Pathology of the pituitary and the adrenal gland Flashcards
(96 cards)
1
Q
What is the adenohypophysis?
A
Anterior pituitary
2
Q
What is the neurohypophysis?
A
Posterior pituitary
3
Q
What trophic hormones does the anterior pituitary secrete?
A
Adrenocorticotrophic hormone
Follicular stimulating hormone
Luteinizing hormone
Thyroid stimulating hormone
4
Q
What non-trophic hormones does the anterior pituitary secrete?
A
Growth hormone
Prolactin
5
Q
What is a trophic hormone?
A
Hormones that act upon endocrine glands
6
Q
What does the posterior pituitary secrete?
A
Anti-diuretic hormone/vasopressin
Oxytocin
7
Q
What colour do acidic cells show up on H&E staining? What about alkaline cells?
A
Acidic - pink
Alkaline - purple
8
Q
Are the cells which secrete the non trophic hormones acidic or alkaline?
A
Acidic (i.e pink)
9
Q
Which pathologies of the anterior pituitary gland can cause hyperfunction?
A
Adenoma
Carcinoma
10
Q
Which pathologies of the anterior pituitary gland can cause hypofunction?
A
Surgery Radiation Sheehan syndrome/ischaemic necrosis Haemorrhage Tumours Sarcoidosis (& other inflammatory conditions)
11
Q
List some common pathologies of the posterior pituitary
A
Diabetes insipidus
Syndrome of inappropriate ADH secretion (SIADH)
12
Q
What extra-pituitary cause is there for SIADH?
A
Paraneoplastic/ectopic production
13
Q
What is diabetes insipidus?
A
Insufficient ADH secretion causing dehydration
14
Q
Is pituitary adenoma associated with MEN1 or MEN2?
A
MEN1
15
Q
How are pituitary adenomas classified?
A
Cell type/hormone produced
16
Q
Which types of pituitary adenomas can you develop?
A
Prolactinoma ACTH-oma GH-oma FSH/LH-oma TSH-oma Mixed Hypofunctioning/non-functioning
17
Q
Is it possible to have a pituitary adenoma with subclinical hormone production levels?
A
Yes
18
Q
What are the mass effects of large pituitary adenomas?
A
Bitemporal hemianopsia
Pressure atrophy
Infarction –> panhypopituitarism
19
Q
What is the most common functional pituitary adenoma?
A
Prolactinoma
20
Q
How does a prolactinoma present?
A
Lack of libido
Amenorrhoa
Infertility
21
Q
Growth hormone causes the production of which substance?
A
Insulin like growth factor 1
22
Q
How does a growth hormone producing adenoma present?
A
Increased growth of bone, cartilage and connective tissue:
- Acromegaly (adults)
- Gigantism (children)
23
Q
How does an ACTH producing adenoma present?
A
Cushing’s syndrome
24
Q
What are the two commonest causes of Cushing’s syndrome?
A
Bilateral adrenal hyperplasia
ACTH secreting pituitary adenoma
25
Are pituitary carcinomas most commonly functional or non-functional?
Functional
26
List some possible causes of panhypopituitarism
```
Rathke cleft cysts
Traumatic brain injury
Subarachnoid haemorrhage
Surgery
Radiation
Granulomatous inflammatory disease (sarcoidosis, TB)
Sheehan's syndrome
Apoplexy/bleeding from internal organ
Hypothalamic tumours
```
27
How might a pituitary apoplexy present?
```
Headache
Diplopia
Hypopituitarism
Cardiovascular collapse
Loss of consciousness
```
28
Why might diplopia result in a pituitary apoplexy?
Haemorrhage puts pressure on the oculomotor nerve
29
Apart from panhypopituitarism what else might hypothalamic tumours cause?
Diabetes insipidus
30
What is a cricopharyngioma derived from?
Rathke's pouch remnants
31
Are most cricopharyngiomas sellar or suprasellar in location?
Suprasellar
32
Which age groups do cricopharyngiomas present in?
Young*
| Old
33
How do cricopharyngiomas present?
Headaches
Visual disturbances (nerve palsies, etc)
Growth retardation
34
How are cricopharyngiomas treated?
Radiation
35
What are the possible causes of central diabetes insipidus?
Trauma
Iatrogenic
Inflammatory disorders
Tumours
36
What is the cause of nephrogenic diabetes insipidus?
Renal resistance
37
What is the most common underlying cause behind syndrome of inappropriate ADH secretion?
Paraneoplastic syndrome
38
Where do the adrenal glands sit in relation to the kidneys?
Superior and medial
39
What are the two parts of the adrenal glands?
Outer cortex
| Inner medulla
40
What type of hormone does the cortex secrete?
Steroid
41
What type of hormone does the medulla secrete?
Catecholamines
42
What are the three zones of the adrenal cortex?
Zona glomerulosa, fasiculata and reticularis (Get Fucked Robyn)
43
What do the zones of the adrenal cortex secrete?
Glomerulosa - mineralocorticoids
Fasiculata - glucocorticoids
Reticularis - sex steroids
44
Name a mineralocorticoid and a glucocorticoid
Aldosterone
| Cortisol
45
Which type of cells secrete catecholamines?
Neuroendocrine/chromaffin
46
What is the adrenal medulla innervated by?
Pre-synaptic sympathetic nerve fibres
47
Which conditions not affecting the adrenals directly can affect adrenal functioning?
Pituitary disease
Shock
Disseminated intravascular coagulation
48
Is congenital adrenal hyperplasia autosomal dominant?
No autosomal recessive
49
How does congenital adrenal hyperplasia cause adrenal pathology?
