Please enable JavaScript.
Coggle requires JavaScript to display documents.
Changing Features, include, include, causes, causes, causes, causes,…
Changing Features
Pituitary Hormones
Prolactin
TRH
Dopamine
Growth hormone
GHRH
Somatostatin
Oxytocin
Paraventricular nuclei
ACTH
ADH
Supraoptic nuclei
LH/FSH
Anterior pituitary adenomas
Clinically Functioning Adenomas
Somatotroph adenoma
Acromegaly
Diabetes mellitus
Gigantism
Corticotroph adenoma
Cushing syndrome
Hyperpigmented skin
Lactotroph adenoma
Oligomenorrhea or amenorrhea, galactorrhea, infertility in
females
Decreased GnRH
Impotence, decreased libido in
males
Hyperprolactinemia
Clinically Non-functioning Adenomas
Local mass effects
Hypopituitarism
Pituitary adenoma pathogenesis
Familial
Mutation in genes regulating transcription and cell cycle
Eg: MEN1, AIP
Sporadic
Activating mutation in GNAS gene
Persistent generation of cAMP
Hypersecretion and cell proliferation
Molecular abnormalities associated with aggressive adenoma
Mutation in cell cycle checkpoint genes
morphology
gross
Small lesions
Well- circumscribed
Soft lesion
Large lesion
Compress adjacent structures
Foci hemorage and/or necrosis are common
Microscopy
Cellular monomorphism
One cell type
Reticulin network
Absent
Hemorrage and necrosis
May occur
Mitosis
Rare
Identify using
IHC
Anatomy of pituitary gland
Adenohypophysis
Pars
tuberalis
Pars
intermedia
Pars
distalis
Neurohypophysis
Pars nervosa
Infundibulum
Stem
Median
eminence
Anatomical relations
Posteriorly
Basilar artery
Pons
Dorsum sellae
Superiorly
Sellar diaphragm
Optic chiasma
Anteriorly
Sphenoid air sinus
Inferiorly
Sphenoid sinus
Body of sphenoid
Lateraly
Cavernous sinus
Acromegaly
causes
Anterior pituitary adenoma
pituitary hyperplasia
ectopic production of GH
signs and symptoms
jaw enlargement
enlarged hands
increase sweating
arthritis
Prognosis
reduced life expectancy by 10 years
death by heart failure
bone abnormalities do not regress with treatment
Lab investigations
serum IGF-1
elevated in acromegaly
oral glucose tolerance test
GH conc. falls to 1ng/ml or less
failure to suppress GH ( >1ng/ml)
MRI
presence of pituitary adenoma
size
micro : < 1cm
macro : > 1cm
suprasellar extension
cavernous sinus invasion
Pharmacological management
somatostatin analogues
Octreotide
Lanreotide
Pasireotide
GHR antagonist
Pegvisomant
Dopamine agonists
Bromocriptine
Cabergoline
include
include
causes
causes
causes
causes
result from
normally
acromegaly
shows
is synthesized by
is synthesized by
is stimulated by
is inhibited by
is stimulated by
is inhibited by