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Endocrine > Pathology of the pituitary and adrenal glands > Flashcards

Pathology of the pituitary and adrenal glands Flashcards

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1
Q

What is the embryological origin of the anterior pituitary?

A

Rathkes pouch

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2
Q

What are the trophic hormones?

A

TSH
ACTH
FSH
LH

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3
Q

What are the non trophic hormones?

A

GH

Prolactin

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4
Q

What is the embryological origin of the posterior pituitary?

A

Extension of neural tissue and modified gliacl cells and axonal processes

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5
Q

What does the posteiror pituiary secrete?

A

ADH

Oxytocin

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6
Q

What does the anteiror pituitary look like histologically?

A 
Islands
Cords of cells
Aciodphils
Basophils
Chromophobe
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7
Q

What are the different types of aciodophils and what do they secrete?

A

Somatotrophs - GH

Mammotrophs - PRL

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8
Q

What are the different types of basophils and what do they secrete?

A

Corticotrophs - ACTH
Thyrotrophs - TSH
Gonadotrophs - FSH/LH

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9
Q

What does the posterior pituitary look like histologically?

A

Non-myelinated axons of neurosecretory neurones

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10
Q

What can cause hyperfunction of the anterior pituitary?

A

Adenoma

Carcinoma

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11
Q

What can cause hypofunction of the anterior pituitary?

A 
Surgery/radiation
Sudden haemorrhage into the gland
Ischaemic necrosis - sheehan syndrome
Tumours extending into sella
Inflammatory conditions (sarcoid)
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12
Q

What are common pathologies of the posterior pituitary?

A

Diabetes insipidus

SAIDH

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13
Q

What can cause SIADH?

A

Ectopic secretion by tumours

Primary disorder of the pituitary

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14
Q

What causes diabetes insipidus?

A

Lack of ADH secretion

Life theratning dehydration

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15
Q

How are pituitary adenomas classed?

A 
By the cell type/ hormone produced: 
Prolacinoma (20-30%)
ACTH (10-15%)
FSH/LH (10-15%)
GH (5%) 
Hypo/non-functional (25-30%)
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16
Q

What other features can a large adenoma have?

A

Visual field defects
Pressure strophy of surrounding normal tissue
Infarction to panhypopituitarism

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17
Q

What will a prolactinoma cause?

A

Infertility
Lack of libido
Amenorrhoea

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18
Q

What will a GH secreting adnoma cause?

A

Growth of bone, cartilage and connective tissue causing gigantism or acromegaly

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19
Q

What will an ACTH secreting adenoma cause?

A

Cushings disease

Bilateral adrenocortical hyperplasia

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20
Q

What can cause panhypopituitarism?

A

Granulomatous inflammation - sarcoidosis
Infarction - sheehan’s syndrome
Primary or metastatic tumours

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21
Q

What is the origin of a craniopharyngioma?

A

Rathke’s pouch

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22
Q

What is the growth like of a craniopharyngioma?

A

Slow growing, cystic, calcification

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23
Q

What are the common symptoms of a craniopharyngioma?

A

Headaches and visual disturbances - children may have growth retardation

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24
Q

What are the different types of diabetes insipidus?

