Transcript Document 7578729

Pathology of the Endocrine Organs - I
Pituitary
Adrenals
Jaroslava Dušková
Inst. Pathol. 1st Med. Fac. Charles Univ. Prague
https://www1.lf1.cuni.cz/~jdusk/
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
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)
1. formation of the
Rathke´s pouch &
proc. infundibularis
2. splitting of the
Rathke´s pouch
3. mature formation
Neuroimunoendocrine
regulation
CRF
TNF
IL-6
IL-1
ACT
H
IL-1 neuronal
connections
n.vagus
Glucocorticoids
Immune cells
Adrenals
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
Neuroimmunoendocrine
Regulation Messengers

Neurotransmitters

Interleukins

Hormons
Pituitary
Females
505 - 1002 mg
(average 660 mg)
pregnant women
560 - 1220 mg
(average 762 mg)
–
weight
Males
400 - 855 mg
(average 570 mg)
Rasmussen, AT
Am.J. Anat. 1928 a 1934
Pituitary - architecture
 adenohypophysis
 pars
infundibularis
 pars intermedia
 neurohypophysis

(tuberalis)
hypophysis pharyngea (+ hidden islets of pit.
cells in the os sphenoides)
Pituitary - cell inclusions
squamous
epithelium
 Rathke´s
pouch between AH and NH
salivary
glands
-
NH, often with
oncocytes
Pituitary - parts - function
 Adenohypophysis
 Pars
secretion of tropins
infundibularis (tuberalis)
modulation of AH secretion
 Pars
intermedia
 Neurohypophysis secretion of neuropeptides
 hypophysis pharyngea
evtl. secretion of
tropins
Pituitary – cell populations
 acidophil
lactotrophs)
 basophil
 chromofobe
(somatotrophs,
(corticotrophs, gonadotrophs,
thyreotrophs)
(transitional. +
foliculostellate)
 oncocytes
(or preoncocytes)
 mesenchymal
 pituicytes (macroglie)
 secretion neurons (tractus supraoptico-
et
tuberohypophyseus)
Hypophysis - cell population
& hormonal production
 acidophil
PRL , STH
 basophil
ACTH, FSH, LH, TSH
 chromophobe
 oncocytes
0, PRL , STH , ACTH, FSH, LH, TSH
0, PRL , STH , ACTH, FSH, LH, TSH
 mesenchymal
 pituicytes
 secretion
neurons oxytocin, vasopresin
Pituitary
- cell population &
hormonal production
Hormonal production
mostly mixed
(e.g.
ACTH+FSH,LH,TSH,PRL)
Pituitary - cell population
&hormonal production
Individual producents
able of interconversion
due to stimulation (e.g.
PRL-GH)
Leptin
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
Pituitary - regressive changes
 Dystrophy
 Atrophy
(Crooke´s hyaline change)
-
in aging increased fibrosis, no
functional influence
NECROSIS
–
–
traumatic
(mostly due to the stalk lesion)
ischemic
Pituitary - vascularisation
 a.
–
–
 a.
hypophysea sup. (from ACI)
a. trabecularis directly to AH
long portal veins in the stalk
hypophysea inf. (from ACI in sinus c.)
– short portal veins
Pituitary - necrosis
 incidence
 1-
8 % large autopt.
series
 pathogenesis
intracranial
hypertension
ischemia
vasospasmus
atherosclerosis
thrombi
stalk lesion
 healing
scar
focal regenerates
possible
 meaning
– hypofunction only in
case of more than
3/4 of volume
destruction
Pituitary - inflammation
 non
specific
 (peri)hypophysitis
 specific

hematogenous
dissemination
solitary
tuberculoma
purulenta
non purulenta
 septic
pyemic
microabscesses
 lymphocytic
– autoimmune
tbc

lues
inborn
acquired
Pituitary syndromes
Hypofunctional
–panhypopituitarismus
–selective hypofunction
Hyperfunctional
–monohormonal
–combined
Hypopituitarismus
Total
Partial
>90% AH
destroyed
monohormonal
combined
Syndromes:
Regulatory
hypofunction




