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Pituitary Gland Pathology

Pituitary Gland Pathology

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Published by GerardLum
Pituitary Gland Pathology
Pituitary Gland Pathology

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Published by: GerardLum on Jun 07, 2010
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Pituitary Gland PathologyAnatomy
Small Bean-Shaped OrganLocated at Base of BrainWithinSella Turcic Close proximity toOptic Chiasm Beneath Hypothalamus, attached by Pituitary Stalk1cm in GD0.5 gm in weight
Anterior Lobe(Adenohypophysis)
(80% of Gland)
Posterior Lobe(Neurohypophysis)Cell Types
Somatotrophs (GH)Lactotrophs (Prolactin)Corticotrophs (ACTH)Thyrotrophs (TSH)Gonadotrophs (FSH,LH)
Modified Glial cells (Pituicytes),Axonal Processes
OxytocinVasopressin (ADH)
Acidophilic – (A) Pink
SecreteGH,Prolactin
Basophilic – (B) Dark Purple
SecreteACTH,TSH,Gonadotrophins 
Chromophobe – (C) Pale Staining
Few Secretary Activities 
Resemble Neural Tissue
GlialcellsNerve FibersNerve EndingsIntra-Axonal Neurosecretory Granules
 
Anterior Pituitary Posterior Pituitary
Larger PortionSmaller Portion 
NH
– Neurohypophysis (Posterior)
AH
– Adenohypophysis (Anterior)
Functions of HormonesSymptoms of Pituitary DiseasesHyperpituitarism
Excessive Secretionof Trophic HormonesFunctionalAdenomaof Anterior PituitaryHyperplasiaof Anterior PituitaryCarcinomasof Anterior Pituitary(Rare, Non-Functional, Metastasis – Lymph Nodes, Bones, Liver) Secretion of Hormones byNon-Pituitary Tumours CertainHypothalamic Disorders 
Hypopituitarism
Deficiency of Tropic Hormones due toDestructive processof Pituitary Gland
Local Mass Effects
OnOptic Chiasmresultingvisual field abnormalities  Cranial Nerve compression↑ Intracranial PressurePituitaryApoplexy(Haemorrhage)
Multiple Endocrine NeoplasiaSyndrome (MENSyndrome)
Group of Genetically InheritedDiseases resulting inProliferative lesions  (Hyperplasia/ Adenoma/ Carcinoma) of Multiple Endocrine Organs 
MEN I MEN IIa MEN IIbPituitary
Adenoma
Parathyroid
HyperplasiaAdenomaHyperplasia
Pancreas
HyperplasiaAdenoma/ Ca 
Adrenal
Cortical Hyperplasia Pleochromocytoma Pleochromocytoma
Thyroid
C-Cell HyperplasiaMedullary CaC-Cell HyperplasiaMedullary Ca
 jslum.com|Medicine   
 
