Difference between revisions of "Pituitary gland"

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m (DDx)
m (autoimmune)
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==Function==
==Function==
Anterior part:<ref name=rcn_com>[http://users.rcn.com/jkimball.ma.ultranet/BiologyPages/P/Pituitary.html http://users.rcn.com/jkimball.ma.ultranet/BiologyPages/P/Pituitary.html]</ref>
===Anterior===
Hormones:<ref name=rcn_com>[http://users.rcn.com/jkimball.ma.ultranet/BiologyPages/P/Pituitary.html http://users.rcn.com/jkimball.ma.ultranet/BiologyPages/P/Pituitary.html]</ref>
*Growth hormone (GH).
*Growth hormone (GH).
*Luteinizing hormone (LH)
*Luteinizing hormone (LH)
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Mnemonic: "Go Look For The Adenoma Please" = GH, LH, FSH, TSH, ACTH, PRL.
Mnemonic: "Go Look For The Adenoma Please" = GH, LH, FSH, TSH, ACTH, PRL.


Posterior part:<ref name=rcn_com/>
===Posterior===
Hormones:<ref name=rcn_com/>
*Oxytocin.
*Oxytocin.
*Antidiuretic hormone (ADH).
*Antidiuretic hormone (ADH).
Line 63: Line 65:


==Pituitary adenoma==
==Pituitary adenoma==
===General===
*Classically presents with visual field defects.
===Microscopic===
Features:<ref name=Ref_PSNP36>{{Ref PSNP|36}}</ref>
Features:<ref name=Ref_PSNP36>{{Ref PSNP|36}}</ref>
*Loss of fibrous stroma.
*Loss of fibrous stroma.
Line 69: Line 75:
:See ''[[Head and neck pathology]]''.
:See ''[[Head and neck pathology]]''.
*Arises from ''intermediate lobe''.
*Arises from ''intermediate lobe''.
*Embryonic remnant.
*Related to ''craniopharyngioma''.


==Craniopharyngioma==
==Craniopharyngioma==
:See ''[[Head and neck pathology]]''.
:See ''[[Head and neck pathology]]''.
*Related to ''Rathke cleft cyst''.


==Necrosis==
==Necrosis==
*Sheehan syndrome - blood loss in childbirth.<ref>URL: [http://www.mayoclinic.com/health/sheehans-syndrome/DS00889 http://www.mayoclinic.com/health/sheehans-syndrome/DS00889]. Accessed on: 16 November 2010.</ref>
*Rare.
*Syphilis (paediatric).<ref>URL: [http://pediatrics.aappublications.org/cgi/content/full/104/1/e4 http://pediatrics.aappublications.org/cgi/content/full/104/1/e4]. Accessed on: 16 November 2010.</ref>
 
*Mollaret's meningitis.<ref name=pmid18715308>{{cite journal |author=Dancer CM, Woods ML, Henderson RD, Robertson T, Mungomery M, Allworth A |title=Mollaret's meningitis and pituitary failure associated with a Rathke's cleft cyst |journal=Intern Med J |volume=38 |issue=7 |pages=609–11 |year=2008 |month=July |pmid=18715308 |doi=10.1111/j.1445-5994.2008.01709.x |url=}}</ref> (???)
===Causes===
*Spontaneous necrosis of pituitary tumours - rare.<ref>{{cite journal |author=Sachdev Y, Evered DC, Hall R |title=Spontaneous pituitary necrosis |journal=Br Med J |volume=1 |issue=6015 |pages=942 |year=1976 |month=April |pmid=1268492 |pmc=1639254 |doi= |url=http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1639254/pdf/brmedj00512-0028a.pdf}}</ref>
*Sheehan syndrome - secondary to blood loss in childbirth.<ref>URL: [http://www.mayoclinic.com/health/sheehans-syndrome/DS00889 http://www.mayoclinic.com/health/sheehans-syndrome/DS00889]. Accessed on: 16 November 2010.</ref>
*Syphilis (fetal-maternal transmission).<ref>URL: [http://pediatrics.aappublications.org/cgi/content/full/104/1/e4 http://pediatrics.aappublications.org/cgi/content/full/104/1/e4]. Accessed on: 16 November 2010.</ref>
*Mollaret's meningitis - very rare.<ref name=pmid18715308>{{cite journal |author=Dancer CM, Woods ML, Henderson RD, Robertson T, Mungomery M, Allworth A |title=Mollaret's meningitis and pituitary failure associated with a Rathke's cleft cyst |journal=Intern Med J |volume=38 |issue=7 |pages=609–11 |year=2008 |month=July |pmid=18715308 |doi=10.1111/j.1445-5994.2008.01709.x |url=}}</ref> (???)
*Spontaneous necrosis of pituitary tumours - case reports.<ref>{{cite journal |author=Sachdev Y, Evered DC, Hall R |title=Spontaneous pituitary necrosis |journal=Br Med J |volume=1 |issue=6015 |pages=942 |year=1976 |month=April |pmid=1268492 |pmc=1639254 |doi= |url=http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1639254/pdf/brmedj00512-0028a.pdf}}</ref>
 
==Autoimmune hypophysitis==
===General===
Features:<ref name=pmid18388197/>
*Rare.
*Autoantigens are unknown.
*May be misdiagnosed as a nonsecreting adenoma.
 
