pathology of pituitary and adrenal

Question 1

where is the anterior pituitary gland derived from?

Answer 1

rathke’s pouch

Question 2

what is secreted from the anterior pituitary?

Answer 2

TSH, ACTH, FSH, LH
GH and Prolactin

Question 3

what is secreted from the posterior pituitary?

Answer 3

ADH (vasopressin) and oxytocin

Question 4

what causes hyperfunction of the anterior pituitary?

Answer 4

Adenoma
Carcinoma

Question 5

what causes hypofunction of the anterior pituitary gland?

Answer 5

Surgery/radiation
Sudden Haemorrhage into gland
Ischaemic necrosis
-Sheehan Syndrome
Tumours extending into sella
Inflammatory conditions (Sarcoidosis)

Question 6

what is the most common pituitary adenoma?

Answer 6

prolactinoma

Question 7

what are the symptoms of prolactinoma?

Answer 7

Infertility, lack of libido, amenorrhea (25% amenorrhoea)

Question 8

what do growth hormone secreting adenomas do?

Answer 8

Stimulates growth of bone, cartilage and connective tissue

Question 9

what are the symptoms of a growth hormone adenoma?

Answer 9

Gigantism or acromegaly

Question 10

what is seen in an ACTH secreting tumour?

Answer 10

Cushing’s disease – wide range of signs and symptoms
Usually a micro-adenoma
Bilateral adrenocortical hyperplasia

Question 11

what are the features of craniopharyngioma?

Answer 11

Slow growing, often cystic, may calcify
Some arise within the sella but most suprasellar
Bimodal incidence
5 -15 years age
6th – 7th decades

Question 12

what are the symptoms of a craniopharyngioma?

Answer 12

headaches and visual growth disturbance
(children may have growth retardation)

Question 13

true or false, craniopharyngioma have a poor prognosis

Answer 13

False
excellent prognosis esp if <5cm

Question 14

what is an example of a posterior pituitary syndrome?

Answer 14

diabetes insipidus

Question 15

what causes diabetes insipidus?

Answer 15

ADH deficiency
Trauma (including surgery), tumours and inflammatory disorders of hypothalamus and pituitary

Question 16

are adrenal glands bilateral?

Answer 16

yes

Question 17

where are the adrenal glands?

Answer 17

sit superiorly and medially to the upper pole of the kidneys

Question 18

what are the three zones of the adrenal gland cortex?

Answer 18

zona glomerulosa
zona fasciculata
zona reticularis

Question 19

what is secreted from the zona glomerulosa?

Answer 19

Mineralocorticoids
Aldosterone

Question 20

what is secreted from the zona fasciculata?

Answer 20

Glucocorticoids
Cortisol

Question 21

what is secreted from the zona reticularis?

Answer 21

sex steroids
glucocorticoids

Question 22

what is the medulla of the adrenal gland?

Answer 22

the central core

Question 23

what is the medulla innervated by?

Answer 23

pre-synaptic fibres from sympathetic nervous system

Question 24

what do neuroendocrine (chromaffin) cells secrete?

Answer 24

secrete catecholamines

Question 25

who is usually affected by adrenocortical tumours?

Answer 25

mainly adults males and females are affected equally

Question 26

how do adrenocortical tumours usually present?

Answer 26

Incidental finding (radiology, autopsy) Hormonal effects Mass lesion Carcinomas with necrosis can cause fever

Question 27

which is more common, an adrenocortical carcinoma or adenoma?

Answer 27

adenoma

Question 28

what are features suggestive of an adrenocortical carcinoma?

Answer 28

Large size (>50g, often >20cm) Haemorrhage and necrosis Frequent mitoses, atypical mitoses Lack of clear cells Capsular or vascular invasion

Question 29

what are the symptoms of addisons disease?

Answer 29

Weakness, fatigue, anorexia, nausea, vomiting, weight loss, diarrhoea Pigmentation (raised POMC) – not seen in hypopituitarism

Question 30

does addisons disease decrease mineral corticosteroids?

Answer 30

yes Hyperkalaemia, hyponatraemia, volume depletion and hypotension

Question 31

what does addisons crisis look like?

Answer 31

Stress – infection, trauma, surgery Vomiting, abdominal pain, hypotension, shock and death

Question 32

when is a neuroblastoma ususally diagnosed?

Answer 32

18 months, 40% diagnosed in infancy

Question 33

what % of neuroblastomas arise in the adrenal medulla?

Answer 33

40%

Question 34

what predicts a poor outcome in a neuroblastoma?

Answer 34

Amplification of N-myc & expression of telomerase predict a poor outcome

Question 35

what is the 10% tumour?

Answer 35

phaeochromocytoma

Question 36

why is phaeochromocytoma known as the 10% tumour?

Answer 36

10% are extra adrenal 10% are bilateral 10% are biologically malignant 10% are not associated with hypertension

Question 37

what % of phaeochromocytoma are familial?

Answer 37

25%