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This Concept Map, created with IHMC CmapTools, has information related to: Pituitary Gland, Pituitary Gland Hypopituitarism -w/ 75% parenchyma gone -may also have pallor (MSH loss) PANHYPOPITUITARISM -total failure Most common deficits: THYROID FCN ADRENAL FCN GROWTH RETARDATION W/ DELAYED PUBERTY FTT, Pituitary Gland Hyperpituitarism Pituitary Adenomas GH ADENOMA - 5% (SOMATOTROPH CELL)-acidiphilic -40% w/ gsh oncogene -mutant Gs -some w/ PRL too, even hyperPRL -subtle Sx, so late, large Dx ->clinical features due to IGF-I -gigantism or acromegaly -before or after epiphyses close -acro: 20s-30s-big soft tissues: heart, thy, liver, adrenals -hyperostosis, prognathism -can->DM, gonadal dysfcn, HTN, mm weakness, arthritis, CHF, GI CA Tx: surgery or drugs->Sx recede, Pituitary Gland Hyperpituitarism Pituitary Adenomas CORTICOTROPH CELL ADENOMA-10-15% -PAS (+) due to CHO in ACTH ->hypercortisolism (Cushing dz) -(Cushing syn for general hypercort'ism) -Nelson syn-large adenoma after adrenal removal->no hypercort'ism -can be hyperpigmentation due to ACTH on melanocytes., Pituitary Gland Hyperpituitarism Pituitary Adenomas General Features -usually single cell type -monomorphic -nonfcnal larger at Dx -adults-30s-50s, esp MALE 3% w/ MEN-I -microəcm<macroads -APOPLEXY-acute hemorr ->rapid enlarging mass -bitemporal hemianopsia -bony erosion->cav sinus -opthalmoplegia (III, IV,VI) -CN V neuralgia -esp prolactinoma -inc'd ICP: N/V, HA, Pituitary Gland Hypothal Suprasellar Tumors ->hypo- or hyperfcn Mostly GLIOMAS CRANIOPHARYNGIOMAS -from Rathke's pouch -50% ងyo -kids:growth dysfcn -adults: visual -mostly cystic, w/ Ca++ -X-ray visualization Adamantinomatous -strat Sq cell nests/cords -spongy reticulum -periph columnar cells -keratin, Ca++ -cholesterol-rich cyst Papillary -no keratin, Ca++ -nothing in cyst, Pituitary Gland Posterior Pituitary Syndromes -ADH and oxytocin from SON, PVN -inappropriate oxy-no Sx DIABETES INSIPIDUS -AVP (ADH) deficiency -excessive free water loss ->[Na+], osmolality increased -polyuria, polydipsia, confusion -30% idiopathic -20% due to tumors -esp craniopharyngioma In HAND-SCHULLER-CHRISTIAN DZ (also Histiocytosis, bone lesions, exophthalmos, mucocut lesions), Pituitary Gland Hypopituitarism -w/ 75% parenchyma gone -may also have pallor (MSH loss) KALLMAN SYNDROME -isolated LH/FSH def -no puberty -ass'd w/ ANOSMIA, CLEFT PALATE -Kalig-1 gene mutation -X-linked, Pituitary Gland Hyperpituitarism Pituitary Adenomas THYROTROPH ADENOMA-1% -basophilic or chromophobic -rare cause of hyperthyroid, Pituitary Gland Hyperpituitarism Pituitary Adenomas NULL CELL ADENOMA-20% -no hormonal products -eosinophilic or chromophobic -due to mito, not sec granules SSx-mass effects, hypopit'ism, Pituitary Gland Hypopituitarism -w/ 75% parenchyma gone -may also have pallor (MSH loss) EMPTY SELLA SYNDROME -enlarged and empty Primary-CSF into sella ->compress pit -obese w/ mult preggers Secondary-mass enlarges sella, then removed, Pituitary Gland Hyperpituitarism Pituitary Adenomas CARCINOMA-rare -mostly non-functional -Dx requires evidence of mets: LNs, bone, liver, etc., Pituitary Gland Hyperpituitarism Pituitary Adenomas PROLACTINOMA-20-30% -acidophilic or chromophobic -even small tumors->lots of PRL -proportional amts -inhibit LH surge ᡪ% in men->lose libido, impotence, HA PRL-emia: (found earlier in young FM) ->amenorrhea, galactorrhea, loss of libido, infertility (present in 25% amen) (physiological in preggers, lactating) -also in lactotroph hyperplasia (low DA) -STALK EFFECT-any suprasellar mass disturbs NL inhibitory hypothal -DA receptor antags, reserpine -renal failure, hypothyroid, estrogens Tx: DA agonist->shrink adenoma -Bromocriptine, Pituitary Gland Hyperpituitarism Pituitary Adenomas GONADOTROPH ADENOMA -LH and FSH - 10-15% -Subtle SSx -usual Dx when big->vision, HAs -middle-aged Deficiencies-> Men-dec'd energy, libido W-amenorrhea Basophilic or chromophobic, Pituitary Gland Hypopituitarism -w/ 75% parenchyma gone -may also have pallor (MSH loss) Hypothalamic Lesions: -Tumors -craniopharyngiomas -breast, lung mets -Radiation nearby -Infiltrative d/os, infx -sarcoid, TB mening, Pituitary Gland Hypopituitarism -w/ 75% parenchyma gone -may also have pallor (MSH loss) Causes: -Tumors, mass lesions -Pit surgery/radiation -Hemochromatosis-Fe into pit -Rathke Cleft Cyst -ciliated cub epith lining -some goblet cells, AP cells -proteinaceous fluid -Pit apoplexy-sudden hemorr -sudden HA, pressure on nn -Ischemic Necrosis -Sheehan Syn-most common -postpartum necrosis -sudden hypoTN->spasm ->necrosis or ant pit -pit enlarged during preg -common in 3rd world -also in DIC, SCA ->replaced by fibrosis -Genetic defects-x-factors -pit-1 defect (GH, PRL, TSH), Pituitary Gland Posterior Pituitary Syndromes -ADH and oxytocin from SON, PVN -inappropriate oxy-no Sx SIADH -excess resorption of water ->hyponatremia, cerebral edema->neuro dysfcn -inc'd water, but NL blood volume -NO periph edema