
Q

posterior pit- consists of?

A

-modified glial cells (pituicytes) and axonal processes that extended from the hypothalamus thru the pit stalk to the posterior lobe (axon terminals)

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3
Q

what stim ADH secretion?

A
  • dec BP- baroRs(in cardiac atria and carotids)

- inc in plasma osmotic P- osmoRs

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4
Q

Anterior pituitary- cell types

A
  • somatotrophs- GH
  • mammosomatotroph- GH and prolactin
  • lactotroph- prolactin
  • corticotroph- ACTH and POMC, and MSH (melanocyte-stimulating H)
  • thyrotroph- TSH
  • gonadotroph- FSH and LH
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5
Q

somatotroph- secrete? adenoma subtypes? assoc syndrome?

A
  • GH
  • densely and sparsely granulated somatotroph adenoma
  • silent somatotroph adenoma
  • gigantism (children); acromegaly (adults)
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6
Q

mammosomatotroph- secrete? adenoma subtypes? assoc syndrome?

A
  • GH and PRL (prolactin)
  • mammosomatotroph adenomas
  • combined features of GH and prolactin excess
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7
Q

lactotroph- secrete? adenoma subtypes? assoc syndrome?

A
  • PRL
  • lactotroph adenoma
  • silent lactotroph adenoma
  • galactorrhea and amenorrhea, sexual dysfxn, infertility
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8
Q

corticotroph- secrete?

A
  • ACTH and POMC, and MSH (melanocyte-stim H)
  • densely and sparsely granulated corticotroph adenoma
  • silent corticotroph adenoma
  • Cushing syndrome, Nelson syndrome
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9
Q

thyrotroph- secrete?

A
  • TSH
  • thyrotroph adenoma
  • silent thyrotroph adenoma
  • hyperthyroidism
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10
Q

gonadotroph- secrete?

A
  • FSH and LH
  • gonadotroph adenoma
  • silent gonadotroph adenoma
  • hypogonadism, mass effects, hypopituitarism
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11
Q

posterior pituitary- 2 hormones

A
  • oxytocin- stim uterine contractions; stim smooth m around lactiferous ducts
  • ADH- conserve water
  • made in hypothalamus
  • stored in axon terminals
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12
Q

diseases of the pituitary

A
  • hyperpituitarism (too much H)

- hypopituitarism

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13
Q

local mass effect

A
  • radiographic abnormalities of sella turcica
  • compression of optic n’s and chiasm- bitemporal hemianopsia (temporal visual fields)
  • elevated intracranial P sx’s- HA, N/V
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14
Q

hyperpituitarism- caused by?

A
  • pituitary carcinoma
  • hypothalamic disorders
  • pituitary adenomas!!!
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15
Q

most common cause of hyperpituitarism

A

-adenoma (in anterior lobe of pituitary)

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16
Q

most common alterations in pituitary adenomas?

A

G-protein mutations!!

-Gsalpha activation is transient- due to intrinsic GTPase activity in the alpha-subunit

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17
Q

40% of somatotroph cell adenomas have what mutation?

A

-GNAS mutations that abrogate the GTPase activity of Gsalpha- leads to constitutive act of Gsalpha, persistent generation of cAMP, and unchecked cellular proliferation!!!

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18
Q

5% of pit adenomas arise form an inherited genetic defect- what genes?

A

-MEN1, CDKN1B, PRKAR1A, AIP

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19
Q

GNAS- most commonly assoc pit tumor?

A

-GH adenomas

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20
Q

PRKAR1A (Protein kinase A, reg subunit 1)- most commonly assoc pit tumor?

A

-GH and prolactin adenomas

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21
Q

Cyclin D1- most commonly assoc pit tumor?

Study These Flashcards
A

aggressive adenomas

22
Q

HRAS- most commonly assoc pit tumor?

Study These Flashcards
A

-pituitary carcinomas

23
Q

loss of fxn- MEN1- most commonly assoc pit tumor?

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A

-GH, prolactin, ACTH adenomas

24
Q

loss of fxn- CDKN1B- most commonly assoc pit tumor?

loss of fxn- AIP (aryl hydrocarbon R interacting protein)- most commonly assoc pit tumor?

Study These Flashcards
A
  • ACTH adenomas

- GH adenomas (esp < 35 yo)

