Path: Pituitary

Question 1

3 cells types of the APit and their colors

Answer 1

Acidophils = pink
Basophils = Blue
Chromophobes = gray

Question 2

What is Apit derived from (be specific)

Answer 2

Dervied from Rathke’s pouch (oral ectoderm)

Question 3

Difference in vascularity of APit and Ppit? Implications

Answer 3

Apit- has only single vascular supply

• Ppit has dual vascular supply
  implication: Apit is more susceptible to ischemic damage

Question 4

What 2 cell types are the acidophils and what do they secrete

Answer 4

Somatotrophs (GH)

Lactotrophs (Prolactin)

Question 5

What 3 cell types are the basophils and what do they secrete

Answer 5

Corticotrophs (ACTH)
Thryotrophs (TSH)
Gonadotrophs (FSH, LH)

Question 6

destructive process usually –> what derangement of pituitary output?

Answer 6

hypopituitarianism

Question 7

hyperpituitarianism is usually cuased by what?

Answer 7

Adenomas

Question 8

pituitary adenomas are assc with what MEN syndrome

Answer 8

MEN I

Question 9

pituitary adenomas are the MC cause of?

Answer 9

MC cause of excess hormone production

Question 10

In Functional adenomas- how many homos are produced

Answer 10

just one hormone overproduced

Question 11

Most Pit adenomas are sporadic but the genetic ones are dt Mutations in gene encoding what protein?

Answer 11

Mutations in gene encoding α-subunit of Gs

Question 12

Microadenomas are distinguished by:

• What size
• What micro change?

Answer 12

size: < 1cm
Micro: ONE cell type with Decreased reticulin network (support tissue around acini)

Question 13

What is the only change that signifies malignancy in pit adenomas

Answer 13

metastasis only

Question 14

What is the MC functional pituitary tumor

Answer 14

prolactinoma

Question 15

What is CP (4) of prolactinoma and why

Answer 15

Amenorrhea (by far the most common sign), galactorrhea, loss of libido, infertility
PRL inhibits GnRH release–> low LH, FSH –> CP

Question 16

Tx for prolactinoma (3)

Answer 16

• Bromocriptine (DA analog)—- also carbergoline (not for class but in pathoma)
• surgery

Question 17

What mutation causes GH adenoma

Answer 17

mutant GTPase dt deficient α-subunit of Gs

Question 18

What mediates tissue growth in GH adenoma

Answer 18

IGF-1 produced by liver

Question 19

Gigantism and Acromegaly occur in what age groups with enlargement of what?

Answer 19

Gigantism: kids, increased linear bone growth
Acromegaly: Adults, enlarged head, hands, feet, jaw tongue, soft tissues

Question 20

If an oral glucose challenge fails to suppress GH, what is the dx

Answer 20

Acromegaly

Question 21

GH effect on Glc levels and condition it gives rise to

Answer 21

GH –> GNG by liver –> hyperglycemia –> Secondary DM

Question 22

ACTH secreting tumor in Apit is called

Answer 22

Cushings disease

Question 23

treatment for GH adenoma (and MOA)

Answer 23

octreotide- a somatostatin analog that inhibits GH release from Apit

Question 24

Nelson Syndrome: Cause, mechanism of disease and 2 CPs

Answer 24

Removal of adrenals–> loss of cortisol’s inhibition on ACTH production–> large adenomas –> mass effect, hyperpigmentation (POMC)

Question 25

2 types of Non-functioning pit adenomas and what is produced/screted

Answer 25

Null cell type- nothing produced | Non-secretory variant - hormone I produced but not secreted

Question 26

how dx pituitary carcinoma

Answer 26

metastasis

Question 27

5 causes of hypopit

Answer 27

``` Ischemic necrosis tumors--> damage Ablation pituitary apoplexy empty sella syndrome ```

Question 28

What cuases pituitary apoplexy? 4 CPs?

Answer 28

sudden hemorrhage into pituitary--> rapid enlargement of tumor--> hypopit, headache, vision, sudden death

Question 29

Ichemic necrosis of pituitary is seen in what condition?

Answer 29

Sheehan syndrome

Question 30

Sheehan syndrome is casued by what, why?

Answer 30

Postpartum necrosis of Anterior pituitary dt maternal blood loss or shock Why - Anterior Pituitary has only single blood supply = more susceptible to shock

Question 31

CP of sheehan (3)

Answer 31

loss of pubic hair poor lactation fatigue

Question 32

What causes empty sella

Answer 32

herniation of CSF and arachnoid mater into sella --> compression of pituitary

Question 33

2 functions of oxytocin

Answer 33

``` Uterine contraction (in gravid uterus only) Lactiferous duct contraction (milk ejection) ```

Question 34

3 findings of Diabetes Insipidus

Answer 34

Low urine osmolality Polyuria/dypsia Hypernateremia (dt relative water loss)

Question 35

3 findings of SIADH

Answer 35

Hyponatremia - dt relative water excess Cerebral edema Neurologic dysfunction- demyelination

Question 36

MC cause of SIADH

Answer 36

SCC of lung or other paraneoplastic syndromes

Question 37

What is the MC Hypothalamic Suprasellar tumor in kids

Answer 37

Craniopharyngioma

Question 38

Craniopharyngioma is derived from ?

Answer 38

Rathke's pouch derived

Question 39

Craniopharyngioma is seen in what pops?

Answer 39

kids and >60

Question 40

Tumor appearance of Craniopharyngioma (5)

Answer 40

Cystic tumor with calcification, squamous epithelium, stroma, "machinery oil"