There are six hypothalamic hormones that regulate six anterior pituitary hormones. Outline which go with which, and give the target organs.
**it’s not one-to-one. very tricky.
TRH(+) --> TSH --> thyroid Dopamine(-) --> Prolactin --> mammary/ovary CRH(+) --> ACTH --> adrenal GHRH(+)/GIH(-) --> GH --> most tissues GnRH(+) --> FSH/LH --> gonads
What hormones come from the posterior pituitary? How does the posterior differ from the anterior in terms of how hormones are produced and released?
ADH and oxytocin are released from the posterior pituitary.
Posterior pituitary hormones are secreted in the hypothalamus and stored in the pituitary.
Anterior pituitary hormones are secreted by specific cells in the pituitary.
T/F: the majority of pituitary adenomas are non-functioning.
True.
MC & 2MC functional pituitary adenoma
- Prolactinoma
2. GH-secreting (somatotropinoma)
MC tumor in the brain
Pituitary adenoma
MC initial presentation of pituitary apoplexy
Sudden headache with rapidly worsening visual field defect
MC presentation of Sheehan syndrome
Agalactorrhea
Pituitary apoplexy
- Definition
- Usu occurs in present of existing…?
- Acute hemorrhage or infarction of pituitary gland
- Pituitary adenoma
Pituitary adenoma
- Gross appearance (typical)
- Micro appearance
- Soft, well-circumscribed lesion confined to sella turcica
- Small round cells with uniformly round nuclei arranged in nests or cords.
Sheehan syndrome
- Population
- Definition
- Postpartum women
- Necrosis of pituitary dt blood loss following childbirth.
(Pituitary enlarges during pregnancy to produce prolactin, no increase in blood supply. Excessive blood loss at childbirth can result in ischemia)
MC patient profile for empty sella syndrome
Multigravida who is hypertensive and obese
MC craniopharyngioma in adults? kids?
Adults: papillary
Kids: adamantinomatous
Characteristic signs of craniopharyngioma on histo (3)
- circles
- pallisading
- wet keratinization
MC mets to pituitary
Breast, lung
MC cause of hypothyroidism in US
Hashimoto’s thyroiditis
What findings are associated with DeQuervain’s thyroiditis?
Thyroid granulomas and giant cells
MC cause of hyperthyroidism
Grave’s disease
MC thyroid cancer
Papillary carcinoma
MC mets of thyroid cancer
Cervical lymph nodes
MC cause of primary hyperparathyroidism
Single, sporadic parathyroid adenoma
MC cause of secondary hyperparathyroidism
Renal failure
MC cause of primary hyperaldosteronism
Functional adrenal adenoma
MC & 2MC cause of Cushing’s syndrome
1: Glucocorticoids
2: Pituitary or adrenal tumor
MC cause of primary Addison’s disease
Autoimmune destruction of adrenal cortex
MC cause of secondary Addison’s disease
Inadequate ACTH from pituitary
MC solid, extracranial cancer in kids
Neuroblastoma
When does DM1 typically manifest?
Puberty
What main antibody target in DM1?
Glutamic acid decarboxylase (GAD)
MC cause of vision loss in DM retinopathy
Macular edema
MCH found in DM1 (2)
HLA-DR3, HLA-DR4
MC & 2MC location of gastrinoma
1: Duodenum
2: Pancreas
MC location of insulinoma
Pancreas
What antibodies are responsible for Hashimoto’s thyroiditis?
Anti-thyroglobulin
Anti-TPO
Micro appearance of Hashimoto’s, including characteristic cell
Lymphocytic infiltrate of thyroid gland
Hurthle cells: large, granular, eosinophilic
Micro appearance of Grave’s disease
Hyperplastic epithelium with prominent infoldings and vacuoles in follicles
What are the features (gross/histo and course) of thyroid follicular carcinoma?
Encapsulated
Aggressive metastasis
What are the histo features of thyroid medullary carcinoma? What might you find in serum?
Amyloid stroma, C cell proliferation
Mildly elevated calcitonin
Histo features of thyroid papillary carcinoma
Fronds
Psammoma bodies
What are the classic symptoms of hyperparathyroidism?
“painful bones, renal stones, abdominal groans, porcelain thrones, and psychic moans”
Micro appearance of parathyroid adenoma
Uniform, polygonal chief cells with small, central nuclei
Micro appearance of parathyroid carcinoma
Nests of neoplastic cells with fibrotic septae
What is Conn’s syndrome? How does it present?
Primary hyperaldosteronism
HTN with unexplained hypokalemia, hypernatremia, low renin
What is the genetic cause of congenital adrenal hyperplasia?
21-hydroxylase deficiency
What is the histo finding for neuroblastoma?
Rosettes: circles of dark tumor cells surrounding pale neurofibril center
Histo appearance of DM1 vs DM2
1: lymphocytic infiltrate of pancreatic islets
2: pink hyalinization of pancreatic islets
What do you see on PE with non-proliferative DM retinopathy?
Hemorrhages, edema, and exudates
Dilated capillaries leaking RBCs and plasma into retina
What do you see on PE with proliferative DM retinopathy?
Proliferation of blood vessels –> vision loss
What is the common pathology of DM nephropathy?
Nodular glomerulosclerosis
What is the triad of Zollinger-Ellison Syndrome?
Gastrinomas, gastric acid hypersecretion, severe PUD
There are four tumors we learned this term that may present with psammoma bodies. What are they?
Papillary thyroid carcinoma
Papillary renal cell carcinoma
Ovarian papillary serous cystadenoma
Prolactinoma
Compare serum findings in DM 1, 1.5, and 2
1 and 1.5: low C-peptide, anti-islet cell antibodies
2: normal or high C-peptide
