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38 Cards in this Set

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Acidophils synthesize _______
Prolactin, growth hormone (stain eosinophilic)
Basocphils synthesize ______.
ACTH, TSH (stain blue)
Chromophobes synthesize_______
Any of the hormones (do not take up any color)

(GH, PRL, ACTH, FSH, LH, TSH)
Majority of adenomas are _________.
Prolactinomas
Microadenoma vs Macroadenoma
Micro is under 1 cm
Macro is over 1 cm
Adenoma vs Carcinoma on Frozen Section
Adenoma has a homogenous cell type (acidophilic or basophilic), carcinoma does not
T/F: Tumors causing compression symptoms are likely to secrete hormones.
False

Microadenomas secreting hormones would present early (before growth into macroadenoma)
Gonadotroph adenomas:
Symptoms
Neurologicla symptoms predominate (MASS effect)

LH and FASH

Secrete hormones inefficiently
Null Cell Adenomas:
Symptoms
Neurological symptoms predominate

NOT secreting hormones so it's a mass effect
TSH Adenomas:
Symptoms
Hyperthyroidism
(1% of all adenomas)
Modified glial cells (known as ______) and axonal processes from nerve cells in _______ nuclei produce ______.
modified glial cells known as pituicytes
axonal processes from nerve cells in supraoptic and paraventricular nuclei
produce:
ADH and oxytocin
Diabetes Insipidus:
Presentation
Ion levels
Causes
Polyuria, low urinary specific gravity

Increased serum sodium

Results from trauma, pit or hthal tumors; inflammn
Hypopituitarism occurs when _______
75% of pituitary is destroyed

Tumors, mass lesions,
Rathke cleft cyst
Sheehan Syndrome (labor induced infarct)
Conglomerated epitheliod histiocytes in the pituitary describes _________.
Granulomatous inflammation of pituitary gland
Suprasellar disorders:
Associated with
Causes
Sleep disturbances, hunger, hypogonadism, precocious puberty

Causes:
Craniopharyngioma***, dermoid cyst, ependymoma, meningioma, trauma, encephalitis
Craniopharyngiomas tend to recapitulate __________.
Rathke's pouch
This growth is usually cystic with calcifications.
Craniopharyngioma
This growth is thick walled epithelial and lined with proteinaceous material.
Rathke's cleft cyst
Rathke's Cleft Cyst vs Craniopharyngioma
Rathke's Cleft Cyst is lined with proteinaceous material

Craniopharyngioma is lined with cholesterol
Central vein of adrenal gland is not well circumscribed and is located in the adrenal ________.

Why is it not well-circumscribed?
In Medulla, not well-circumscribed to allow for quick release of catecholamines
Most common cause of adrenocortical hypercortisolism?
Exogenous glucocorticoids
Common Causes of Cushing's Syndrome:
Children vs Adults
Adults: Pituitary Based dz, ectopic ACTH/CRH, Adenoma, Carcinoma (5%)

Children: Carcinoma (50%!), Pit based dz, Adenoma
This growth typically has a yellow color.

Why?
Cortical adenomas (fasciculata) typically is yellow bc of lipid content
Adenomas tend to be ______ and composed of _______.

How does this composition differ by tumor functionality

What is the affect of an adenoma on adjacent endocrine tissue?
well circumscribed and composed of lipid RICH and lipid POOR cells

Fnal tumors would be more lipid poor (using up fat to produce hormones)

Adjacent layers of adrenal gland (in case of adrenal adenoma) will atrophy
Adrenocortical carcinomas tend to have a heterogenous texture on imaging. Why?
Areas of necrosis (growth rate greater than blood supply can handle), hemorrhage
This growth has cells with enlarged and hyperchromatic nuclei with mitoses.
Adrenal cortical carcinomas
What tumpors contribute to ectopic ACTH production?

How does this affect the adrenal gland (grossly)?
SCC
Pancreatic
MTC

Causes substantial adrenal hypertrophy
Primary hyperaldosteronism:
Clinical Features
Adenoma Features
HTN
Hypokalemia
Low serum renin

Less than 2 cm in diameter (early effects)
Bright yellow/orange
Small, round, regular nuclei
Autoimmune Adrenalitis:
Type 1 vs Type 2
Type 1: Chronic adrenal insufficiency
AKA APECED: autoimmune polyendocrinopathy-candidiasis-ectodermal dystrophy)

Type 2: Chronic adrenal insufficiency, autoimmune thyroid dz, IDDM
In this disorder the adrenal cortex is almost completely atrophic and is infiltrated by lymphocytes.
Autoimmune adrenalitis
In infants with this syndrome, the adrenals can be larger than the kidneys because of intense stimulation of the glands by ACTH.
Adrenogenital syndrome (21-OHase deficiency)
Adrenal metastases tend to originate in the _______.

Would the metastases exhibit adrenal histology?
Lungs
(can also come from breast/liver)

Can be unilateral or bilateral (adrenal glands)

Would exhibit primary tumor histology (lung)
This process exhibits caseous necrosis in the adrenals glands.
Adrenal tuberculosis (CHALKY appearance)
What is Waterhouse Friderichsen Syndrome?

Symptoms?

Effects on adrenal gland?
Overwhelming bacterial infection (typically N. meningitidis)
Rapidly progressive hypotn leads to schock

Disseminated intravascular coagulation leads to widespread purpura


Rapidly developing adrenal cortical insufficiency associated with massive bilateral adrenal hemorrhage
Pheochromocytoms vs Paraganglioma
Pheo: within adrenal medulla

Paraganglioma: extra-adrenal pheochromocytoma; just above kidney
Defining presentation of pheochromocytoma.
Paroxysmal symptoms (spells)
Pheochromocytoma:
Most Common Cause
Familial (25%)

No more rule of 10's!
This disorder can result in an adrenal gland with multiple pheochromocytomas and hyperplasia of the medulla.
Multiple Endocrine Neoplasias?-->MEN2!