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67 Cards in this Set
- Front
- Back
What embryologic structure is the anterior pituitary derived from?
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Rathke's pouch
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What embryologic structure is the posterior pituitary derived from?
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the Diencephalon
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What type of cells are found in the posterior vs anterior pituitary?
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Posterior: pituicytes/neuropil
Anterior: endocrine cells |
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What are 3 types of cells found in the anterior pituitary and what hormones are secreted by each?
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Acidophils: GH and Prl
Basophils: ACTH TSH FSH LH Chromophobes: nothing |
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Where are the posterior pituitary hormones ADH/oxytocin made?
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ADH - in the supraoptic nucleus
Oxytocin - Paraventricular nu: (both in the hypothalamus) |
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How do the releasing hormones from the hypothalamus get to the anterior pituitary?
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Via a portal capillary network
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What is the most common tumor to arise in the pituitary?
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Benign Pituitary adenoma
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What is the typical age at which Pituitary adenomas are diagnosed?
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30-50
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What symptoms are often associated with pituitary adenomas?
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-Hormonal/endocrine
-Visual |
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What genetic mutation is associated with 3% of pituitary adenomas?
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MEN I
(pan, para, PITuitary) |
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What pattern do we normally see in the anterior pituitary?
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Lobular endocrine distribution of all 3 cell types, with a fibrovascular stroma
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What pattern is seen in most pituitary adenomas?
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Loss of the lobular pattern
-Diffuse sheets of cells -Only one cell type |
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What stain can be used to see the presence/loss of the lobular patterning?
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A reticulin stain
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Which will show pos reticulin?
-Normal pituitary -Pituitary hyperplasia -Pituitary adenoma |
Hyperplasia/normal = positive
Pituitary adenoma will have no pos reticulin stain due to the loss of fibrovascular stroma. |
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What is the treatment for pituitary adenomas?
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Transphenoidal resections
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Top 3 pituitary adenoma types:
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-Prolactinoma
-Null/nonsecretory -ACTH |
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Clinical manifestaton of GH
-deficiency -hypersecretion |
Defic: dwarfism
Hyper: Gigantism/Acromegaly |
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Clinical manifestaton of Prl
-deficiency -hypersecretion |
Defic: decreased lactation in postpartum period
Hyper: Galactorrhea/amenorrhea |
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Clinical manifestaton of TSH
-deficiency -hypersecretion |
Defic: hypothyroidism
Hyper: hyperthyroidism |
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Clinical manifestaton of ACTH
-deficiency -hypersecretion |
Defic: Addison's disease
Hyper: Cushing's disease |
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Clinical manifestaton of LH/FSH
-deficiency -hypersecretion |
Defic: hypogonadism
Hyper: HYPOGONADISM |
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Clinical manifestaton of ADH
-deficiency -hypersecretion |
Defic: Diabetes insipidus
Hyper: siADH with hyponatremia |
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Excess secretion of GH before closure of growth plates results in:
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Gigantism
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Excess secretion of GH after growth plates close results in:
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Acromegaly
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3 sx of acromegaly:
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Big nose
Big lips Big fingertips |
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Does cancer ever develop in the pituitary?
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Rarely
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What is the only accepted criteria for diagnosis of pituitary carcinoma?
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Distant metastasis
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How much parenchyma of the anterior pituitary has to be lost before hypopituitarism occurs?
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75%
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What is primary hypopituitarism?
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Due to an intrinsic dysfunction in the pituitary itself
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What is 2ndary hypopituitarism?
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Due to hypothalamic dysfunction
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What is a Rathke Cleft Cyst formed from?
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The posterior portion of Rathke's pouch
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Where in the pituitary gland will a rathke cleft cyst be seen?
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In the pars intermedia
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What cells can be found within a Rathke Cleft cyst?
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Ciliated cuboidal or columnar epithelium with goblet cells
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What condition can be caused by Rathke cleft cyst compression of surrounding structures?
