Pituitary+parathyroid

Question 1

parathyroid hyperplasia morphology

Answer 1

typically multigland, affecting all glands

loss of normal adipocytes, though some fat remains

ssimilar to adenomas, but no rim of normal gland

Question 2

second most common pituitary tumor

presentation

Answer 2

Growth hormone cell adenoma

gigantism or acromegaly

Question 4

Asrenocortical adenoma morphology

Answer 4

small, encapsulated, unilateral

predominantly fasiculata cells

most are non functional

alveolar architecture and lipid rich cells

Question 4

parathyroid adenoma morphology

Answer 4

typically solitary, unilateral mass

primarily chief cells with islands of oxyphil cells

loss of normal adipocytes within tumor

typically rim of compressed normal parathyroid at periphery

Question 5

Adrenal cortex morphology - zona fasciculata

Answer 5

clear cells

Question 6

Pheochromocytoma =

Answer 6

neoplasms of adrenal medulla chromafin cells

synthesize and secrete catecholamines > HTN

Question 7

pituitary adenoma morpholohy

Answer 7

uniform cells in sheets or cords

supporting reticulin network is lost

Question 7

Li-fraumeni syndrome =

inherted cause of

Answer 7

inherited cause of adrenocortical carcinoma

mutant p53 alelle

(also breast CA, sarcoma, leukemia, brain CA)

Question 8

causes of hypopituitarism

Answer 8

Pituitary tumors - mass effect

Pituitary adenoma

Cranipharyngioma

Sheenhan Syndrome

Iatrogenic (surgery or radiation)

Rathke Cleft Cyst

Question 8

Sheehan syndrome

Answer 8

pospartum necrosis caused by ischemia or pituitary gland

Question 8

adrenal medulla morphology

Answer 8

chromaffin cells with rich vascular network

Question 9

Conn Syndrome =

Answer 9

hyperaldosteronism caused by adrenal cortical adenoma

Question 10

most common finding in endogenous cushings

Answer 10

bilateral hyperplasia

Question 11

causes of hypercortisolism (and mechanism)

Answer 11

Cortical atrophy - exogenous gluccocorticoid (dec ACTH)

Bilateral hyperplasia - endogenous hypercortisolism, ZF hyperplasia (inc ACTH)

Adrenocortical adenoma - endogenous secretion of cortisol (ACTH independent)

Adrenocortical carcinoma - (ACTH independent)

Question 13

Beckwith-Wiedmann syndrome =

genetic cause of ___

Answer 13

genetic cause of Adrenocortical carcinoma

genomic imprinting of ch11 at WT2 locus

enlargement of body organs or body segments

(also Wilm’s tumor, hepatoblastoma, rhabdomyosarcoma, pancreatic tumors)

Question 13

relative distribution of primary hyperparathyroidism

Parathyroid adenoma

hyperplasia

carcinoma

Answer 13

80% adenoma

15% hyperplasia

5% carcinoma

Question 14

Craniopharyngioma morphology

Answer 14

bening suprasellar or sellar tumors arising from Rathke Pouch

nests and cords of squamous columnar cells in loose stroma, often cystic an associated with calcification

Question 14

parathyroid carcinoma morphology

Answer 14

firm lesion

adheres to surrounding tissue (infiltration)

very high calcium

dx based on invasion or metatasis

Question 16

Rule of 10s for Pheochromocytoma

Answer 16

10% familial (MEN-2A, MEN-2B, type 1 neurofibromatosis, on Hippel Lindau, Sturge Weber)

10% extra adrenal = paragangliomas

10% bilateral

10% malignant - more frequent in extra-adrenal

Question 17

large pituitary tumors can cause

Answer 17

bilatemporal hemianopsia

Question 18

pituitary adenomas are classified based on

Answer 18

immunohistochemistry stains regardless of fxnl stus

Question 19

pheochromocytoma morphology

Answer 19

small nests of zellnallen chromafin cells with rich vascular network

cytoplasm typically granular and basophilic

pleomorphic nuclei

Question 20

adrenocortical hyperplasia morphology

Answer 20

bilateral thickening of adrenal cortex

predominantly fasciculata cells

diffuse with relatively even thickening

OR

nodular with multiple bilateral nodules separated by thickened cortex

Fat

Question 22

aside from prolactin cell adenoma, hyperprolactinemia can be associated with

Answer 22

Rx (methyl-dopa, reserpine) that interfere with DA

Stalk effect from regional tumors preventing hypothalamic inhibition

pregnancy

Question 24

most common cause of primary hyperparathyroidism

Answer 24

parathyroid adenoma

Question 25

brown tumors of hyperparathyroidism, morphology

Answer 25

aggregates of osteoclasts, giant cells, and hemorrhagic debris

Question 26

2 cell types of parathyoid gland

general morphology

Answer 26

cheif cells

oxyphil cell

consists of lobules with intervening adipocytes

Question 27

adrenocortical carcinoma is dx by finding

Answer 27

invasion or metastases

Question 28

osteoitisfibrosacystica

Answer 28

caused by hyperparathyroidism

cystic lesiosn caused by bone resoprtion leading to

thinned cortex and

marrow fibrosis with

cystic degeneration

Question 29

bone manifestations of hyperparathyroidism result from _____ and include ___ and ____

Answer 29

result from osteoclast activation

include osteitisfibrosacystica and brown tumors

Question 31

Rathke cleft cyst

Answer 31

cysts lined by ciliated cuboidal cells with scattered goblet cells and anterior pituitary cells

a cause of hypopituitarism

Question 32

adrenocortical carcinoma morphology

Answer 32

large size with invasion

lymph node mettases common

compact cells, nuclear atypia, necrosis

Question 33

most common pituitary tumor

Answer 33

prolactin cell adenoma