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67 Cards in this Set

  • Front
  • Back
What embryologic structure is the anterior pituitary derived from?
Rathke's pouch
What embryologic structure is the posterior pituitary derived from?
the Diencephalon
What type of cells are found in the posterior vs anterior pituitary?
Posterior: pituicytes/neuropil

Anterior: endocrine cells
What are 3 types of cells found in the anterior pituitary and what hormones are secreted by each?
Acidophils: GH and Prl
Basophils: ACTH TSH FSH LH
Chromophobes: nothing
Where are the posterior pituitary hormones ADH/oxytocin made?
ADH - in the supraoptic nucleus
Oxytocin - Paraventricular nu:
(both in the hypothalamus)
How do the releasing hormones from the hypothalamus get to the anterior pituitary?
Via a portal capillary network
What is the most common tumor to arise in the pituitary?
Benign Pituitary adenoma
What is the typical age at which Pituitary adenomas are diagnosed?
30-50
What symptoms are often associated with pituitary adenomas?
-Hormonal/endocrine
-Visual
What genetic mutation is associated with 3% of pituitary adenomas?
MEN I
(pan, para, PITuitary)
What pattern do we normally see in the anterior pituitary?
Lobular endocrine distribution of all 3 cell types, with a fibrovascular stroma
What pattern is seen in most pituitary adenomas?
Loss of the lobular pattern
-Diffuse sheets of cells
-Only one cell type
What stain can be used to see the presence/loss of the lobular patterning?
A reticulin stain
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.
What is the treatment for pituitary adenomas?
Transphenoidal resections
Top 3 pituitary adenoma types:
-Prolactinoma
-Null/nonsecretory
-ACTH
Clinical manifestaton of GH
-deficiency
-hypersecretion
Defic: dwarfism
Hyper: Gigantism/Acromegaly
Clinical manifestaton of Prl
-deficiency
-hypersecretion
Defic: decreased lactation in postpartum period
Hyper: Galactorrhea/amenorrhea
Clinical manifestaton of TSH
-deficiency
-hypersecretion
Defic: hypothyroidism
Hyper: hyperthyroidism
Clinical manifestaton of ACTH
-deficiency
-hypersecretion
Defic: Addison's disease
Hyper: Cushing's disease
Clinical manifestaton of LH/FSH
-deficiency
-hypersecretion
Defic: hypogonadism
Hyper: HYPOGONADISM
Clinical manifestaton of ADH
-deficiency
-hypersecretion
Defic: Diabetes insipidus
Hyper: siADH with hyponatremia
Excess secretion of GH before closure of growth plates results in:
Gigantism
Excess secretion of GH after growth plates close results in:
Acromegaly
3 sx of acromegaly:
Big nose
Big lips
Big fingertips
Does cancer ever develop in the pituitary?
Rarely
What is the only accepted criteria for diagnosis of pituitary carcinoma?
Distant metastasis
How much parenchyma of the anterior pituitary has to be lost before hypopituitarism occurs?
75%
What is primary hypopituitarism?
Due to an intrinsic dysfunction in the pituitary itself
What is 2ndary hypopituitarism?
Due to hypothalamic dysfunction
What is a Rathke Cleft Cyst formed from?
The posterior portion of Rathke's pouch
Where in the pituitary gland will a rathke cleft cyst be seen?
In the pars intermedia
What cells can be found within a Rathke Cleft cyst?
Ciliated cuboidal or columnar epithelium with goblet cells
What condition can be caused by Rathke cleft cyst compression of surrounding structures?
Diabetes insipidus
What other neoplasm in the skull base can develop from Rathke pouch?
Craniopharyngioma
What is the age distribution of Craniopharyngioma?
Bimodal
-5-15 yo's
-50-60 yo's
Is Craniopharyngioma benign or malignant?
Benign, but its behavior is malignant
Why is the behavior of craniopharyngiomas malignant?
Because they are destructive to the pituitary and lead to panhypopituitarism.
How do children age 5-15 with Craniopharyngioma present?
With growth retardation
How do adults age 50-60 with Craniopharyngioma present?
With visual disturbances or other endocrine dysfunctions
What are 4 distinct microscopic findings in the histology of craniopharyngiomas?
-Squamous epithelium
-Columnar epithelium
-Lipid clefts
-Cholesterol clefts
What is the appearance of a craniopharyngioma on cut surface? Why?
motor oil appearance - brown and viscous due to lipid/cholesterol
So on the boards, if you see the words MOTOR OIL APPEARANCE ON CUT SURFACE what should you think of almost immediately?
Craniopharyngioma!
What are 3 structures that craniopharyngiomas can compress? What can this lead to for each?
-Third ventricle - hydrocephalus
-Optic nerve - visual impairment
-Hypothalamus - dysregulation of homeostasis
What can often show up on MRI scans of craniopharyngioma?
Calcification
What is a rare neoplasm in the skull base, derived from primitive notochord remnants?
Chordoma
What are the characteristic cells seen in Chordomas?
Physaliphorous cells
What are Physaliphorous cells?
Epithelioid cells with bubbly cytoplasm due to vacuoles
At what 3 sites can Chordomas occur?
-Sacrum
-Along the spinal cord
-Intracranial at the clivus
What is the avg age of an intracranial Chordoma?
48 yrs old
What is the progression of Chordomas like?
Slow growing but very locally destructive
What are 3 typical symptoms of Chordomas?
Headaches
Diplopia
CN palsies
What is Empty Sella Syndrome?
Lack of pituitary gland filling the sella turcica!
What are 2 forms of ESS?
Primary ESS
Secondary ESS
What is Primary empty sella syndrome caused by?
Defects in the diaphragma sella, which allow CSF to enter and compress the pituitary gland
What can 2ndry ESS be caused by?
-Mass resection
-Radiation therapy
What is Sheehan syndrome?
Hypertrophy of the pituitary gland during pregnancy, with lack of accompanying increase in venous blood supply
What can hypotension of hemorrhage during delivery of the baby lead to when there is Pituitary hypertrophy during pregnancy?
Ischemia and necrosis of the PG
What are 3 similar situations that have potential for causing ischemia/necrosis of the pituitary?
DIC
Sickle cell anemia
Increased ICP
What is pituitary hemorrhage called and what is it often 2ndary to?
Apoplexy - often due to adenoma
What symptoms can arise in Pituitary Apoplexy?
-Sudeen excruciating headache
-Diplopia
-Panhypopituitarism
-CV collapse, lose consciousness, death
How often is Pituitary apoplexy? Why do we care about it?
Rare - it's a neurosurgical emergency
What are 2 infiltrative disorders of the pituitary?
-Lymphocytic hypophysitis
-Granulomatous hypophysitis
In what patients is lymphocytic hypophysitis typically seen?
Postpartum or pregnant
What is the proposed etiology of Lymphocytic hypophysitis?
Autoimmune
What are the usual ways that Lymphocytic hypophysitis might present? Treatment?
-Mild hyperprolactinemia
or
-Asymptomatic
Txmt: maybe sterois or surgery
What are 3 infections/things that could cause granulomatous hypophysitis?
-Sarcoid
-Syphilis
-TB