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Endocrine II DF > Pituitary Guerin > Flashcards

Pituitary Guerin Flashcards

(51 cards)

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1
Q

anterior pituitary cell types

A

somatotrophs

mammosomatotrophs

lactotrophs

corticotrophs

thyrotrophs

gonadotrophs

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2
Q

somatotrophs secrete

A

GH

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3
Q

mammosomatotrophs secrete

A

prolactin and GH

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4
Q

lactrotrophs secrete

A

prolacting

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5
Q

corticotrophs secrete

A

ACTH and POMC, and melanocyte stimulating hormone (MSH)

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6
Q

thyrotrophs secrete

A

TSH

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7
Q

gonadotrophs secrete

A

FSH and LH

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8
Q

local mass effect pituitary

A

radiographic abnormalities of sella turcica

compression of optic nerves and chiasm–> visual fiedl abnormalities
-lateral (temporal) visual fields

signs and symptoms of elevated intracranial pressure
-HA, nausea, vomitin

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9
Q

pituitrary adenoma, if really big can cause

A

hypopituitarism

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10
Q

pituitary adenoma peak age and size

A

35-60 y/o

if above 1 cm then macroadenoma if below 1 cm then microadenoma

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11
Q

atypical adenomas

A

more likely to behave aggressively

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12
Q

Gross typical pituitary adenoma

A
  • soft and well circumscribed
  • when small, confined to sella turcica
  • as expand, they erode sella turcica and anterior clinoid processes

larger ones extend superiorly and often compress the optic chiasm and adjcaent structures like cranial nerves

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13
Q

pituitary adenoma histology

A

uniform, polygonal cells in sheets or cords

  • reticulin is sparse
  • mitotic activity is usually sparse
  • cytoplasm may be acidophilic, basophilic, or chromophobic
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14
Q

atypical adenomas

A

elevated mitotic activity
nuclear p53 expression from TP53 mutations
more likely to behave aggressively, including invasion and recurrence

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15
Q

GNAS mutation in what

A

pituitary adenomas: except for GTL (gonadotrophs, lactotrophs, thyrotrophs)

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16
Q

galactorrhea and amenorrhea in females, sexual dysfunction, infertility

A

lactotroph adenoma

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17
Q

gigantism (children)

acromegaly (adults)

A

somatotroph adenoma

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18
Q

combined features of gH and prolcating excess

A

mammosomatotroph adenoma

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19
Q

cushing syndrome, nelson syndrome

A

corticotrohp adenoma

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20
Q

hyperthyroidism

A

thryotroph

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21
Q

hypogonadism, mass effects, and hypopituitarism

22
Q

other causes of hyperprolactinemia

-physiologic/normal

Study These Flashcards
A

physiologic/normal

  • pregancy
  • nipple stimulation during suckling
  • response to stress
23
Q

other causes of hyperprolactinemia

-pathologic

Study These Flashcards
A

lactotroph hyperplasia occurs when there is loss of dopamine mediated inhibition of prolactin

  • damage of dopaminergic neurons of hypothal
  • damage of pituitary stalk from head trauma
  • drugs that block dopamine receptors on lactoroph cells
  • any mass in suprasellar compartment may interfeere with inhibitory effect of hypothalamus on prolactin secretion
  • renal failure
  • hypothyroidism
24
Q