Hyperpituitarism - Pituitary AdenomaDefinition
10% of Intracranial NeoplasmAdult– 30-50 y/oIsolated Lesions(mostly)Most common cause of Hyperpituitarism Functional, Non-Functional (Silent)3% - Associated withMEN Type I Associated with Gene Abnormalitie
Genetic Abnormalities
Monoclonal in origin (Single Somatic Cells)
G-Protein Mutation
Mutation in α-subunit of G-Protein (Signal Transduction)Interferes with its GTPase activityActivation of cAMP generation, Unchecked Cellular ProliferationAssociation withMEN-I Syndrom 
Aggressive Pituitary Adenoma
Mutation of RAS oncogene Over Expression of c-MYC oncogene 
Gross Morphology
Soft,Well-circumscribedlesion,confined to Sella Turcica 
Larger lesions
Extend intoSuprasellar regionCompressOptic ChiasmCompress adjacent structures –Cranial Nerves
Invasive Adenoma(30%)
NonencapsulatedInfiltrateAdjacentBone,Dura,Brain,Nasopharynx,Nasal Cavity 
Pituitary Adenoma
CircumscribedMass Lesion(in Sella Turcica)Brain, Pituitary AdenomaCompressingOptic Chiasm 
Pituitary Adenoma
Massive, Nonfunctional AdenomaGrow beyond confines of Sella TurcicaDistorted the overlying brain 
Histology
Monomorphic, Uniform, Polygonal cells arrayed in Sheets/ CordSupporting Connective Tissue/ Reticulin is sparse(soft gelatinous consistency)Nuclei – Uniform, Pleomorphic
Cytoplasms (depending on type, amount of secretary product)
AcidophilicBasophilicChromophobicCellular monomorphism, Absence of significant Reticulin Network distinguishfrom Non-Neoplastic Anterior Pituitary Parenchyma (Pituitary Hyperplasia)Classification based on Hormones Produced by Neoplastic Cellsdetected by Immunohistochemical (IHC) stains on tissue sections
Adenohypophyseal Adenoma
Small round cellsSmall round NucleiPink to Blue cytoplasmCells are monotonously arrangedAbsence of Reticulum Network
Reticulin StainNormal Hyperplasia Adenoma
Normal AcinararchitectureExpanded Acini of HyperplasiaTotal breakdown of Reticulin Fiber network
Types of Pituitary Adenoma
Prolactin Cell Adenoma(20-30%)Growth Hormone Cell Adenoma(5%)Mixed GH-Prolactin Adenoma (5%)ACTH Cell Adenoma (10-15%)Gonadotroph Cell Adenoma (10-15%)Null Cell Adenoma (20%)TSH Hormone Cell Adenoma (1%)Other Pleurihormonal Adenoma (15%)
Pituitary Adenoma H&EGrowth Hormone (GH) +veACTH +veProlactin +vePIT-1 +ve
(Pituitary specific transcription factor responsiblefor pituitary development, hormone production inmammals)
 jslum.com|Medicine   
 
 
Prolactinoma
(Lactotroph Adenoma)Hyperfunctioning Adenoma (most common)Female ↑ - 20-40 y/oAmenorrhea, Galactorrhea, Loss of Libido, Infertility
Microscopic
Weakly Acidophilic/ Chromophobic cells
IHC
Within secretory granules in cytoplasm of cells
Corticotroph Cell Adenoma
(ACTH)Basophilic or Chromophobic↑ ACTH– Hypersecretion of Adrenal CortisolHypercortisolism → Cushing Syndrome(Due to excess ACTH by Pituitary)24h Urine Free Cortisol Level ↑Loss of Normal Diurnal pattern of Cortisol Secretion
Hypercortisolism (Cushing Syndrome)
Central ObesityMoon FaceWeakness, FatigabilityHirsutismPlethoraHypertensionGlucose IntoleranceOsteoporosisNeuropsychiatric AbnormalitiesMenstrual AbnormalitiesSkin Striae
IHCOther Pituitary Adenoma
Gonadotroph Adenoma (LH, FSH)Thyrotroph Adenoma (TSH)
Nonfunctioning Adenoma (25%)
Null cell Adenoma (Hormone –ve Adenoma)Clinically Silent counterparts of functioning Adenomas
Growth Hormone Adenoma
(Somatotrophic Adenoma)2
nd
most common functioning Adenoma
Microscopic
Granulated cells which are Acidophilic or Chromophobic
IHC
GH within Cytoplasm of cells
Gigantism/ Acromegaly
Persistent Hypersecretionof GH  StimulateHepatic Secretionof Insulin-like Growth Factor-I (IGF-I/Somatomedin C)
Gigantism Acromegaly
Children before Closure of Epiphyses After Closureof EpiphysesDue to GH, IGF-1 GHGeneralized ↑ in body size
Growth most conspicuous in
Skin, Soft Tissue, Viscera (Thyroid,Heart, Liver, Adrenal), Bones of Face,Hands, FeetDisproportionately Long Arms, Leg
↑ Bone Density (Hyperostosis)
Spine, Hips
Enlargement of Jaw
Protrusion (Prognathism)Broadening of Lower Face
Enlarged Hands, Feet
Broad, Sausage-like FingersGonadal dysfunctionDiabetes MellitusGeneralised Muscle WeaknessHypertensionArthritisCHF↑ Risk of GI Bleeding
Diagnosis
↑ Serum GH, IGF-1 LevelFailure to suppress GH Production inresponse to oral load of glucoseBroadening of Lower FaceProtrusion of Jaw (Prognathism)Mandibular overgrowth
 Hand of Acromegaly
WidenThickenedStubby
 jslum.com|Medicine   

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