Altered enzyme pathways cause an increase in androgen production
Reduced cortisol stimulates ACTH release and hyperplasia
50
How does congenital adrenal hyperplasia present?
Masculinisation
| Precocious puberty
51
What are the underlying causes behind acquired adrenal hyperplasia?
```
Pituitary adenoma (cushing's)
Ectopic ACTH (paraneoplastic)
```
52
What is the difference between nodular and diffuse acquired adrenal hyperplasia in terms of ACTH?
Diffuse usually ACTH dependent
| Nodular usually ACTH independent
53
Which age group gets adrenal tumours?
Adults
54
In which condition do children get adrenal tumours?
Li-Fraumeni syndrome
55
How do adrenal tumours present?
Hormonal effects
Mass effects
Fever of unknown origin (carcinoma w/ necrosis)
Incidental
56
Are adrenal adenomas typically functional?
No
57
How common is adrenal cancer?
Rare
58
Are adrenal cancers typically functional?
Yes (virilising)
59
How does adrenal cancer typically spread?
Local
Vascular metastases
Peritoneum
Regional lymph nodes
60
What are the features of an adrenal mass that would suggest cancer?
Large >20cm
Haemorrhage +/- necrosis
Capsular or vascular invasion
Histological signs
61
What pathology of the adrenal glands is primary aldosteronism (conn's) associated with?
Bilateral hyperplasia (common)
Adenoma
Glucocorticoid remediable
62
What is glucocorticoid remediable primary aldosteronism an is it ACTH linked?
Rare genetic disorder and yes
63
What is the underlying mechanism behind secondary aldosteronism?
Increased renin
64
What causes secondary aldosteronism?
Decreased renal perfusion
Pregnancy
Hypovolaemia
65
Hypercortisolism is endogenous. T/F
False - non specific term which can refer to endogenous or exogenous pathologies
66
What is the cause of exogenous hypercortisolism?
Steroid therapy (iatrogenic)
67
How can the endogenous causes of hypercortisolism be divided?
ACTH dependent
| ACTH independent
68
What is cushing's disease?
A ACTH secreting pituitary adenoma
69
What is the most common source of ectopic ACTH production?
Small cell lung cancer
70
What are the ACTH dependent mechanisms of hypercortisolism?
Cushing's
| Ectopic production
71
What are the ACTH independent mechanisms of hypercortisolism?
Adrenal adenoma
Adrenal carcinoma
Non-lesional atrophy
72
How can primary causes of adrenal insufficiency be divided?
Acute
| Chronic
73
What are the acute causes of adrenal insufficiency?
Withdrawal of steroid treatment
Crisis induced in chronic insufficiency patients (e.g infeciton)
Adrenal haemorrhage
74
What are the causes of adrenal haemorrhage?
Newborn babies
Septicaemia --> waterhouse-fruderuchsen syndrome
Anticoagulation treatment
Disseminated intravascular coagulation
75
What are the chronic causes of adrenal insufficiency?
```
Addison's disease/autoimmune adrenalitis
Infection (TB, fungal, HIV)
Metastatic malignancy
Amyloidosis
Sarcoidosis
Haemochromatosis
```
76
Does addison's disease develop fast or slow?
Slowly
77
How does Addison's disease present?
```
Weakness
Fatigue
Anorexia
Vomiting
Weight loss
Diarrhoea
Palmer pigmentation
```
78
Why does palmer pigmentation result in addison's disease and no hypopituitarism?
Raised proopiomelanocortin only occurs in addison's
79
What is the effect of decreased mineralocorticoids in addison's disease?
Potassium retention
Sodium loss
Volume depletion
Hypotension
80
What is the effect of decreased glucocorticoids in addison's disease?
Hypoglycaemia
81
How does an addison's crisis present?
```
Inducted by stress (infection, trauma, surgery, etc)
Vomiting
Abdominal pain
Hypotension
Shock
```
82
When is a neuroblastoma diagnosed?
Children and infants
83
Where do neuroblastomas arise?
Adrenal medulla
| Sympathetic chain
84
How is the prognosis of a neuroblastoma affected by age?
The younger the patient the better the prognosis
85
What is a phaeochromocytoma derived from?
Chromaffin cells of the adrenal medulla
86
What do phaeochromocytomas secrete and what can this cause?
Catecholamines
| Secondary hypertension
87
How does a phaeochromocytoma present?
(Paroxysmal) hypertension (younger patients)
Aggravated by exercise, posture, stress
Micturation (bladder involvement)
88
What are the complications of phaeochromocytoma?
Heart failure
MI
Arrhythmia
CVA
89
How is phaeochromocytoma diagnosed?
Catacholeamines in urine
90
Why is phaeochromocytoma called the 10% tumour?
```
Bilateral
Extra-adrenal
Familial
Malignant
Not associated with hypertension
```
91
What are extra-adrenal phaeochromocytomas called and where are they found?
Paraganglioma
| Carotid body
92
Where do cancerous phaeochromocytomas usually metastasise to?
Bone (common)
Lymph nodes
Liver
Lung
93
What are the two classifications of multiple endocrine neoplasia type 2?
Type 2A - Sipple syndrome
| Type 2B
94
What mutation is multiple endocrine neoplasia type 2 associated with?
RET
95
What are the features of sipple sydrome?
Phaeochromocytoma
Medullary thyroid cancer
Parathyroid hyperplasia
96
What are the features of MENT2B?
Phaeochromocytoma
Medullary thyroid cancer
Marfinoid habitus
Neuroma/ganlioneuroma