===Microscopic===
Features:<ref name=pmid18388197>{{cite journal |author=Tzou SC, Lupi I, Landek M, ''et al.'' |title=Autoimmune hypophysitis of SJL mice: clinical insights from a new animal model |journal=Endocrinology |volume=149 |issue=7 |pages=3461–9 |year=2008 |month=July |pmid=18388197 |pmc=2453094 |doi=10.1210/en.2007-1692 |url=}}</ref>
*Lymphocytic infiltration.


==See also==
==See also==

Revision as of 13:26, 17 November 2010

The pituitary gland is known as the master gland.

Divisions:[1]

  • Anterior pituitary (AKA adenohypophysis).
  • Posterior pituitary (AKA neurohypophysis, neural pituitary).

Function

Anterior

Hormones:[2]

  • Growth hormone (GH).
  • Luteinizing hormone (LH)
  • Follicle-stimulating hormone (FSH)
  • Thyroid stimulating hormone (TSH)
  • Adrenocorticotropic hormone (ACTH)
  • Prolactin (PRL)

Mnemonic: "Go Look For The Adenoma Please" = GH, LH, FSH, TSH, ACTH, PRL.

Posterior

Hormones:[2]

  • Oxytocin.
  • Antidiuretic hormone (ADH).

Anatomy and histology

Basic anatomy (simplified):[3]

  • Anterior:
    • Pars distalis.
    • Pars intermedia.
  • Posterior:
    • Pars nervosa.

Embryological origin:[3]

  • Anterior - Rathke's pouch (roof of mouth).
  • Posterior - diencephalon (ventral aspect).

Image:

Histology

Anterior

  • Acidophils (40% of cells) = red or orange.
    • GH, PRL.
  • Basophils (10% of cells) = basophilic (light blue).
    • TSH, LH, FSH.
  • Chromophobes (50% of cells) = amphophilic (purplish/grey).

Notes:

  • The cellular product (i.e. hormone produced) is not strictly correlated with the cell type.[4]

Posterior

Features:[4]

  • Herring bodies - key feature.
    • Eosinophilic axonal dilations filled with lysosomes and neurosecretory granules.
  • Less cellular.
    • Usually more cellular in perivascular location.

Image: Herring bodies (ouhsc.edu).

DDx for stellar lesions

  • Pituitary adenoma.
  • Rathke cleft cyst.
  • Craniopharyngioma.
  • Germ cell tumour.
  • Meningioma.

Pituitary adenoma

General

  • Classically presents with visual field defects.

Microscopic

Features:[5]

  • Loss of fibrous stroma.

Rathke cleft cyst

See Head and neck pathology.
  • Arises from intermediate lobe.
  • Embryonic remnant.
  • Related to craniopharyngioma.

Craniopharyngioma

See Head and neck pathology.
  • Related to Rathke cleft cyst.

Necrosis

  • Rare.

Causes

  • Sheehan syndrome - secondary to blood loss in childbirth.[6]
  • Syphilis (fetal-maternal transmission).[7]
  • Mollaret's meningitis - very rare.[8] (???)
  • Spontaneous necrosis of pituitary tumours - case reports.[9]

Autoimmune hypophysitis

General

Features:[10]

  • Rare.
  • Autoantigens are unknown.
  • May be misdiagnosed as a nonsecreting adenoma.

Microscopic

Features:[10]

  • Lymphocytic infiltration.

See also

References

  1. ↑ http://www.vivo.colostate.edu/hbooks/pathphys/endocrine/hypopit/histo.html
  2. ↑ 2.0 2.1 http://users.rcn.com/jkimball.ma.ultranet/BiologyPages/P/Pituitary.html
  3. ↑ 3.0 3.1 URL: http://www.vivo.colostate.edu/hbooks/pathphys/endocrine/hypopit/histo_pit.html. Accessed on: 31 October 2010.
  4. ↑ 4.0 4.1 Perry, Arie; Brat, Daniel J. (2010). Practical Surgical Neuropathology: A Diagnostic Approach: A Volume in the Pattern Recognition series (1st ed.). Churchill Livingstone. pp. 26. ISBN 978-0443069826.
  5. ↑ Perry, Arie; Brat, Daniel J. (2010). Practical Surgical Neuropathology: A Diagnostic Approach: A Volume in the Pattern Recognition series (1st ed.). Churchill Livingstone. pp. 36. ISBN 978-0443069826.
  6. ↑ URL: http://www.mayoclinic.com/health/sheehans-syndrome/DS00889. Accessed on: 16 November 2010.
  7. ↑ URL: http://pediatrics.aappublications.org/cgi/content/full/104/1/e4. Accessed on: 16 November 2010.
  8. ↑ Dancer CM, Woods ML, Henderson RD, Robertson T, Mungomery M, Allworth A (July 2008). "Mollaret's meningitis and pituitary failure associated with a Rathke's cleft cyst". Intern Med J 38 (7): 609–11. doi:10.1111/j.1445-5994.2008.01709.x. PMID 18715308.
  9. ↑ Sachdev Y, Evered DC, Hall R (April 1976). "Spontaneous pituitary necrosis". Br Med J 1 (6015): 942. PMC 1639254. PMID 1268492. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1639254/pdf/brmedj00512-0028a.pdf.
  10. ↑ 10.0 10.1 Tzou SC, Lupi I, Landek M, et al. (July 2008). "Autoimmune hypophysitis of SJL mice: clinical insights from a new animal model". Endocrinology 149 (7): 3461–9. doi:10.1210/en.2007-1692. PMC 2453094. PMID 18388197. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2453094/.

External links

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