On the exam Know anterior pituitary + posterior pituitary, cells, hormones, diseases

produced **Hypopituitarism, Melatonin**

Endocrine
System keeps organs in metabolic equilibrium
Signaling by extracellular:
o autocrine
o Paracrine
o endocrine.
Endocrine Diseases:
Classified as:
o under or overproduce of hormones
biochemical and clinical consequences
o or diseases associated w/ mass lesions
o nonfunctional/functional
Endocrine Organs:
Pituitary
Thyroid gland
Parathyroid glands
Endocrine pancreas
Adrenal glands
Multiple endocrine neoplasia
Pineal gland.
Pituitary and Hypothalamus
Anatomy
Pituitary
located in sella turcica
2 components:
Anterior (80% larger)
Posterior
pituitary stalk connects pituitary + hypothalamus
Hypothalamus
Links nervous system to endocrine system via pituitary gland.
Pituitary-Hypothalamus axis
ANTERIOR PITUIATARY
Hypothalamus release stimulating hormone (trophic hormones)
portal vascular system stimulate anterior pituitary anterior
produce pituitary hormone
Endocrine cells release hormones into the second set of capillaries for
distribution to rest of the body

POSTERIOR PITUITARY
Hypothalamus make hormones in he hypothalamus store in axon
terminal in posterior pituitary when stimulated secrete 2
peptide hormones

Anterior and Posterior Pituitary Histology

Anterior pituitary
Hematoxylin + eosin colorful array of cells b/c different secretions
5 cell types based on specific antibodies against the pituitary
hormones
Somatotrophs
growth hormone (GH); 50% of cells.
Lactotrophs (mammotrophs)
prolactin
Corticotrophs
adrenocorticotropic hormone (ACTH)
pro-opiomelanocortin (POMC
meloanocyste stimulating hormone (MSH)
Thyrotrophs
thyroid-stimulating hormone (TSH)
Gonadotrophs (ovary)
follicle-stimulating hormone (FSH)
luteinizing hormone (LH)
Posterior Pituitary**
Contain modified glial cells (pituicytes)
b/c only stored hormones not produce
Oxytocin and Antidiuretic hormone (ADH, a vasopressin)
Made in hypothalamus
released into systemic circulation in response to appropriate
stimuli
Labor- uterus to contract
Postpartum to contract
Dehydration and hypovolemia heart receptors
contract to tell body to counter dehydration
Pituitary Disease
Hyperpituitarism
pituitary adenoma
Hyperplasia
Carcinomas (less than 1%)
secretion of hormones by nonpituitary tumors
certain hypothalamic disorders

Hypopituitarism
ischemic injury, surgery or radiation
inflammatory reactions
nonfunctional pituitary adenomas

Local mass effects

radiographic abnormalities of the sella turcica
visual field abnormalities
elevated intracranial pressure
pituitary apoplexy

Pituitary Adenoma
most common cause of hyperpituitarism
anterior lobe
functional or nonfunctional
common cause of hyperpituitarism
peak incidence from 35 to 60 years of age
microadenomas (<1 cm in diameter) or macroadenomas (>1 cm in diameter ,
silent and hormone-negative)
classified on the basis of hormone(s) produced by the neoplastic cells,
detected by immunohistochemical stains.
Pituitary Adenomas
Genetic alteration
Sporadic (95%)
G-protein mutations in the alpha subunit that interferes with
its intrinsic GTpase activity
Familial
MEN1, CDKN1B, PRKAR1A, and AIP
Molecular abnormalities associated with aggressive behavior:
over expression of cyclin D1
mutations of p53
epigenetic silencing of the retinoblastoma gene (RB1)
Pituitary Adenoma Morphology
Soft, well circumscribed
When infiltrate neighboring tissues, are called invasive adenomas
Composed of sheets/cords of uniform polygonal cells with absent reticulin
network (in contrast to normal pituitary)
Atypical adenomas if brisk mitotic activity and extensive nuclear p53
immunoreactivity, exhibit aggressive behavior
Lacks reticulum in this tumor
Large non functioning tumor
There is just one uniform population of cells

Pituitary Adenoma Clinical Effect

Overproduction of hormone based on the specific types of adenomas
Local mass effects
radiographic abnormalities of the sella turcica
visual field abnormalities
elevated intracranial pressure
pituitary apoplexy
Adenomas Types*
Prolactinomas
Most common type, constitutes 30% of the cases
Increased prolactin secretion
Amenorrhea/galactorrhea/decreased libido/infertility
Other causes such as physiological/ drugs/ estrogens/ renal failure
Treatment- surgery or bromocriptine

