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ENRP Exam II > Pituitary Pathoglogy Singh > Flashcards

Pituitary Pathoglogy Singh Flashcards

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1
Q

Mass Effect of pituitary lesions?

A
  • Inc. ICP
    • ha, n/v, bradycardia, htn,papilledema
  • Hyperprolactinemia
  • underproduction of hormones
  • Pituitary apoplexy
  • b/l temporal hemianopsia
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2
Q

What is Pituitary apoplexy

A

Hemorrhage into an adenoma

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3
Q

If a pituitary lesion is compressing the stalk, what hormone is going to be overproduced?

A

Prolactin as dopamine can no longer inhibit its release from the anterior pituitary

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4
Q

Lactotroph?

A

secretes prolactin

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5
Q

Somatotroph?

A

growth hm secreting

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6
Q

Corticotroph?

A

ACTH secreting

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7
Q

Thyrotroph?

A

TSH secreting

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8
Q

Gonadotroph?

A

LH/FSH secreting

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9
Q

How does a lactotroph adenoma (prolactinoma) present in females vs males?

A

Female:

  • Menstrual irregularites
  • galactorrhea
  • diminished libido
  • infertility
  • mass effect

Male:

  • Mass effect
  • diminished libido and sperm count
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10
Q

What is the most common secretory pituitary adenoma?

A

Lactotroph adenoma

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11
Q

How do you stain for a suspected lactotroph adenoma?

A

PRL stain, + for procatin

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12
Q

How do lactotroph adenomas progress?

A

Stromal hyalinization with psammoma bodies leading to a pituitary stone

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13
Q

How do you treat lactotroph adenomas?

A
  • Dopamine or somatostatin analogs
  • surgery
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14
Q

What can cause hyperprolactinemia in the absence of an adenoma?

A
  • pregnancy, lactation/nipple stimulation
  • loss of dopamine
  • renal failure
  • hypothyroidism
    • inc. TRH can stimulate PRL production
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15
Q

How can a somatotroph adenoma cause both acromegaly and gigantism?

A
  • If the somatotroph adenoma is present before the epiphyseal plates close it releases GH causing the bones to grow leading to gigantism
  • If the adeoma is present after the growth plates have closed it causes the bones to thicken rather than lengthen
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16
Q

Features of acromegaly?

A
  • Enlargement of hands and face
  • protruding jaw, nose, thickened lips
  • Joint pain and limited mobility
  • shortened life due to CV issues
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17
Q

How do you diagnose a somatotroph adenoma?

A
  • Check serum levels of IGF-1
  • If it is elevated give oral glucose tolerance test for GH response
    • normally glucose would inhibit GH release which would decrease IGF-1 levels
    • in an adenoma the IGF-1 levels remain high
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18
Q

How do you treat somatotroph adenomas?

A
  • somatostatin analogs
  • GH receptor antagonists
  • surgery
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19
Q

Whta is unique about corticotroph adenomas?

A
  • They can have a very small size but they are also very functional and can induce cushing disease
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20
Q

Differentiate between Cushing’s syndrome and disease.

A
  • Syndrome is hypercortisolism and all of the sx associated with it
  • Disesase is derived from the pituiutary ACTH → Corticotroph adenoma
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21
Q

What is the most common cause of Cushing Syndrome?

Study These Flashcards
A

Iatrogenic CUshing syndrome → we cause it with glucocorticoid administration

22
Q

If we have cushing syndrome and ACTH is high, what could cause this and what does it mean?

Study These Flashcards
A
  • If ACTH is high it is an ACTH dependent process
  • This can be caused by a pituitary tumor (Cushing’s Disease) OR an Ectopic ACTH producing tumor
23
Q

If we have a patient with Cushing Syndrome and low ACTH, what does this mean and what can cause it?

Study These Flashcards
A
  • It is an ACTH independent process (adrenal cushings)
  • Caused by an adrenal adenoma/cancer OR b/l adrenal hyperplasia
24
Q

If you have an ACTH dependent hypercortisolism how do you test to figure out the cause?

