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Pathology of the Endocrine Organs - I

Explore the fascinating world of pituitary hormone regulation, function, and associated disorders in this detailed guide. Learn about the history, cell populations, hormonal production, and pathologies of the pituitary gland. Discover the intricate neuroimmunoendocrine regulation and the different pituitary syndromes, including hypofunctional and hyperfunctional conditions. Dive into the complexities of pituitary adenomas and their classification based on endocrine activity, imaging, histology, and more.

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Pathology of the Endocrine Organs - I

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  1. Pathology of the Endocrine Organs - I Pituitary Adrenals Jaroslava Dušková Inst. Pathol. 1st Med. Fac. Charles Univ. Prague https://www1.lf1.cuni.cz/~jdusk/

  2. Pituitary - history - I Galenos (2nd cent.) lat. pituita = gr. phlegm = moisture, mucus A. Vesalius(16th cent.) glandula pituitam cerebri excepiens R. Lower(17.stol.) Dissertatio de origine catarrhi – incretion

  3. Pituitary - history - II Rathke, H.: (1838) Über die Entstehung der glandula pituitaria (Arch Anat. Physiol. u. Wiss. Med. , 5, 482-5) W. Haberfeld(1909) Die Rachendachhypophyse, andere Hypophysengangreste und deren Bedeutung für die Pathologie Beiträge zur path. Anat. u. allg. Pathol. , 46, 133-232)

  4. 1. formation of the Rathke´s pouch & proc. infundibularis 2. splitting of the Rathke´s pouch 3. mature formation

  5. Neuroimunoendocrine regulation CRF IL-1 neuronal connections ACTH TNF IL-6 IL-1 n.vagus Glucocorticoids Adrenals Immune cells

  6. Pituitary - regulation Higher neural centra limbic system reticular system hypothalamus liberins & statins adenohypophysis trophic hormons of the adenohypophysis periferal endocrine glands hormons of periph. glands tissues

  7. Neuroimmunoendocrine Regulation Messengers • Neurotransmitters • Interleukins • Hormons

  8. Pituitary – weight Females 505 - 1002 mg (average 660 mg) pregnant women 560 - 1220 mg (average 762 mg) Males 400 - 855 mg (average 570 mg) Rasmussen, AT Am.J. Anat. 1928 a 1934

  9. Pituitary- architecture • adenohypophysis • pars infundibularis (tuberalis) • pars intermedia • neurohypophysis • hypophysis pharyngea (+ hidden islets of pit. cells in the os sphenoides)

  10. Pituitary- cell inclusions • squamous epithelium • Rathke´s pouch between AH and NH • salivary glands- NH, often with oncocytes

  11. Pituitary- parts - function • Adenohypophysis secretion of tropins • Pars infundibularis (tuberalis) modulation of AH secretion • Pars intermedia • Neurohypophysissecretion of neuropeptides • hypophysis pharyngea evtl. secretion of tropins

  12. Pituitary– cell populations • acidophil(somatotrophs, lactotrophs) • basophil(corticotrophs, gonadotrophs, thyreotrophs) • chromofobe(transitional. + foliculostellate) • oncocytes(or preoncocytes) • mesenchymal • pituicytes (macroglie) • secretion neurons(tractus supraoptico- et tuberohypophyseus)

  13. Hypophysis- cell population & hormonal production • acidophil PRL , STH • basophil ACTH, FSH, LH, TSH • chromophobe 0, PRL , STH , ACTH, FSH, LH, TSH • oncocytes 0, PRL , STH , ACTH, FSH, LH, TSH • mesenchymal • pituicytes • secretion neurons oxytocin, vasopresin

  14. Pituitary- cell population & hormonal production Hormonal production mostly mixed (e.g. ACTH+FSH,LH,TSH,PRL)

  15. Pituitary - cell population &hormonal production Individual producents able of interconversion due to stimulation (e.g. PRL-GH)

  16. L e p t i n • adipocytes - blood - CSF -hypothalamus (ncl. arcuatus ) • regulation of energetic homeostasis • correlation with the body fat content • in most obese individuals high levels -resistence? Friedman et al., Nature 1994

  17. Pituitary- regressive changes • Dystrophy(Crooke´s hyaline change) • Atrophy - in aging increased fibrosis, no functional influence • NECROSIS • traumatic (mostly due to the stalk lesion) • ischemic

  18. Pituitary- vascularisation • a. hypophysea sup. (from ACI) • a. trabecularis directly to AH • long portal veins in the stalk • a. hypophysea inf. (from ACI in sinus c.) • short portal veins

