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34 Cards in this Set
- Front
- Back
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5-tiered classification system for Pituitary Adenomas
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Clinical Pres (secretory or not)
Radiology (micro or macro) Histopath (typical/atypical) IHC profile Ultrastructural Subtype |
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3 main clinical presentations?
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Hypo-pituitarism
Hyper-pit Neurologic (visual, hypothalamus) |
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Sx's of Pituitary Apoplexy?
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Sudden Onset of excruciating HA
Diplopia Subsequent hypopituitarism |
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Kicker's for Pituitary Adenoma histology?
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Nests, sheets, or cords of cells
Rich in capillaries Salt and Pepper chromatin |
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Which hormone secreting area of ant pit is most central? why?
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ACTH area
b/c minute by minute its the most needed. thus, most protected |
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Gold standard for Dx of pit adenoma?
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Histopathology
Immunohistochemistry |
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Besides Gigantism/Acromegaly, what else can a GH secreting adenoma cause?
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Gonadal dysfxn
DM HTN CHF |
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Rx for GH adenoma?
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Surgery
Somatostatin agonist |
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Kicker for PRL ademo histo?
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Psammoma bodies
i.e. calcifications |
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DDx for PRL ademoa?
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Stalk compression (<150)
Drugs (dopamine antagonists) |
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Rx for PRL ademoa?
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Bromocriptine...i.e. dopamine agonist
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Invasiveness of PRL adenomas?
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not in women
downwardly in men |
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Kickers for ACTH adenoma?
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Micro (present early)
Cushing's disease Misdiagnosis can lead to adrenalectomy and Nelson's |
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Change in our perception of FSH/LH adenomas?
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used to think they were non-fxning, now we know they're jsut inefficient secretors
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Histo of FSH/LH Adenomas?
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Pseudo-papillary +/- Pseudo-rosettes
often oncocytic |
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What else do FSH/LH adenomas resemble histologically?
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Null-Cell Adenomas
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how do you decide if a pit adenoma is atypical?
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Ki67 and p53 labeling
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How do Ki67/p53 stains and EM affect prognosis?
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Positive Stains or Sparsely granulated are more aggressive
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Kickers for pituitary carcinoma?
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BAD
RARE Dx by metastasis |
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Lymphocytic hypophysitis kickers?
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Almost all women
Pregnant or Postpartum Lymphocytic infiltrate |
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when do you granulomatous hypophysitis?
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Sarcoidosis
TB |
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Difference between sarcoid and tb hypophysitis?
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Sarcoid: suprasellar, noncaseating granulomas
TB: sellar and caseating |
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What is MEN-1?
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Multiple Endocrine Neoplasia type 1
tumor suppressor gene |
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Kickers for Pit adenomas and MEN-I
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3 P's
Pituitary Tumors Parathyroid Hyperplasia, adenomas, or carcinomas Pancreatic Islet Cell Tumors |
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how much pituitary loss is needed for hypopituitarism?
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>75%
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Hormone deficiency sequence w/ slow mass effect?
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FSH/LH
TSH GH ACTH |
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causes for hypopituitary?
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Tumors
Surgery/Rad Rathke cleft cyst Hemorrhage Ischemic necrosis (sheehan's) Empty Sella syndrome |
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What happens to the pituitary during a normal pregnancy?
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grows to twice its normal size w/o increasing blood supply
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Sx's of ADH deficiency?
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DI
Polydipsia Polyuria Hypernatremia (of blood) Hyperosmolality (of blood) |
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sx's of SIADH?
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Hyponatremia
Cerebral edema (not peripheral) Neuro dysfxn |
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Hypothalamic tumor to know? causes?
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Craniopharyngioma (benign)
growth retardation |
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when does craniopharyngioma occur?
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kids
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where does craniopharyngioma occur?
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mostly suprasellar but can be intra
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Histo of craniopharyngioma?
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Stellate Reticulum
Flakes of keratin beta catenin mutation |
