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Flashcards in Pathology of the Pituitary Deck (66):
1

location of pituitary

sella turcica

2

80% of pituitary

adenohypophysis

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ADH and oxytocin production

neurohypophysis of pituitary gland

4

secreted by anterior pituitary

TSH
PRL
ACTH
GH
FSH
LH

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control of GH release

somatostatin - inhibitory
GHRH - stimulatory

6

cells of anterior pituitary

somatotrophs
mammosomatotrophs
lactotrophs
corticotrophs
thyrotrophs
gonadotrophs

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cells secreting GH

somatotrophs

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cells secreting GH and PRL

mammosomatotrophs

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cells secreting PRL

lactotrophs

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cells secreting ACTH, POMC, and MSH

corticotrophs

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cells secreting TSH

thyrotrophs

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cells secreting FSH and LH

gonadotrophs

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vasopressin

ADH
from posterior pituitary

14

ACTH and POMC

same analog

hypopituitary - loss of pigmentation

15

acidophil

cells of pituitary

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loss of lateral visual fields

bitemporal hemianopsia

local mass effect with pituitary gland size increase

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N/V, headaches, papilledema

cerebral edema

pituitary growth leading to brain swelling

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milky discharge

galactorrhea

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bilateral galactorrhea, onset of HAs, elevated PRL

pituitary adenoma - prolactinoma

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combined features of GH and PRL excess

mammosomatotroph pituitary adenoma

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types of pituitary adenomas

lactotroph - most common
somatotroph
mammosomatotroph
corticotroph
thyrotroph
gonadotroph

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gigantism and acromegaly

somatotroph pituitary adenoma

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HRAS

pituitary carcinoma

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GNAS

GH adenomas

25

PRKAR1A

GH and PRL adenomas

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MEN1

GH, PRL, ACTH adenomas

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larger pituitary adenomas

tend to be nonfunctional - more local mass effects

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bleeding into pituitary adenoma

pituitary apoplexy

29

amenorrhea, galactorrhea, loss of libido, infertility

prolictinemia

typically female age 20-40

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1/4 amenorrhea cases

lactotroph adenoma

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men and older women with lactotroph adenoma

hormone manifestations may be subtle
-so not detected until large size - macroadenoma

32

dense core granules

think endocrine source

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gigantism

children - before epiphyseal plates close

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acromegaly

adults - after epiphyseal plates close

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IGF-1

from liver
-stimulated by GH

causes many of the clinical manifestations of somatotroph adenomas (acromegaly and gigantism)

36

acromegaly growth

skin, soft tissue, thyroid, heart, liver, adrenal, bones of face, hands, and feet

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increased body size with long arms and legs

gigantism

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increased bone density

hyperostosis

seen in somatotroph adenomas

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protrusion of jaw

prognathism

seen in somatotroph adenoma

40

sausage hands

acromegaly

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GH excess associations

gonadal dysfunction
DM
muscle weakness
HTN
arthritis
CHF
GI cancer risk increase

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diagnosis of GH excess

elevated serum and IGF-1

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sensitive test for acromegaly

failure to suppress GH production in response to oral load of glucose**

44

cushings disease vs. syndrome

syndrome - elevated cortisol

disease - elevated cortisol due to corticotroph adenoma in pituitary

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predominant hormone in gonadotroph adenoma

FSH

46

hyperthyroidism

can be due to thyrotroph adenoma

rare**

47

nonfunctioning pituitary adenomas

25-30% of all pituitary tumors

aka silent variant or null-cell adenomas

typically present with mass effects

can lead to hypopituitarism

48

middle aged men and women, impaired vision, HA, diplopia, pituitary apoplexy

gonadotroph adenoma mass effects

also impaired secretion of LH - decrased energy and libido in men and amenorrhea in premenopausal women

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most common cause of hyperpituitarism

anterior lobe pituitary adenoma

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macroadenoma

greater than 1cm in diameter

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corticotroph adenoma

secrete ACTH
-cushing syndrome
-hyperpigmentation

52

25yo M IED explosion with multiple medical problems, hypopigmentation, loss of libido, impotence, loss of pubic and axillary hair

FSH and LH decrease
TSH increase
ACTH decreased

hypothyroid

wound to neck - loss of thyroid

53

most common causes of pituitary hypofuction

traumatic brain injury
subarachnoid hemorrhage

54

rathke cleft cyst

differential for hypopituitarism

55

pituitary growth failure

in children

hypopituitary

56

amenorrhea and infertility

gonadotropin deficiency

57

MSH

synthesized in anterior pituitary

hypopituitarism - can lead to pallor due do loss of MSH stimulation on melanocytes

58

ADH deficiency

diabetes insipidus

with polyuria

59

ADH excess

SIADH
-hyponatremia - because of excess free water absorption

60

52yo male smoker, confusion, HA, hyponatremia

small cell carcinoma of lung

SIADH

61

23yo M head trauma in MVA, confused

hypernatremia

subdural hematoma

possible diabetes insipidus

loss of ADH from pituitary

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diagnosis of diabetes insipidus

neurogenic (central) and nephrogenic

63

large volume dilute urine, lower specific gravity, hypernatremia, hyperosmolar, thirst, polydipsia

diabetes insipidus

64

craniopharyngioma

compact lamellar wet keratin and cords of squamous epitheilum

3-4cm

children - adamantinomatous
adult - papillary

65

motor oil like with tumor aspiration

adamantinomatous craniopharyngiomas

also see calcification

66

prognosis of craniopharyngiomas

less than 5cm excellent
-recurrent free

larger lesions - mre invasive

malignant transformation is rare