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Diabetes insipidus
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What other neoplasm in the skull base can develop from Rathke pouch?
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Craniopharyngioma
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What is the age distribution of Craniopharyngioma?
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Bimodal
-5-15 yo's -50-60 yo's |
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Is Craniopharyngioma benign or malignant?
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Benign, but its behavior is malignant
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Why is the behavior of craniopharyngiomas malignant?
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Because they are destructive to the pituitary and lead to panhypopituitarism.
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How do children age 5-15 with Craniopharyngioma present?
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With growth retardation
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How do adults age 50-60 with Craniopharyngioma present?
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With visual disturbances or other endocrine dysfunctions
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What are 4 distinct microscopic findings in the histology of craniopharyngiomas?
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-Squamous epithelium
-Columnar epithelium -Lipid clefts -Cholesterol clefts |
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What is the appearance of a craniopharyngioma on cut surface? Why?
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motor oil appearance - brown and viscous due to lipid/cholesterol
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So on the boards, if you see the words MOTOR OIL APPEARANCE ON CUT SURFACE what should you think of almost immediately?
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Craniopharyngioma!
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What are 3 structures that craniopharyngiomas can compress? What can this lead to for each?
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-Third ventricle - hydrocephalus
-Optic nerve - visual impairment -Hypothalamus - dysregulation of homeostasis |
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What can often show up on MRI scans of craniopharyngioma?
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Calcification
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What is a rare neoplasm in the skull base, derived from primitive notochord remnants?
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Chordoma
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What are the characteristic cells seen in Chordomas?
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Physaliphorous cells
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What are Physaliphorous cells?
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Epithelioid cells with bubbly cytoplasm due to vacuoles
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At what 3 sites can Chordomas occur?
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-Sacrum
-Along the spinal cord -Intracranial at the clivus |
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What is the avg age of an intracranial Chordoma?
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48 yrs old
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What is the progression of Chordomas like?
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Slow growing but very locally destructive
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What are 3 typical symptoms of Chordomas?
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Headaches
Diplopia CN palsies |
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What is Empty Sella Syndrome?
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Lack of pituitary gland filling the sella turcica!
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What are 2 forms of ESS?
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Primary ESS
Secondary ESS |
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What is Primary empty sella syndrome caused by?
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Defects in the diaphragma sella, which allow CSF to enter and compress the pituitary gland
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What can 2ndry ESS be caused by?
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-Mass resection
-Radiation therapy |
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What is Sheehan syndrome?
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Hypertrophy of the pituitary gland during pregnancy, with lack of accompanying increase in venous blood supply
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What can hypotension of hemorrhage during delivery of the baby lead to when there is Pituitary hypertrophy during pregnancy?
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Ischemia and necrosis of the PG
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What are 3 similar situations that have potential for causing ischemia/necrosis of the pituitary?
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DIC
Sickle cell anemia Increased ICP |
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What is pituitary hemorrhage called and what is it often 2ndary to?
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Apoplexy - often due to adenoma
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What symptoms can arise in Pituitary Apoplexy?
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-Sudeen excruciating headache
-Diplopia -Panhypopituitarism -CV collapse, lose consciousness, death |
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How often is Pituitary apoplexy? Why do we care about it?
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Rare - it's a neurosurgical emergency
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What are 2 infiltrative disorders of the pituitary?
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-Lymphocytic hypophysitis
-Granulomatous hypophysitis |
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In what patients is lymphocytic hypophysitis typically seen?
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Postpartum or pregnant
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What is the proposed etiology of Lymphocytic hypophysitis?
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Autoimmune
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What are the usual ways that Lymphocytic hypophysitis might present? Treatment?
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-Mild hyperprolactinemia
or -Asymptomatic Txmt: maybe sterois or surgery |
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What are 3 infections/things that could cause granulomatous hypophysitis?
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-Sarcoid
-Syphilis -TB |