Study These Flashcards
A
  • Dexamethasone suppression test → if you give a high enough dose, pituitary adenomas will eventually decrease production
  • If there is no response it is NOT a pituitary adenoma and you need to look into a small cell carcinoma
25
What is inferior petrosal sinus sampling?
* thread a catheter up through jugular vein into the sinus and collect a sample to ID if there is secretion of a pitutary hormone into the sinus * can be done if you suspect the problem is pituitary but you can't see it on imaging
26
How do you treat a corticotroph adenoma?
* Somatostatin analog * bromocriptine * surgery
27
What is Nelson Syndrome?
* Occurs when you remove the adrenal glands due to a pituitary adenoma that you can't remove * give exogenous cortisol for physiologic needs, but it fails to inhibit pituitary turmor and ACTH secretion * **results in increased pigmentation and relief of cushing syndrome**
28
What are the “silent” or “null cell” adenomas?
* Non functioning and Gonadotroph adenomas * NF typically present with a mass effect * GA show minimal functioning
29
What is the TF that is associated with most functioning pituitary adenomas?
PIT-1
30
Most Functioning pituitary adenomas are associated with the TF \_\_\_\_. The exception is _____ adenoma which is associated with \_\_\_\_\_.
Most Functioning pituitary adenomas are associated with the TF **_PIT-1**_. The exception is _**Corticotroph**_ adenoma which is associated with _**TPIT._** * *"TPIT or not TPIT, that is the Cushing"*
31
What somatic mutations are associated with pituitary adenomas?
* GNAS * USP8 * corticotroph (32-62%) * mutation upregulates EGFR
32
What are the familial germline mutations that causes pituitary adenomas?
* AIP * Somatotroph pituitary adenoma predisposition
33
Describe the GNAS mutation associated with pituitary adenomas.
* Mutation of GNAS makes the alpha subunit of Gs lose its GTPase activity * GDP isn't there to turn off the cascade, so GTP initiates cascade with cAMP * normally GTPase activity favors GTP to GDP * GDP turns off the cascade
34
Compare pituitary adenomas and Aggressive adenomas.
35
What is Rathke's Cleft Cyst? What is the histilogical makeup?
* Cystic mass derived from Rhathke's pouch * This can expand and compress the normal pituitary * Can also rupture and result in inflammation of pituitary or meningitis * Comes from oral ectoderm, which makes up respiratory epithelium
36
What is a craniopharyngioma?
* Kids (5-15 yo) * most often adamantinomatous and causes growth retardation from hypopituitarism * adamantinomatous=calcified tough external shell * Adults (\>65 yo) * papillary craniopharyngioma * signs of increased ICP or hypopituitarism
37
What makes up the histology of craniopharyngioma?
* derived from remnants of Rathke's pouch * made of squamous epithelium * wet keratin * calcified cyst
38
What can cause hypopituitarism?
* Tumors/mass lesions * TBI/hemorrhage * Surgery/radiation * Apoplexy * Ischemic necrosis/Sheehan syndrome * Inflammatory disorders * Genetic defects *All of these occur via three mechanisms→ “squashed”, “killed off”, or “bled into”*
39
What is primary empty sella syndrome?
* CSF leaks into sella and compresses the pituitary
40
What is secondary empty sella syndrome?
Pituitary expands and infarcts within the sella leaving an empty space
41
What results from anterior hypopituitarism GH?
Incr. body fat, decreased muslce, reduced strength
42
What results from anterior hypopituitarism gonaddotropins?
* Men: poor libido/impotence, infertility, reduced facial/body hair * Women: amenorrhea, dyspareunia, infertilty, breast atrophy
43
What results from anterior hypopituitarism TSH
Decreased energy constipation weight gain
44
What results from anterior hypopituitarism ACTH?
Weakness tiredness and hypoglycemia
45
What results from anterior hypopituitarism prolactin
Lactation failure
46
what is Sheehan syndrome?
* Postpartum necrosis * ischemia and infarction can occur during labor and delivery due to a rapid enlargement of the pituitary outgrowing the sella and compressing the vessels supplying it * results in secondary empty sella * initial result of this is lack of ability to nurse baby
47
Posterior pituitary ADH deficiency and excess?
Deficiency results in diabetes insipidus and excess results in SIADH
48
Diabetess Insipidus?
* Decreaed reclaimed free water from renal collecting duct * incerased serum osmolality and hypernatremia * dilute excessive urine * polyuria * Can be caused centrally or nephrogenic * central: kidneys respond with inc. water retention and increased urine Na/osmolality to DDAVP * Nephrogenic: no response to DDAVP
49
SIADH and sx? What is the msot common cause of it?
* Increased reclaimed free water from renal collecting duct * decreased serum osmality * concentrated urine * mental status changes, mm weakness, seizures * Small cell carcinoma of the lung is mc cause * also TBI and subarachnoid hemorrhage and SSRI's can cause
50
Compare DI and SIADH.

ENRP Exam II (9 decks)

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