Flashcards in Pathology of the Pituitary Deck (36):
Where are the hormones of the posterior pituitary made?
What are the 3 cells of the anterior pituitary?
What network makes up the anterior pituitary?
Over secretion of 1 or more hormones
What is the most common cause of hyperpituitarism?
Anterior Pituitary Adenoma
What are pituitary adenomas that produce hormones called?
What is the most common type of pituitary adenoma?
What are other common hormones secreted by pituitary adenomas?
What are some manifestations of pituitary adenoma?
- Bitemporal Hemianopsia
What is the effect of GNAS1 mutation?
Leads to unchecked cellular proliferation - turning cell cycle on permanently.
What is the presentation of prolactinomas in females?
What is the presentation of prolactinomas in males?
What else can cause elevated prolactin?
- Decreased DOPA
What drugs are used to treat prolactinomas?
What is the effect of GH-secretitng adenoma on prepubertal patients?
What is the effect of GH-secretitng adenoma on postpubertal patients?
What are lab features of GH adenomas?
- Elevated GH
- Elevated IGF-1
- Lack of GH suppression by oral glucose
What is the treatment for GH adenomas?
What can ACTH adenomas cause?
What is Cushing Syndrome?
Excess cortisol due to increased released from adrenals.
Distinct from Cushing Disease which is due to ACTH adenoma.
- Round face
- “buffolo hump”
- Glucose intolerance
- Increased susceptibly to Infections
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
Deficiency of pituitary hormones
Acute hemorrhage into an adenoma
What is the most lethal hormone loss with loss of the pituitary?
Postpartum hemorrhage leads to necrosis of the anterior pituitary leading to lactation failure and lethal adrenal insufficiency
What are other causes of hypopituitarism?
- Sickle Cell Disease
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
Central Diabetes Insipidus
ADH deficiency - polyuria
Nephrogenic Diabetes Insipidus
Renal tubules do not respond to ADH
What are the causes of SIADH?
- CNS Injury
- Ectopic Secretion (Lung SCC)
– Benign tumor
– Arises from vestigial remnants of Rathke’s pouch
– Primarily suprasellar location
– 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
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
E. Abnormal glucose tolerance test
F. Decreased serum TSH