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The Endocrine System. Pituitary Gland. Anterior pituitary Somatotrophs – GH Lactotrophs – prolactin Corticotrophs – ACTH, POMC, MSH Thryotrophs – TSH Gonadotrophs – FSH, LH Posterior pituitary – axonal processes from hypothalamus: Oxytocin ADH

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pituitary gland
Pituitary Gland

Anterior pituitary

Somatotrophs – GH

Lactotrophs – prolactin

Corticotrophs – ACTH, POMC, MSH

Thryotrophs – TSH

Gonadotrophs – FSH, LH

Posterior pituitary – axonal processes from hypothalamus:

Oxytocin

ADH

Clinical – Hyperpituitarism, Hypopituitarism, local mass effects – radiographic abnormalities of the sellaturcica, visual field abnormalities, elevated intracranial pressure, pituitary apoplexy

pituitary gland1
Pituitary Gland

Hyperpituitarism – pituitary adenoma

Most common cause is adenoma arising in the anterior pituitary

Classified based on the hormone produced

Functional or nonfunctional

Microadenoma < 1 cm

Macroadenoma > 1 cm

Usually soft, well-circumscribed

30% invasive adenomas – no capsule

Cellular monomorphism and the absence of a significant reticulin network distinguish pituitary adenomas from non-neoplastic anterior pituitary parenchyma

Atypical adenomas – p53 mutations, aggressive

pituitary gland2
Pituitary Gland

Prolactinomas

Most frequent hyperfunctioning adenoma

Amenorrhea, galactorrhea, loss of libido, infertility

Tend to undergo dystrophic calcification

Any mass in the suprasellar department may disturb the normal inhibitory influence of the hypothalamus (via dopamine secretion) on prolactin secretion resulting in hyperprolactinemia

pituitary gland3
Pituitary Gland

Somatothroph adenoma

Second most common

GH stimulates the hepatic secretion of IGF-1 ( somatomedin C)

Gigantism or acromegaly

Failure to suppress GH production in response to a glucose challenge is one of the most sensitive tests for acromegaly

pituitary gland4
Pituitary Gland

Corticotroph adenoma

Cushing disease

Nelson syndrome

Gonotroph adenoma

Thyrotroph adenoma

Nonfunctioning pituitary adenoma

Pituitary carcinoma ( <1% of all pituitary tumors)

pituitary gland5
Pituitary Gland

Hypopituitarism

Decreased secretion of pituitary hormones

Hypofunction when > 75% of pituitary is lost or absent

Causes – Tumors and other mass lesions, traumatic brain injury, subarachnoid hemorrhage, pituitary surgery or irradiation, pituitary apoplexy, ischemic necrosis and Sheehan syndrome, Rathke cleft cyst, empty sella syndrome, genetic defects, hypothalamic lesions, inflammatory or infections

pituitary gland6
Pituitary Gland

Posterior pituitary syndromes

DI

SIADH

Hypothalamic suprasellar tumors

Gliomas

Craniopharygiomas

thyroid gland
Thyroid Gland

Hyperthyroidism

Hypermetabolic state caused by elevated circulating levels of free T3 and T4

Thyrotoxicosis

Most common forms:

Diffuse hyperplasia associated with Graves disease ( 85%)

Hyperfunctionalmultinodular goiter

Hyperfunctional adenoma of the thyroid

thyroid gland1
Thyroid GLand

Clinical manifestations of hyperthyroidism

Hypermetabolic state

Overactivity of the sympathetic nervous system

Warm, flushed skin

heat intolerance

Sweating

Weight loss despite increased appetite

Cardiac- tachycardia, palpitations, cardiomegaly, arrhythmias,CHF,cardiomyopathy

Neuromuscular – tremor, hyperactivity, emotional lability, anxiety, inability to concentrate, insomnia, myopathy

Ocular – wide staring gaze, lid lag

Osteoporosis

Thyroid storm

Apathetic hyperthyroidism

thyroid gland2
Thyroid Gland

Hypothyroidism

Causes-

Primary – Thyroid dysgenesis, Thyroid hormone resistance syndrome, postablative, Hashomoto’s thyroiditis, Iodine deficiency, drugs, dyshormonogenetic goiter

Penred syndrome (+hearing loss)

Secondary – Pituitary failure, Hypothalamic failure

thyroid gland3
Thyroid Gland

Clinical manifestations:

Cretinism – infancy or childhood, impaired development of the skeletal system and CNS, short stature and mental retardation

Myxedema- older child or adult, slowing of physical and mental activity, fatigue, apathy, mental sluggishness, decreased sympathetic activity, non-pitting edema due to accumulation of matrix substances, decreased cardiac output

thyroid gland4
Thyroid gland

Thyroiditis

Infectious- acute or chronic

Hashimoto – autoimmune; anti- thyroglobulin, anti-thyroid peroxidase antibodies, Painless enlargement with hypothyroidism in a middle- aged woman, inflammatory infiltrate, germinal centers, Hurthle cells

Subacute (granulomatous or DeQuervain) - triggered by a viral infection, painful enlargement, transient

Subacute lymphocytic (painless) – also post- partum, variant of Hashimoto

Riedel – extensive fibrosis of thyroid and contiguous structures

thyroid gland5
Thyroid Gland

Graves disease

Hyperthyroidism

Infiltrative ophthalmopathy exothalmos

Localized, infiltrative dermopathy  pretibial myxedema

Antibodies: Thyroid-stimulating immunoglobulin, thyroid growth- stimulating immunoglobulin, TSH- binding inhibitor immunoglobulin

Diffuse hypertrophy and hyperplasia with tall, crowded follicular cells

thyroid gland6
Thyroid Gland

Diffuse nontoxic (simple) goiter- colloid goiter, iodine deficiency, clinically euthyroid, sporadic usually related to substances that interfere with thyroid hormone synthesis, mass effects from enlarging size

Multinodular goiter- recurrent hyperplasia and involution from a long-standing simple goiter, mistaken for neoplasia, mass effects, occasionally toxic - hyperthyroidism

thyroid gland7
Thyroid gland

Neoplasias

Adenoma

Carcinoma

Papillary

Follicular

Anaplastic

Medullary

Congenital anomaly – Thyroglossal duct or cyst