treament for lactotroph adenoma

Study These Flashcards
A

bromocriptine

surgery

25
somatoroph adenomas secrete GH which stimulates
hepatic secretion of IGF-1
26
acromegaly
after closure of epiphyses - growth in skin and soft tissue - viscera- thyroid, heart, liver, adrenals - bones of face, hands, feet - increased bone density
27
other findings with excess GH
``` gonadal dysfunction DM generalized muscle weakness hypertension arthritis CHF increased risk of GI cancer ```
28
diagnosis of excess GH
elevated GH and IGF-1 failure to suppress GH production in respons to an oral load of glucose -very sensitive test for acromegaly
29
treatment for somatotroph adenoma
- surgery to remove - somatostatin analogs (inhibit pituitary GH secretion) - GH receptor antagnoist
30
corticotroph adenomas
secrete ACTH--> adrenal hypersecretion of cortisol-->hypercortisolism (cushing syndrome) - usually microadenomas - adenomas are PAS positive (PAS the weed in CA) - carbs in POMC, the ACTH precursor molecule - variable immunoreactivity for POMC and its derivatives, like ACTH and B-endorphin
31
cushing disease
when excessive production of ACTH by the pituitary called this
32
nelson syndrome
pt with preexisting corticotroph microadenoma - occurs after surgical removal of adrenal glands for treatment of cushings syndrome - loss of inhibiotor effect of adrenal corticosteroids - large destructive pituitary adenoma with mass effect - hyperpigmentation bc of ACTH precursor molecule on melanocyte
33
symptoms gonadotroph adenomas
most have mass effect - impaired vision, HA, diplopia, pituitary apoplexy - can get deficiency in LH = decreased energy and libido in men and amenorrhea in premenopausal women
34
nonfunctionaing pituitary adenoma can also cause what
can compress residual anterior pituitary causing hypopituitarism - either slowly from enlargment - abruptly from acute intratumoral hemorrhage (pituitary apoplexy)
35
pituitary carcinoma
rare defined by metastases most are functional and most commnly secrete prolacting and ACTH
36
if you have hypopituitarism and posterior pituitary dysfunction =
diabetes insipidus = hypothalamic origin
37
causes of hypopituitarism
tumors and other mass lesions traumatic brain injury and subarachnoid hemorrhage pituitary surgery or radiation pituitary apoplexy (hemorrhage into pituitary gland, often occurin in pituitary adenoma, can cause death) iscehmic necrosis of pituitary and sheehan syndrome
38
sheehan syndrome effects
anterior pituitary | posterior pituitary receives blood directly from arterial branches so less susceptible to injury
39
rathke cleft cyst can cause
hypopituitarism
40
hypothalamic lesions causing hypopituitarism
can also diminsh secretion of ADH-->DI | tumors: benign (craniopharyngioma) or maligant (metastases to the hypothalamus)
41
inflammatory disorders and infections causing hypopituitarism
sarcoidosis or tuberculous meningitis
42
primary empty sella
arachnoid mater and CSF herniate into sella and compress pituitary seen in obese women with history of multiple pregnancies pts have visual field defects, sometimes with hyperprolactinemia bc of interruption of inhibitory hypothalamic inputs
43
hypopituitarism GH deficiency
children can dvelop growth failure
44
hypopituitarism gonadotropin deficiency
amenorrhea and infertility in women decreased libido, impotence, and loss of pubic and axillary hair in men
45
most frequent causes of SIADH
secretion of ADH by malignant neoplasms (particularly SCC of the lung) drugs that increase ADH secretion CNS disorders like infections and trauma
46
clinical manifestations of SIADH
hyponatremia, cerebral edema, and reultant neurologic dysfunction
47
most common suprasellar tumors and cause what
gliomas craniopharyngiomas cause hypo or hyper function of AP, DI or combinations
48
craniopharyngioma arise from what age distribution presentation prognosis
remnants of rathkes pouch bimodal age - 1st peak is 5-15 yrs - 2nd peak is at 65 and older headaches and visual distrubances children can have growth retardation due to pituitary hypofunction and GH deficiency good prognosis
49
craniopharyngioma morphology
size is 3-4 cm in diameter typically cystic, sometimes multiloculated (can be encapsulated) often encroach on optic chiasm and CNs can bulge into floor of third ventricle and base of brain
50
adamantinomatous craniopharyngioma age morphology what rxn
children calcified nests of cords of stratified squamous epithelium with peripheral palisading and compact, lamerllar keratin cyst formation: cholesterol-rich, thick brown-yellow fluid that is compared to "machine oil" firbosis and chronic inflammation extend little fingers of epithelium into adjacent brain-->brisk glial rxn
51
papillary craniopharyngioma age morphology
adults rarely calcified both solid sheets and papillae lined by well diff squamous epithelium -no peripheral palisading -usually lack keratin, calcification, and cysts

Endocrine II DF (7 decks)

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