Pituitary Pathology

Question 1

What is the most common cause of hyperpituitarism?

Answer 1

Pituitary Adenomas

Question 2

What is special about Atypical Adenomas?

Answer 2

They are more likely to be aggressive

Question 3

Uniform, monomorphic sheets/cords of cells with an absence of reticulin

Answer 3

Pituitary Adenoma

Question 4

What mutation is associated with Pituitary Adenomas?

Answer 4

GNAS –> inhibition of GPCR –> continual activation of hormone synthesis

Question 5

Sx’s = amenorrhea, galactorrhea, loss of libido, infertility

Answer 5

Prolactinemia (commonly Lactotroph Adenoma)

Question 6

What type of adenoma can cause gigantism and acromegaly?

Answer 6

Somatotroph Adenoma

Question 7

What hepatic product is released due to a Somatotroph Adenoma?

Answer 7

IGF-1

Question 8

What pituitary hormone is released due to a Somatotroph Adenoma?

Answer 8

GH

Question 9

Sx’s = Increased body size with disproportionately long arms and legs, some signs of acromegaly in children

Answer 9

Gigantism

Question 10

Sx’s = Enlarged jaw, feet, and hands, sausage-like fingers, thyroid, liver, heart, and adrenal issues

Answer 10

Acromegaly

Question 11

What are some other findings due to GH oversecretion?

Answer 11

DM/Glucose intolerance
HTN
Muscle weakness
Gonadal dysfunction

Question 12

How would you Dx a Somatotroph Adenoma?

Answer 12

Elevated serum GH/IGF-1 + failure to suppress GH after oral glucose load

Question 13

What hormones does a Mammosomatotroph Adenoma secrete?

Answer 13

GH and PRL

Question 14

What hormone does a Corticotroph Adenoma secrete and what is the net effect?

Answer 14

ACTH –> increased cortisol secretion –> hypercotisolism

Question 15

What disease is due to excess ACTH secretion by a tumor?

Answer 15

Cushing Syndrome

Question 16

What disease is due to excess ACTH secretion by the pituitary?

Answer 16

Cushing Disease

Question 17

Corticotroph Adenomas will stain + for which things?

Answer 17

PAS, POMC

Question 18

Sx’s = Buffalo hump, round face, stretch marks, ab weight gain, easy bruising, hirsutism

Answer 18

Excessive ACTH/Cortisol secretion

Question 19

What is Nelson Syndrome?

Answer 19

Excessive cortisol secretion with no inhibitory effect due to Corticotroph Microadenoma present and surgical removal of the adrenal glands

Question 20

How does excess ACTH lead to hyperpigmentation?

Answer 20

ACTH is a precursor molecule for melanocytes

Question 21

What type of pituitary adenoma typically doesn’t cause any clinical Sx’s?

Answer 21

Gonadotroph Adenoma

Question 22

How doo Gonadotroph Adenomas typically cause Sx’s and what are those Sx’s?

Answer 22

Mass effect

Sx’s = impaired vision, HA, diplopia, pituitary apoplexy

Question 23

Define Plurihormonal Adenomas

Answer 23

They elaborate more than one hormone

Are aggressive

Question 24

How do non-functioning Pituitary Adenomas typically present?

Answer 24

Mass effect Sx’s

Question 25

How are Pituitary Carcinomas Dx?

Answer 25

By the presence of metastases

Question 26

What are the most common hormones secreted from Pituitary Carcinomas?

Answer 26

ACTH, PRL

Question 27

What is the most common cause of hypopituitarism?

Answer 27

Destruction of the anterior pituitary

Question 28

What is Sheehan syndrome?

Answer 28

Postpartum necrosis of the anterior pituitary

Question 29

What is the most common cause of ischemic necrosis of the anterior pituitary?

Answer 29

Sheehan syndrome

Question 30

What is Primary Empty Sella syndrome?

Answer 30

A defect in the diaphragma sella --> arachnoid mater/CSF herniating into sella --> expansion of sella --> compression of pituitary

Question 31

In what type of people does Primary Empty Sella syndrome typically occur?

Answer 31

Obese women with a history of multiple pregnancies

Question 32

What are the most common presenting Sx's of Primary Empty Sella syndrome?

Answer 32

Visual field defects Hyperprolactinemia Other endocrine abnormalities

Question 33

Which hormone causes pallor due to loss of stimulatory effects on melanocytes?

Answer 33

MSH

Question 34

Decreased ADH secretion due to a pituitary issue...

Answer 34

Central DI

Question 35

Decreased ADH activity due to renal inability to find hormone...

Answer 35

Nephrogenic DI

Question 36

Sx's = excessive urination with low specific gravity, increased serum Na/Osmolality, thirst and polydipsia, dehydration

Answer 36

DI

Question 37

Sx's = hyponatremia, cerebral edema, neurologic dysfunction

Answer 37

SIADH

Question 38

What are the most common causes of SIADH?

Answer 38

ADH secreting neoplasm (small cell carcinoma of lung) Drugs increasing ADH secretion CNS disorders

Question 39

What tumors arise from remnants of the Rathke pouch?

Answer 39

Craniopharyngiomas

Question 40

What are the main presenting Sx's of Craniopharyngiomas?

Answer 40

HA | Visual disturbances

Question 41

What is the morphology of Craniopharyngiomas?

Answer 41

Cystic and multilobulated with a capsule

Question 42

Morphology = Calcified, nests/cords of squamous epithelium with peripheral palisading and lamellar keratin

Answer 42

Adamantinomatous Craniopharyngioma

Question 43

Cysts containing cholesterol-rich, thick brown-yellow (machine-oil) fluid

Answer 43

Adamantinomatous Craniopharyngioma

Question 44

What age group do Adamantinomatous Craniopharygiomas affect?

Answer 44

Children

Question 45

Morphology = Solid sheets of papillae lined by well-differentiated squamous epithelium and NO calcifications, keratin, or cysts

Answer 45

Papillary Craniopharyngioma

Question 46

What age group do Papillary Craniopharyngiomas affect?

Answer 46

Adults

Question 47

What is the prognosis for Papillary Craniopharyngiomas?

Answer 47

Excellent, malignancy is very rare