25
loss of fxn- RB- most commonly assoc pit tumor?
-aggressive adenomas
26
pituitary adenoma
- non-fxnal- if big can cause hypopituitarism - functional - ages 35-60 - microadenoma- <1 cm - macroadenoma- >1 cm - atypical adenoma- aggressively
27
typical pituitary adenoma- pathology- gross
- soft and well-circumscribed - if small- confined to sella turcica - invasive adenomas- erode sella turcica and anterior clinoid processes; macroadenomas are invasive more freq! - larger ones- compress optic chiasm and cranial n's
28
typical pituitary adenoma- pathology- histology
- UNIFORM, polyglonal cells in sheets/cords - CT (reticulin) is sparse!!- soft, gelatinous consistency - sparse mitotic activity
29
histology- pituitary adenoma vs normal nonneoplastic ant pit parenchyma
-monomorphism and the absence of significant reticulin!!!!
30
atypical adenomas- histology
- elevated mitotic activity - nuclear p53 expression (TP53 mutations) - behave aggressively
31
Lactotroph adenoma- what is it?
- most common type of hyperfxning pit adenoma- 30% of cases | - secrete prolactin (even small tumors secrete enough to cause hyperprolactinemia)
32
Lactotroph adenoma- clinical course
- Amenorrhea, galactorrhea, loss of libido, infertility - women 20-40- amenorrhea!! (causes 1/4 of cases of amenorrhea) - men and postmenopausal women- subtle!- macroadenomas before detected clinically
33
Other causes of hyperprolactinemia
- physiologic/normal- pregnancy, nipple stim (suckling), stress - lactotroph hyperplasia when there is loss of dopamine-mediated inhibition of prolactin: - damage of dopaminergic neurons in hypothalamus - damage of pit stalk (head trauma) - drugs that block dopamine Rs on lactotroph cells - mass in suprasellar compartment can interfere with inhibitory effect of hypothalamus on PRL secretion - renal failure - hypothyroidism
34
Lactotroph Adenoma- tx
- bromocriptine- dopamine R agonist that causes the lesions to diminish in size - surgery
35
Somatotroph Adenomas- secretes? effects?
- second most common type of fxning pit adenoma! - secrete GH!: - stim hepatic secretion of IGF-1 (insulin-like GF) - gigantism in children; acromegaly in adults - need A LOT of GH to cause clinical signs!!- usually big when come to attention
36
Gigantism- clinical course
- children b/f the epiphyses have closed - inc in body size with disproportionately long arms/legs - some signs of acromegaly
37
Acromegaly- clinical course
- after closure of epiphyses - growth- skin/soft tissues, viscera (thyroid, heart, liver, adrenals, bones of face, hands, feet - jaw protrusion (prognathism), broadening of lower face - enlarged hands, feet - sausage-like fingers - inc bone density in spine and hips
38
other findings seen with excess GH?
- gonadal dysfxn - DM - generalized m weakness - HTN - arthritis - CHF - risk of GI cancers
39
Somatotroph Adenomas- morphology
- classified into densely granulated and sparsely granulated subtypes - densely granulated- strong cytoplasmic GH reactivity on immunohistochemistry - sparsely granulated- focal, weak staining for GH
40
Somatotroph Adenomas- diagnosis
- elevated serum GH and IGF-1 levels | - failure to suppress GH production in response to an oral load of glucose- sensitive test for acromegaly!
41
Somatotroph Adenomas- tx
- surgery - somatostatin analogs- inhibits pit GH secretion - GH R antagonists - tissue overgrowth gradually recedes, metabolic abnormalities improve
42
Mammosomatotroph Adenomas- secrete?
- GH and PRL - signs, sx of both - same tx
43
Corticotroph adenomas- secrete? morphology?
- ACTH-> adrenal hypersecretion of cortisol- hypercortisolism (Cushing syndrome) - usually microadenomas - often basophilic- densely granulated! - occasionally chromophobic-sparsely granulated! - PAS positive!!!- carbohydrate in POMC (ACTH precursor molecule)
44
Cushing syndrome- clinical course; vs Cushing Dz
- round face, hump, easy bruising, abd weight gain, stretch marks - syndrome- hypercortisolism - disease- when due to excessive prod of ACTH by pit!!
45
Nelson syndrome
- pt with preexisting corticotroph microadenoma - occurs after surgical removal of the adrenal glands for tx of Cushing syndrome - loss of inhibitory effect of adrenal corticosteroids- large destructive pit adenoma with mass effect!! - hypercortisolism doesnt develop (no adrenal glands) - hyperpigmentation (ACTH precursor molecule stim melanocytes)
46
Gonadotroph adenomas- secrete? clinical?
- FSH (predominantly) and LH); or nonfxning! - difficult to recognize- secrete H's inefficiently/variably- dont cause a recognizable clinical syndrome - middle-aged men and women- mass effect - impaired vision, HA, diplopia, pit aploplexy - can get pit hormone deficiencies, most commonly LH!- dec energy and libido in men, amenorrhea in women
47
Thyrotroph adenomas
- produce TSH - uncommon- 1% of all pit adneomas - causes hyperthyroidism
48
plurihormonal adenomas
- elaborate more than 1 H (ex- mammosomatotroph adenoma) | - usually aggressive
49
Nonfunctioning pituitary adenomas
- 20-30% of all pit tumors - sx's of mass effect!! - can compress the residual ant pituitary- hypopituitarism- slowly from enlargement, or abruptly from pituitary apoplexy (acute intratumoral hemorrhage)
50
Pituitary carcinoma
- rare, <1% of pit tumors - defined my metastases (Craniospinal or systemic)!! (late in course) - most are fxnal- PRL and ACTH most commonly

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