Pathology of the Pituitary Flashcards Preview

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Flashcards in Pathology of the Pituitary Deck (36):
1

Where are the hormones of the posterior pituitary made?

Hypothalamus

2

What are the 3 cells of the anterior pituitary?

- Chromophobes
- Acidophils
- Basophils

3

What network makes up the anterior pituitary?

Reticulin Network

4

Hyperpituitarism

Over secretion of 1 or more hormones

5

What is the most common cause of hyperpituitarism?

Anterior Pituitary Adenoma

6

What are pituitary adenomas that produce hormones called?

Functional

7

What is the most common type of pituitary adenoma?

Prolactinoma

8

What are other common hormones secreted by pituitary adenomas?

- GH
- ACTH

9

What are some manifestations of pituitary adenoma?

- Headache
- Bitemporal Hemianopsia

10

What is the effect of GNAS1 mutation?

Leads to unchecked cellular proliferation - turning cell cycle on permanently.

11

What is the presentation of prolactinomas in females?

- Galactorrhea
- Amenorrhea

12

What is the presentation of prolactinomas in males?

- Impotence
- Infertility

13

What else can cause elevated prolactin?

- Decreased DOPA
- Drugs

14

What drugs are used to treat prolactinomas?

- Bromocriptine
- Cabergoline

15

What is the effect of GH-secretitng adenoma on prepubertal patients?

Gigantism

16

What is the effect of GH-secretitng adenoma on postpubertal patients?

Acromegaly

17

What are lab features of GH adenomas?

- Elevated GH
- Elevated IGF-1
- Lack of GH suppression by oral glucose

18

What is the treatment for GH adenomas?

- Surgery
- Somatostatin
- Octreotide
- Lantreotide

19

What can ACTH adenomas cause?

Cushing Disease

20

What is Cushing Syndrome?

Excess cortisol due to increased released from adrenals.

Distinct from Cushing Disease which is due to ACTH adenoma.

21

- Round face
- “buffolo hump”
- Osteopenia
- Hypertension
- Atherosclerosis
- Glucose intolerance
- Hyperlipidemia
- Increased susceptibly to Infections
- Depression

Cushing Syndrome

22

Nelson Syndrome

Adrenal glands removed for treatment of hypercortisolism due to Cushing Disease with an unknown presence of coritoctroph micro adenoma.

- No inhibitory effect of adrenal corticosteroids on pituitary adenoma so the adenoma will grow

23

Hypopituitarism

Deficiency of pituitary hormones

24

Pituitary Apoplexy

Acute hemorrhage into an adenoma

25

What is the most lethal hormone loss with loss of the pituitary?

ACTH

26

Sheehan Syndrome

Postpartum hemorrhage leads to necrosis of the anterior pituitary leading to lactation failure and lethal adrenal insufficiency

27

What are other causes of hypopituitarism?

- DIC
- Sickle Cell Disease
- Trauma

28

Empty Sella Syndrome

Enlarged sella turcica not filled entirely with pituitary tissue which leads to CSF leak and increases pressure around the pituitary and results in pituitary atrophy

29

Central Diabetes Insipidus

ADH deficiency - polyuria

30

SIADH

Excess ADH

31

Nephrogenic Diabetes Insipidus

Renal tubules do not respond to ADH

32

What are the causes of SIADH?

- Drugs
- CNS Injury
- Ectopic Secretion (Lung SCC)
- Idiopathic

33

Craniopharhygioma

– Benign tumor
– Arises from vestigial remnants of Rathke’s pouch
– Primarily suprasellar location

34

– Developmental Failure of Rathke’s pouch obliteration
– Lined by cuboidal epithelium with cilia and/or goblet cells
– Growth may compromise pituitary gland

Rathke Cleft Cysts

35

A 30‐year‐old woman, who has three healthy children, notes that she has had no menstrual periods for the past 6 months, but she is not pregnant and takes no medications. Within the past week, she has noted some milk production from her breasts. She has been bothered by headaches for the past 4 months. After nearly hitting a bus while changing lanes driving her vehicle, she is concerned with her vision. On physical examination she is afebrile and normotensive. Her lateral vision is reduced. Which of the following laboratory test findings is most likely to be present in this woman?

A. Increased serum cortisol
B. Lack of growth hormone suppression
C. Hyperprolactinemia
D. Hyponatremia
E. Abnormal glucose tolerance test
F. Decreased serum TSH

C. Hyperprolactinemia

36

A 24‐year‐old presents with the onset of labor at 38 weeks gestation. As a consequence of placenta accreta she develops severe hemorrhage. She remains hypotensive for 4 hours and requires transfusion of 10 packed RBC units. Postpartum, she becomes unable to breast‐feed the infant. She does not have a resumption of normal menstrual cycles. She becomes more sluggish and tired. Laboratory findings include hyponatremia, hyperkalemia, and hypoglycemia. Which of the following pathologic lesions is she most likely to have had following delivery?

A. Bilateral adrenal hemorrhage
B. Pituitary necrosis
C. Metastatic choriocarcinoma
D. Subacute thyroiditis
E. Posterior pituitary adenoma

B. Pituitary necrosis

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