Somatotropinoma
Second most common type
Excessive GH (stimulates hepatic secretion of IGF-1)
Children gigantism
Adults- acromegaly
Treatment surgery or somatostatin analogs

ACTH cell (corticotroph) adenomas

Usually small microadenomas at time of diagnosis
Excess production of ACTH
Hypercortisolism (Cushings disease)

Bihormonal adenomas
PRL and G cells

Nonfunctioning adenomas
25-30% of all pituitary tumors
Typical presentation is mass effect

Hypopituitarism
ischemic injury, surgery or radiation
inflammatory reactions
nonfunctional pituitary adenomas
at least 75% of parenchyma is lost
mostly because of destructive process
tumors and other mass lesions
traumatic brain injury
Surgery or radiation
Pituitary apoplexy (sudden hemorrhage)
Ischemic necrosis
- DIC, Sickle cell anemia, Sheehan syndrome (postpartum necrosis of
anterior pituitary)
Empty sella syndrome (enlarged empty ,sella turcica)
Inflammatory disorders/infections
Hypothalamic lesions

Clinical manifestations
GH deficiency dwarfism
LH and FSH deficiency- amenorrhea, infertility and others
TSH deficiency hypothyroidism
ACTH deficiency hypoadrenalism
Prolactin deficiency- failure of postpartum lactation

Posterior pituitary syndromes

Involves ADH
Antidiuretic hormone binds to receptors on cells in the collecting
ducts of the kidney and promotes reabsorption of water back into the
circulation.

Diabetes insipidus losing a lot of water

ADH deficiency loss of water
Central or nephrogenic something wrong with hypothalamus
Loss of large volumes of dilute urine, hypernatremia, polydypsia

Syndrome of inappropriate ADH secretion

Reabsorption of excessive amounts of free water
Water retention, hyponatremia, cerebral edema
Cause
Excess production by CNS.
ectopic secretion by small cell carcinoma of lung
due to tumor

Lesions of hypothalamus
Disruption of function of hypothalamic/pituitary axis
Hypopituitarism
Hyperprolactinemia
Neurologic
Visual field defects
Hypothalamic suprasellar tumors
Clinically significant because may cause
Hypofunction or hyperfunction of anterior pituitary
Diabetes insipidus
Includes
Gliomas
Craniopharyngiomas rare, slow growing tumor

Craniopharyngioma**
slow-growing, accounts for 1-5% of intracranial tumors.
bimodal age distribution
commonly cystic and multiloculated
arises from remnants of the craniopharyngeal duct and/or Rathke
cleft

2 distinct histologic types:

Adamantinomatous
Children
squamous epithelium
wet keratin and calcification
cysts contain machine oil
Papillary
Adults
lack keratin
calcification
cysts

Pineal gland
100-180 mg pine cone shaped, located near the center of the brain, between
the two hemispheres.
pineal gland is a midline structure, and is often seen in plain skull X-rays as it
is often calcified.
The pineal body consists of a lobular parenchyma of epithelial pinealocytes
and glia.
Produces
Melatonin, a serotonin derived molecule that inhibits GnRH release.
Blood levels highest in dark
*Know that its for melatonin * to help you sleep
Pineal lesions
Endocrine
Precocious puberty due to melatonin deficiency
Neurologic
increased intracranial pressure due to mass effect
Non neoplastic cysts
Germ cell neoplasms
Pineal parenchymal tumors

Classification of Pituitary adenomas

Cell type

Hormone

Tumor type

Ass. Syndrome

Corticotroph

ACTH and
other POMCderived
peptides

ACTH cell adenoma

Cushing Syndrome

Somatotroph

GH

GH cell adenoma

Gigantism
Acromegaly

Lactotroph

Prolactin

Prolactin cell adenoma Galactorrhea,

amenorrhea, sexual
dysfunction, infertility

Mammosomatotroph

Prolactin, GH

Mammosomatotroph

Combined

Gonadotroph

FSH, LH

Null cell/oncocytic
adenoma

Hypogonadism, mass
effects, hypopituitarism

Thyrotroph

TSH

TSH cell adenoma

Hyperthyroidism

Blue- hypothalamus
Pink-anterior hormones