  19. incidence 1- 8 % large autopt. series pathogenesis intracranial hypertension ischemia vasospasmus atherosclerosis thrombi stalk lesion healingscar focal regenerates possible meaning hypofunction only in case of more than 3/4 of volume destruction Pituitary- necrosis

  20. non specific (peri)hypophysitis purulenta non purulenta septic pyemic microabscesses lymphocytic autoimmune specific tbc hematogenous dissemination solitary tuberculoma lues inborn acquired Pituitary- inflammation

  21. Pituitary syndromes • Hypofunctional • panhypopituitarismus • selective hypofunction • Hyperfunctional • monohormonal • combined

  22. Total >90% AH destroyed Syndromes: Simmonds Sheehan Falta Lorain Partial monohormonal combined Regulatory hypofunction peripheral glands ectopic production iatrogenous Hypopituitarismus

  23. m. Adisoni centralis • adrenal atrophy • vacuolisation of cardiomyocytes • lack of the skin hyperpigmentation • hypotension • weekness • hyperkalaemia

  24. Pituitary Adenomas 9% • chiasma opticum compression 43 • acromegaly 23 • galactorea-amenorea 7 • hypopituitarismus 7 - most frequent clin. symptomes 9% 54% 28%

  25. The WHO Classificationof Adenohypophysial Neoplasms . A proposed five-tier scheme 1. endocrine activity 2. imaging/ surgery 3. histology 4. immunohistochemistry 5. ultrastructure Kovacs, K., Scheithauer, B., Horvath Eva, Lloyd, R Cancer 1996, 78,502-10

  26. Pituitary Adenomas • acidophillic • basophillic • chromophobe • mixed

  27. Acidophillic adenomas • somatotroph • lactotroph • mixed somatotroph and lactotroph • somatolactotroph densely granulated • onkocytic

  28. Basophillic adenomas • corticotrophic • thyreotrophic • gonadotrophic densely granulated

  29. Chromophobe adenomas • all types of hormonal productions scarcely granulated • null cell

  30. Monohormonal Syndromes: 1. gigantismus/acromegaly 2. hyperprolactinemia (galaktorea, amenorea) 3. Cushing 4. hyperthyreosis 5. (hypergonadotropinismus) Combined 1+2, 1+3, 1+4, 2+3, 3+4 Regulatory hyperfunction periph. glands ectopic production iatrogenous Hyperpituitarismus

  31. Plurihormonal and PlurifunctionalPituitary Adenoma with Acromegaly Syndroma doc. MUDr Jaroslava Dušková, CSc*, prof. MUDr Josef Marek, DrSc**, prof. MUDr Ctibor Povýšil,DrSc*

  32. F 75 yrs • 30 yrs lasting acromegaly • refused surgery • Symptomatic therapy • hyperfunction thyr . – Carbimazol • cardiomegaly - cardiotonica • 5 yrs prior tu death ca coli – surg. removed • 6 yrs prior tu death corticoid substitution • death cardial failure

  33. STH +++ Prl ++ ACTH ++ TSH +++ FSH (beta)+ LH (beta)+ Plurihormonal and PlurifunctionalPituitary Adenoma with Acromegaly

  34. Pituitary INCIDENTALOMA- algorithm of Investigation and treatment

  35. Other Pituitary Tumours • craniopharyngeoma • metastases

  36. Adrenals • cortex • definitive • fetal (90% regression by 6 months of age) • neonate 8g (3,5kg) 0,002 • healthy adult 9g (70kg) 0,0001 • zones G,F,R 20x • medulla

  37. Adrenals - syndromes • hypofunction - panhypocorticalism • acute • chronic – Adison • peripheral • central • hyperfunction • AGS • Cushing • hyperaldosteronismus Conn,Bartter

  38. norm hypoplasia congenitalis

  39. Adrenals - syndromes • hypofunction - panhypocorticalism • acute • chronic – Adison • peripheral • central • hyperfunction • AGS • Cushing • hyperaldosteronismus Conn,Bartter

  40. m Adison: peripheral central

  41. Adrenals - syndromes • hypofunction - panhypocorticalismus • acute • chronic – Adison • periferic • central • hyperfunction • AGS • Cushing • hyperaldosteronismus Conn,Bartter

  42. m. Cushing periph. hypothalamic

  43. m. Cushing paraneopl. pituitary C.

  44. Androgen overproduction AGS

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