Pathology of the Pituitary and Adrenal Glands

Question 1

What is the anterior pituitary derived from

Answer 1

Rathke’s pouch

Question 2

What does the anterior pituitary secrete

Answer 2

trophic and non-trophic hormones
Trophic: TSH, ACTH, FSH, LH
Non-trophic: GH and prolactin

Question 3

What is the posterior pituitary an extension of

Answer 3

neural tissue consisting of modified flail cells and axonal processes

Question 4

What does the posterior pituitary secrete

Answer 4

ADH and oxytocin

Question 5

What are the types of cells found in the anterior pituitary

Answer 5

Islands, cords of cells,
Acidophils (Somatotrophs and Mammotrophs)
Basophils (corticotrophs, thyrotophs, gonadotrophs
Chromophobe

Question 6

What does the posterior pituitary contain

Answer 6

Non-myelinated axons of neurosecretory neurones

Question 7

What can cause hyper function of the anterior pituitary

Answer 7

Adenoma or carcinoma

Question 8

What can cause hypo function of the anterior pituitary

Answer 8

Surgery/ radiation 
Sudden haemorrhage into the gland 
ischamic necrosis (Sheehan syndrome)
Tumours extending into sella 
Inflammatory conditions (Sarcoidosis)

Question 9

What part of the pituitary gland does Diabetes insipidus

Answer 9

Posterior pituitary

Question 10

What does diabetes insipidus result in

Answer 10

Lack of ADH secretion

Question 11

What does SIADH result in

Answer 11

Ectopic secretion of ADH by tumours

Primary disorder in the pituitary

Question 12

What is a pituitary adenoma sometimes associated with

Answer 12

MEN1

Question 13

How can we classify pituitary adenomas

Answer 13

By the cell type / hormone produced

Question 14

What do large adenomas cause

Answer 14

visual field defects

Question 15

What can infarction caused by a pituitary adenoma lead to

Answer 15

Panhypopituitarism

Question 16

If a pituitary adenoma has a mutation of the p53 gene, it is cancerous. True or False

Answer 16

False - they can be benign

Question 17

What is the most common functional tumour

Answer 17

Prolactinoma

Question 18

What does prolactinoma result in

Answer 18

infertility
lack of libido
amenorrhoea

Question 19

What is the second most common pituitary adenoma

Answer 19

Growth hormone secreting

Question 20

What does a growth hormone secreting adenoma cause

Answer 20

Stimulation of bone growth, cartilage and and connective tissue

Question 21

What can growth hormone secreting adenomas result in

Answer 21

Gigantism or acromegaly

Question 22

What is another form of functional pituitary adenoma ?

Answer 22

ACTH secreting

Question 23

What can be caused as a result of ACTH secreting adenoma

Answer 23

Cushing’s disease

Question 24

What are some of the causes of panhypopituitarism

Answer 24

Primary or metastatic tumours 
Traumatic brain injury 
Subarachnoid haemorrhage 
Surgery or radiation
Granulomatous inflammation (sarcoidosis or tuberculous meningitis 
Infarction 
Hypothalmic lesions

Question 25

What is a craniopharyngioma derived from

Answer 25

remnants of Rathke's pouch

Question 26

Describe the growth of craniopharyngioma

Answer 26

Slow growing, often cystic and may calcify

Question 27

What are some of the symptoms of a craniopharyngioma

Answer 27

headaches and visual disturbances | Children may have growth retardation

Question 28

What is the prognosis for a craniopharyngioma

Answer 28

Excellent

Question 29

Where do the adrenal glands sit

Answer 29

Superior and medial to the upper pole of the kidneys

Question 30

What are the adrenal glands composed of

Answer 30

An outer cortex and a central medulla

Question 31

What are the 3 zones of the adrenal cortex

Answer 31

Zona glomerulosa zona fasciculata zona reticularis

Question 32

What is produced in the zona glomerulosa

Answer 32

mineralocirticoids | aldosterone

Question 33

What is produced in the zona fasciculata

Answer 33

Glucocorticoids | Cortisol

Question 34

What is produced in the zone reticular

Answer 34

sex steroids and glucocorticoids

Question 35

What innervates the adrenal medulla

Answer 35

pre-synaptic fibres from sympathetic nervous system

Question 36

What do the neuroendocrine cells in the medulla do

Answer 36

Secrete catecholamines

Question 37

What is another name for neuroendocrine cells

Answer 37

Chromaffin cells

Question 38

Adrenal pathology may be a manifestation of what ?

