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    Chapter 20: The Endocrine System Pituitary Hyperpituitarism and Pituitary Adenomas

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    The document summarizes key aspects of the pituitary gland and its disorders. It describes the most common type of pituitary adenoma as being a functional or silent anterior lobe adenoma. It also discusses specific types of adenomas that secrete hormones like prolactin, growth hormone, and corticotropin which can cause hyperprolactinemia, acromegaly/gigantism, and Cushing's syndrome respectively. The document also summarizes hypopituitarism which can be congenital or acquired through conditions like pituitary necrosis, surgery/radiation, or other rare causes that damage the anterior pituitary.

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    Chapter 20: The Endocrine System Pituitary Hyperpituitarism and Pituitary Adenomas

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    xgracer15
    12 views2 pages
    The document summarizes key aspects of the pituitary gland and its disorders. It describes the most common type of pituitary adenoma as being a functional or silent anterior lobe adenoma. It also discusses specific types of adenomas that secrete hormones like prolactin, growth hormone, and corticotropin which can cause hyperprolactinemia, acromegaly/gigantism, and Cushing's syndrome respectively. The document also summarizes hypopituitarism which can be congenital or acquired through conditions like pituitary necrosis, surgery/radiation, or other rare causes that damage the anterior pituitary.

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    Ch20Endo

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    The document summarizes key aspects of the pituitary gland and its disorders. It describes the most common type of pituitary adenoma as being a functional or silent anterior lobe adenoma. It also discusses specific types of adenomas that secrete hormones like prolactin, growth hormone, and corticotropin which can cause hyperprolactinemia, acromegaly/gigantism, and Cushing's syndrome respectively. The document also summarizes hypopituitarism which can be congenital or acquired through conditions like pituitary necrosis, surgery/radiation, or other rare causes that damage the anterior pituitary.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as DOC, PDF, TXT or read online from Scribd
    Download as doc, pdf, or txt
    12 views2 pages

    Chapter 20: The Endocrine System Pituitary Hyperpituitarism and Pituitary Adenomas

    Uploaded by

    xgracer15
    The document summarizes key aspects of the pituitary gland and its disorders. It describes the most common type of pituitary adenoma as being a functional or silent anterior lobe adenoma. It also discusses specific types of adenomas that secrete hormones like prolactin, growth hormone, and corticotropin which can cause hyperprolactinemia, acromegaly/gigantism, and Cushing's syndrome respectively. The document also summarizes hypopituitarism which can be congenital or acquired through conditions like pituitary necrosis, surgery/radiation, or other rare causes that damage the anterior pituitary.

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    CHAPTER 20: THE ENDOCRINE SYSTEM

    PITUITARY
    • Hyperpituitarism and Pituitary Adenomas
    o Anterior lobe adenoma is the most common cause of hyperpituitarism
     Pituitary adenomas can be functional or silent
    • Both composed of single cell type and produce single predominant tumor
    • Exception: adenomas that secrete two hormones (GH and PRL)
     Can be microadenomas (< 1 cm) or macroadenomas (>1 cm in diameter)
     Most occur as isolated lesions, associated w/ multiple endocrine neoplasia type 1
    (MEN-1)
    o Pathogenesis
     G-proteins – GNAS1 gene
    • Mutation in α -subunit may result in constitutive activation  persistent
    levels of cAMP and unchecked proliferation
     Two distinctive morphologic features of most adenomas are their cellular
    monomorphism and absence of a reticulin network
    o Prolactinomas
     Most common type of hyperfunctioning of pituitary adenoma
     Hyperprolactinemia causes amenorrhea, galactorrhea, loss of libido, and infertility
    • Other causes of hyperprolactinemia are pregnancy, high-dose estrogen
    therapy, renal failure, hypothyroidism, hypothalamic lesions, dopamine-
    inhibiting drugs, etc.
     Stalk effect  any mass in suprasellar compartment may disturb normal inhibitory
    influence of hypothalamus on PRL secretion, resulting in hyperprolactinemia
     Therefore, mild elevations of serum PRL ( < 200 ug/L) in an individual w/ pituitary
    adenoma do not necessarily indicate PRL-secreting neoplasm
    o Growth Hormone-Producing Adenomas
     Second most common type
     Persistent hypersecretion of GH stimulates hepatic secretion of IGF-I (somatomedin
    C)
     Before epiphyses close  GH adenomas result in gigantism
     After epiphyses close  acromegaly
     GH excess also associated w/ abnormal glucose tolerance and DM, generalized
    muscle weakness, htn, arthritis, osteoporosis and CHF
    o Corticotroph Cell Adenomas
     These stain positively w/ periodic acid-Schiff (PAS) stains because of glycosylated
    ACTH protein
     May be clinically silent or cause hypercortisolism aka Cushing Syndrome
     After surgical removal of adrenals, the inhibitory effect of corticosteroids on
    hypothalamus-pituitary axis is lost, resulting in mass effects of pituitary tumor –
    Nelson Syndrome
     ACTH prehormone, which includes the melanocyte-stimulating hormone, will
    continue to be synthesized, so patients may also present w/ hyperpigmentation
    o Other Anterior Pituitary Neoplasms
     LH and FSH adenomas
    • Neoplastic cells usually demonstrate immunoreactivity for common
    gonadotropin α -subunit and the specific β -FSH and β -LH subunits
    • FSH is usually the predominant secreted hormone
     TSH adenomas
     Nonfunctioning pituitary adenomas
     Pituitary carcinomas
    • Hypopituitarism
    o Can be congenital or acquired
    o Hypopituitarism accompanied by evidence of posterior pituitary dysfunction in forms of
    diabetes insipidus is almost always of hypothalamic origin
    o Anterior pituitary hypofunction usually caused by:
     Nonfunctioning pituitary adenomas
     Ischemic necrosis of anterior pituitary causing insufficiency (in general, AP tolerates
    ischemic insults fairly well – loss of ½ of AP parenchyma causes no clinical
    consequences; >75% symptoms develop)
    • Sheehan syndrome  postpartum necrosis of AP; during pregnancy, AP
    enlarges due to hypertrophy of PRL-secreting cells w/o an increase in blood
    supply, making it vulnerable to ischemic injury
     Ablation of pituitary by surgery/radiation
     Less common causes  sarcoidosis, TB, trauma, metastatic neoplasms, mutations of
    Pit-1
    • Posterior Pituitary Syndromes

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