Flashcards in Pathology of the pituitary and the adrenal gland Deck (96):
What is the adenohypophysis?
What is the neurohypophysis?
What trophic hormones does the anterior pituitary secrete?
Follicular stimulating hormone
Thyroid stimulating hormone
What non-trophic hormones does the anterior pituitary secrete?
What is a trophic hormone?
Hormones that act upon endocrine glands
What does the posterior pituitary secrete?
What colour do acidic cells show up on H&E staining? What about alkaline cells?
Acidic - pink
Alkaline - purple
Are the cells which secrete the non trophic hormones acidic or alkaline?
Acidic (i.e pink)
Which pathologies of the anterior pituitary gland can cause hyperfunction?
Which pathologies of the anterior pituitary gland can cause hypofunction?
Sheehan syndrome/ischaemic necrosis
Sarcoidosis (& other inflammatory conditions)
List some common pathologies of the posterior pituitary
Syndrome of inappropriate ADH secretion (SIADH)
What extra-pituitary cause is there for SIADH?
What is diabetes insipidus?
Insufficient ADH secretion causing dehydration
Is pituitary adenoma associated with MEN1 or MEN2?
How are pituitary adenomas classified?
Cell type/hormone produced
Which types of pituitary adenomas can you develop?
Is it possible to have a pituitary adenoma with subclinical hormone production levels?
What are the mass effects of large pituitary adenomas?
Infarction --> panhypopituitarism
What is the most common functional pituitary adenoma?
How does a prolactinoma present?
Lack of libido
Growth hormone causes the production of which substance?
Insulin like growth factor 1
How does a growth hormone producing adenoma present?
Increased growth of bone, cartilage and connective tissue:
- Acromegaly (adults)
- Gigantism (children)
How does an ACTH producing adenoma present?
What are the two commonest causes of Cushing's syndrome?
Bilateral adrenal hyperplasia
ACTH secreting pituitary adenoma
Are pituitary carcinomas most commonly functional or non-functional?
List some possible causes of panhypopituitarism
Rathke cleft cysts
Traumatic brain injury
Granulomatous inflammatory disease (sarcoidosis, TB)
Apoplexy/bleeding from internal organ
How might a pituitary apoplexy present?
Loss of consciousness
Why might diplopia result in a pituitary apoplexy?
Haemorrhage puts pressure on the oculomotor nerve
Apart from panhypopituitarism what else might hypothalamic tumours cause?
What is a cricopharyngioma derived from?
Rathke's pouch remnants
Are most cricopharyngiomas sellar or suprasellar in location?
Which age groups do cricopharyngiomas present in?
How do cricopharyngiomas present?
Visual disturbances (nerve palsies, etc)
How are cricopharyngiomas treated?
What are the possible causes of central diabetes insipidus?
What is the cause of nephrogenic diabetes insipidus?
What is the most common underlying cause behind syndrome of inappropriate ADH secretion?
Where do the adrenal glands sit in relation to the kidneys?
Superior and medial
What are the two parts of the adrenal glands?
What type of hormone does the cortex secrete?
What type of hormone does the medulla secrete?
What are the three zones of the adrenal cortex?
Zona glomerulosa, fasiculata and reticularis (Get Fucked Robyn)
What do the zones of the adrenal cortex secrete?
Glomerulosa - mineralocorticoids
Fasiculata - glucocorticoids
Reticularis - sex steroids
Name a mineralocorticoid and a glucocorticoid
Which type of cells secrete catecholamines?
What is the adrenal medulla innervated by?
Pre-synaptic sympathetic nerve fibres
Which conditions not affecting the adrenals directly can affect adrenal functioning?
Disseminated intravascular coagulation
Is congenital adrenal hyperplasia autosomal dominant?
No autosomal recessive
How does congenital adrenal hyperplasia cause adrenal pathology?
Altered enzyme pathways cause an increase in androgen production
Reduced cortisol stimulates ACTH release and hyperplasia
How does congenital adrenal hyperplasia present?
What are the underlying causes behind acquired adrenal hyperplasia?
Pituitary adenoma (cushing's)
Ectopic ACTH (paraneoplastic)
What is the difference between nodular and diffuse acquired adrenal hyperplasia in terms of ACTH?
Diffuse usually ACTH dependent
Nodular usually ACTH independent
Which age group gets adrenal tumours?
In which condition do children get adrenal tumours?
How do adrenal tumours present?
Fever of unknown origin (carcinoma w/ necrosis)
Are adrenal adenomas typically functional?
How common is adrenal cancer?
Are adrenal cancers typically functional?
How does adrenal cancer typically spread?
Regional lymph nodes
What are the features of an adrenal mass that would suggest cancer?
Haemorrhage +/- necrosis
Capsular or vascular invasion
What pathology of the adrenal glands is primary aldosteronism (conn's) associated with?
Bilateral hyperplasia (common)
What is glucocorticoid remediable primary aldosteronism an is it ACTH linked?
Rare genetic disorder and yes
What is the underlying mechanism behind secondary aldosteronism?
What causes secondary aldosteronism?
Decreased renal perfusion
Hypercortisolism is endogenous. T/F
False - non specific term which can refer to endogenous or exogenous pathologies
What is the cause of exogenous hypercortisolism?
Steroid therapy (iatrogenic)
How can the endogenous causes of hypercortisolism be divided?
What is cushing's disease?
A ACTH secreting pituitary adenoma
What is the most common source of ectopic ACTH production?
Small cell lung cancer
What are the ACTH dependent mechanisms of hypercortisolism?
What are the ACTH independent mechanisms of hypercortisolism?
How can primary causes of adrenal insufficiency be divided?
What are the acute causes of adrenal insufficiency?
Withdrawal of steroid treatment
Crisis induced in chronic insufficiency patients (e.g infeciton)
What are the causes of adrenal haemorrhage?
Septicaemia --> waterhouse-fruderuchsen syndrome
Disseminated intravascular coagulation
What are the chronic causes of adrenal insufficiency?
Addison's disease/autoimmune adrenalitis
Infection (TB, fungal, HIV)
Does addison's disease develop fast or slow?
How does Addison's disease present?
Why does palmer pigmentation result in addison's disease and no hypopituitarism?
Raised proopiomelanocortin only occurs in addison's
What is the effect of decreased mineralocorticoids in addison's disease?
What is the effect of decreased glucocorticoids in addison's disease?
How does an addison's crisis present?
Inducted by stress (infection, trauma, surgery, etc)
When is a neuroblastoma diagnosed?
Children and infants
Where do neuroblastomas arise?
How is the prognosis of a neuroblastoma affected by age?
The younger the patient the better the prognosis
What is a phaeochromocytoma derived from?
Chromaffin cells of the adrenal medulla
What do phaeochromocytomas secrete and what can this cause?
How does a phaeochromocytoma present?
(Paroxysmal) hypertension (younger patients)
Aggravated by exercise, posture, stress
Micturation (bladder involvement)
What are the complications of phaeochromocytoma?
How is phaeochromocytoma diagnosed?
Catacholeamines in urine
Why is phaeochromocytoma called the 10% tumour?
Not associated with hypertension
What are extra-adrenal phaeochromocytomas called and where are they found?
Where do cancerous phaeochromocytomas usually metastasise to?
What are the two classifications of multiple endocrine neoplasia type 2?
Type 2A - Sipple syndrome
What mutation is multiple endocrine neoplasia type 2 associated with?
What are the features of sipple sydrome?
Medullary thyroid cancer