A

Central - ADH deficiency, trauma

Nephrogenic

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25
Where does the adrenal gland sit?
Superior and medial to the upper pole of the kidneys
26
What is the adrenal gland composed of?
Outer cortex and central medulla
27
What can adrenal pathology be a manifestation of?
Pituitary disease | Shock/DIC
28
What can cause hyperfunction of the adrenal cortex?
Hyperplasia Adenoma Carcinoma
29
What can cause hypofunction of the adrenal cortex?
Acute: waterhouse friderichsen Chronic: addisons
30
What is waterhouse friderichesen?
Adrenal gland failure due to bleeding into the adrenal glands, commonly caused by severe bacterial infection. Typically it is caused by Neisseria meningitidis
31
What can congenital adrenocortical hyperplasia lead to?
Increased androgen production -- masculinisation, precocious puberty
32
What can cause endogenous ACTH production?
``` Pituitary adenoma (cushings) Ectopic ACHT - paraneoplastic syndorme such as in small cell lung cancer ```
33
What can cause acquire adrenocortical hyperplasia?
Endogenous ACTH production Bilateral adrenal enlargement Diffuse or nodular
34
In what condition can an adrenocortical tumour occur in children?
Li-Fraumeni syndrome - germline mutation of p53
35
What is the presentation of adrenocortical tumours?
Incidental finding Hormonal effects Mass lesion Carcinomas with necrosis can cause fever
36
What will an adrenocortical adenoma look like?
Well cirumscribed - encapsulated lesion Small Yellow/brown cute surface
37
What will the cells look like in adrenocortical adenomas?
Cells resembling adrenocorticl cells | Well differentiated, small nuclei, rare mitoses
38
Where will adrenocortical carinomas spread?
Localy - retroperitoneum, kidney Metastasis - liver, lung and bone Peritoneum and pleura Regional lymph nodes
39
What are the survival rates for adrenocortical carcinomas?
5 year survival is 20-35% | 50% dead in 2 years
40
What features suggest an adrenocortical tumour?
``` Large size Haemorrhage and necrosis Frequent mitosis, atypical mitoses Lack of clear cells Capsualr or vascualr invasion ```
41
What is primary hyperaldosteronism?
Conn's syndrome
42
What are the presenting features of conn syndrome?
Hypokalaemia - fatigue, numbness, increased urination, increased thirst, muscle cramps, muslce weakness
43
What will an adenoma causing primary hyperaldosteronism look like?
Solitary, small, bright yellow Buried within the gland Spiranolacton bodies Do not supress ACTH so adjacenet and contralateral adrenal tissue is not atrophic
44
What are the different types of cushings syndrome?
Cushings disease | Endogenous - ACTH dependent, ACTH independent
45
What can cause adrenocortical hypofunction?
Failure to simulate adrenal cortex - hypothalamic-pituitary disorder Supression of adrenal cortex - treatment with steroids
46
What causes acute primary adrenocortical insufficiency?
Rapid withdrawel of steroid treatment Crisis in patients with chronic adrenocortical insufficiency due to stress - infection, no increasing dose of steroid treatment Massive adrenal haemorrhage
47
What can cause massive adrenal haemorrhage?
Newborn Anticoagulant treatment DIC Septicaemic infection -waterhouse friderichsen
48
What can cause chronic primary adrenocortical insufficiency?
Addison's disease
49
What can cause addisons disease/
Autoimmune Infections - TB, fungal (histplasma), HIV (kaposi's sarcoma) Metastatic malignancy (lung, breast) Amylid, sarcoid, haemachromatosis
50
What are the symptoms of addisons disease?
Weakness, fatigue, anorexia, N+V, Wt loss, diarrhoea | Pigmentation (raised POMC)
51
What biochemical signs will addisons show?
K+ retention Na+ loss Hyperkalaemia, hyponatraemia, volume depletion, hypotension Hypoglycamia
52
What will an addisonian crisis show?
Stress - infection, trauma or surgery | Vomiting, abdo pain, hypotension, shock and death
53
What innervates the adrenal medulla?
Pre-synaptic fibres from the sympathetic nervous system
54
What cells make up the adrenal medulla?
Neuroendocrine (chromaffin) cells
55
What tumours affect the adrenal medullar?
Phaeochromocytoma | Neuroblastoma - paeds
56
When are neuroblastomas commonly diagnosed?
18 months
57
What causes a neurblastoma?
Amplification of N-myc and expression of telmoerase
58
What is a phaeochroomocytoma?
Neoplasm derived from chromaffin cells of the adrenal medulla Secrete catecholamines Secondary hypertension
59
What paroxyxsmal episodes of hypertension are common in a phaeo?
Stress, exericse, posture, palpation of tumour
60
What are complications of a phaeochromocytoma?
Cardiac failure Infarction Arrhythmias CVA
61
What is the lab diagnosis of a phaechromocytoma?
Detection of urinary exretion of catecholamines and metaboltes
62
Where will extre-adrenal phaeochromocytomas be?
Paragangliomas | Organs of zuckerkandl
63
What is the rule of 10% of a phaeo?
``` 10% extra-adrenal 10% bilateral 10% biologically malignant 10% NOT associated with hypertension 25% familal ```
64
What is teh organ of zuckerkandl?
Chromaffin body derived form neural crest located at the bifurcation of the aorta or at the origin of the inferior mesenteric artery
65
What will the adrenal gland look like if there is a phaeochromocytoma?
Yellow, red/brown to haemorrhagic and necrotic
66
If the phaeochromocytoma is metastatic where will it commonly metastasize to?
Skeletal Regional lymph nodes Liver Lung
67
What is MEN2A?
Sipple syndrome; | Phaeochromocytoma, medullary thyroid carcinoma and parathyroid hyperplasia
68
What is MEN2B?
Phaeochromocyoma, medullary htyroid carcinoma, neuroma or ganglioineuromas and marfanoid habitus
69
What are the 3 zones of the adrenal cortex?
Zona glomerulosa - mineralocorticoids, aldosterone Zona fasciculata- glucocorticocids, cortisol Zone reticularis - sex steroids, glucorticoids

Endocrine (35 decks)

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