Answer 38

Pituitary disease Shock/ DIC Various conditions that may damage or destroy adrenal tissue

Question 39

What are some of the causes of hyper function of of the cortex of the adrenal gland

Answer 39

Hyperplasia Adenoma Carcinoma

Question 40

What are some of the causes of hypo function of the cortex of the adrenal gland

Answer 40

Acute (Waterhouse-Friderichsen) | Chronic (Addison's disease)

Question 41

What is there a deficiency in in congenital adenocortical hyperplasia

Answer 41

The enzyme required for steer biosynthesis

Question 42

What does altered biosynthesis lead to in terms of adrenocortical hyperplasia

Answer 42

Increased androgen production

Question 43

What does reduced cortisol stimulate?

Answer 43

ACTH release and cortical hyperplasia

Question 44

What are some examples of acquired adrenocortical hyperplasia

Answer 44

Pituitary adenoma Cushing's disease Ectopic ACTH Bilaterla adrenal enlargement

Question 45

What is the difference between a nodular or diffuse adrenocortical hyperplasia

Answer 45

Diffuse is ACTH driven and nodular is usually ACTH independent

Question 46

What is required to form aldosterone, cortisol and testosterone

Answer 46

Cholesterol

Question 47

What is cholesterol converted to in order to produce hormones

Answer 47

Pregnolone

Question 48

Who is usually affected by an adrenocortial tumour

Answer 48

Mainly adults - both males and females

Question 49

How is an adrenocortical tumour found

Answer 49

As an incidental finding

Question 50

Describe an adrenocortical adenoma

Answer 50

Well circumscribed, encapsulated lesion usually small - up to 2-3cm yellow / yellow brown cut surface Composed of cells resembling adrenocortical cells Well differentiated, small nuclei, rare mitoses Can be functional, but most likely not

Question 51

How common is adrenocortical carcinoma

Answer 51

Rare

Question 52

What can adrenocortical carcinomas resemble

Answer 52

Adenoma

Question 53

Where can adrenocortical carcinomas spread to

Answer 53

Retroperitoneum, kidney or metastasis to liver, lung and bone

Question 54

What is the survival rate of adrenocortical carcinoma

Answer 54

5 year is 30-25% | 50% dead in 2 years

Question 55

What are some features that suggest an adrenocortical carcinoma

Answer 55

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

Question 56

What syndrome is a form of primary hyperaldosteronism

Answer 56

Conn's syndrome

Question 57

What syndrome is a form of a Hypercortisolism

Answer 57

Cushings syndrome or disease

Question 58

What disease is associated with primary adrenocortical insufficiency

Answer 58

Addison's disease

Question 59

What are some causes of acute adrenocortical insufficiency

Answer 59

Rapid withdrawal of steroid treatment Crisis in patients with chronic adrenocortical insufficiency Massive adrenal haemorrhage (newborn, anticoagulant treatment, DIC, septicaemia infection)

Question 60

What are some other causes of chronic adrenocortical insufficiency

Answer 60

TB Fungal infection HIV Metastatic malignancy

Question 61

When do symptoms of primary adrenocortical insufficiency occur

Answer 61

Once >90% of the gland is destroyed

Question 62

Describe some symptoms of Addison's disease

Answer 62

``` Weakness Fatigue Anorexia Nausea Vomiting Weight loss Diarrhoea Hyper pigmentation ```

Question 63

Describe the mineralocorticoids in Addison's disease

Answer 63

``` K+ retention Na+ loss Hyperkalaemia Hyponatraemia Volume depletion and hypotension ```

Question 64

What are the 2 types of adrenal medullary tumours

Answer 64

Phaeochromocytoma | Neuroblastoma

Question 65

At what age are patients with neuroblastoma diagnosed

Answer 65

18 months

Question 66

What are 2 important aspects for a prognosis

Answer 66

Age and stage

Question 67

What predicts a poor outcome in neuroblastoma

Answer 67

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

Question 68

What is a pheochromocytoma

Answer 68

A neoplasm derived from chromaffin cells of the adrenal medulla

Question 69

What do phaeochromocytomas secrete

Answer 69

catecholamines

Question 70

What main thing does phaeochromocytoma cause

Answer 70

Hypertension

Question 71

What are some complications of phaeochromocytoma

Answer 71

Cardiac failure Infarction Arrhythmias CVA

Question 72

How is pheochromocytoma diagnosed

Answer 72

Detection of urinary excretion of catecholamines and metabolites

Question 73

What is pheochromocytoma also known as

Answer 73

the 10% tumour

Question 74

Why does phaeochromocytoma have the 10% tumour title

Answer 74

10% are extra-adrenal 10% are bilateral 10% are biologically malignant 10% are NOT associated with hypertension

Question 75

What do malignant phaeochromocytoma tumours ten to be

Answer 75

Large and necrotic

Question 76

What does MEN stand for

Answer 76

Multiple Endocrine Neoplasia

Question 77

What is a feature of both MEN1 and MEN2

Answer 77

Phaeochromocytoma