Pathology of the pituitary and the adrenal gland Flashcards Preview

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Flashcards in Pathology of the pituitary and the adrenal gland Deck (96):
1

What is the adenohypophysis?

Anterior pituitary

2

What is the neurohypophysis?

Posterior pituitary

3

What trophic hormones does the anterior pituitary secrete?

Adrenocorticotrophic hormone
Follicular stimulating hormone
Luteinizing hormone
Thyroid stimulating hormone

4

What non-trophic hormones does the anterior pituitary secrete?

Growth hormone
Prolactin

5

What is a trophic hormone?

Hormones that act upon endocrine glands

6

What does the posterior pituitary secrete?

Anti-diuretic hormone/vasopressin
Oxytocin

7

What colour do acidic cells show up on H&E staining? What about alkaline cells?

Acidic - pink
Alkaline - purple

8

Are the cells which secrete the non trophic hormones acidic or alkaline?

Acidic (i.e pink)

9

Which pathologies of the anterior pituitary gland can cause hyperfunction?

Adenoma
Carcinoma

10

Which pathologies of the anterior pituitary gland can cause hypofunction?

Surgery
Radiation
Sheehan syndrome/ischaemic necrosis
Haemorrhage
Tumours
Sarcoidosis (& other inflammatory conditions)

11

List some common pathologies of the posterior pituitary

Diabetes insipidus
Syndrome of inappropriate ADH secretion (SIADH)

12

What extra-pituitary cause is there for SIADH?

Paraneoplastic/ectopic production

13

What is diabetes insipidus?

Insufficient ADH secretion causing dehydration

14

Is pituitary adenoma associated with MEN1 or MEN2?

MEN1

15

How are pituitary adenomas classified?

Cell type/hormone produced

16

Which types of pituitary adenomas can you develop?

Prolactinoma
ACTH-oma
GH-oma
FSH/LH-oma
TSH-oma
Mixed
Hypofunctioning/non-functioning

17

Is it possible to have a pituitary adenoma with subclinical hormone production levels?

Yes

18

What are the mass effects of large pituitary adenomas?

Bitemporal hemianopsia
Pressure atrophy
Infarction --> panhypopituitarism

19

What is the most common functional pituitary adenoma?

Prolactinoma

20

How does a prolactinoma present?

Lack of libido
Amenorrhoa
Infertility

21

Growth hormone causes the production of which substance?

Insulin like growth factor 1

22

How does a growth hormone producing adenoma present?

Increased growth of bone, cartilage and connective tissue:
- Acromegaly (adults)
- Gigantism (children)

23

How does an ACTH producing adenoma present?

Cushing's syndrome

24

What are the two commonest causes of Cushing's syndrome?

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

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