Simmonds
Sheehan
Falta
Lorain

peripheral glands
ectopic production

iatrogenous

m. Adisoni centralis
• adrenal atrophy
• vacuolisation of cardiomyocytes
• lack of the skin hyperpigmentation
• hypotension
• weekness
• hyperkalaemia
Pituitary Adenomas
- most
frequent clin.
symptomes
1.
2.
3.
4.
9%
9%
54%
28%
chiasma opticum compression
acromegaly
galactorea-amenorea
hypopituitarismus
43
23
7
7
The WHO Classification
of Adenohypophysial Neoplasms .
A proposed five-tier scheme
1.
2.
3.
4.
5.
endocrine activity
imaging/ surgery
histology
immunohistochemistry
ultrastructure
Kovacs, K., Scheithauer, B., Horvath Eva, Lloyd, R
Cancer 1996, 78,502-10
Pituitary Adenomas




acidophillic
basophillic
chromophobe
mixed
Acidophillic adenomas




somatotroph
lactotroph
mixed somatotroph and lactotroph
somatolactotroph
densely granulated

onkocytic
Basophillic adenomas



corticotrophic
thyreotrophic
gonadotrophic
densely granulated
Chromophobe adenomas


all types of hormonal productions
scarcely granulated
null cell
Hyperpituitarismus
Monohormonal
Combined
1+2, 1+3, 1+4, 2+3, 3+4
Syndromes:
1. gigantismus/acromegaly
2. hyperprolactinemia
(galaktorea, amenorea)
3. Cushing
4. hyperthyreosis
5. (hypergonadotropinismus)
Regulatory
hyperfunction
periph. glands
ectopic production
iatrogenous
Plurihormonal and Plurifunctional
Pituitary Adenoma with
Acromegaly Syndroma
doc. MUDr Jaroslava Dušková, CSc*,
prof. MUDr Josef Marek, DrSc**,
prof. MUDr Ctibor Povýšil,DrSc*
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
Plurihormonal and Plurifunctional
Pituitary Adenoma
with Acromegaly
STH +++
Prl ++
ACTH ++
TSH +++
FSH (beta)+
LH (beta)+
Pituitary INCIDENTALOMA
- algorithm of Investigation and treatment
Funkce hypofý zy
hyperf.
<1cm
> 1cm
prolaktinom
jiný
opakovat NMR za 1,2,5,let
zorné pole
vyl. hypopituitarismus
medikament. th.
bromocriptin
operace
beze změ ny
opakovat NMR za 0,5 1,2,5,let
konec sled.
rů st tumoru
porucha zor. pole
hypopituitarismus)
operace
Other Pituitary Tumours
craniopharyngeoma
 metastases

Adrenals

cortex
– definitive
– fetal (90% regression by 6 months of age)


neonate
8g
healthy adult 9g
(3,5kg)
(70kg)
0,002
0,0001
– zones G,F,R
20x

medulla
Adrenals - syndromes

hypofunction - panhypocorticalism
– acute
– chronic – Adison
– peripheral
– central

hyperfunction
– AGS
– Cushing
– hyperaldosteronismus Conn,Bartter
norm
hypoplasia congenitalis
Adrenals - syndromes

hypofunction - panhypocorticalism
– acute
– chronic – Adison
– peripheral
– central

hyperfunction
– AGS
– Cushing
– hyperaldosteronismus Conn,Bartter
m Adison: peripheral
central
Adrenals - syndromes

hypofunction - panhypocorticalismus
– acute
– chronic – Adison
– periferic
– central

hyperfunction
– AGS
– Cushing
– hyperaldosteronismus Conn,Bartter
m. Cushing periph.
hypothalamic
m. Cushing paraneopl.
pituitary C.
Androgen overproduction
AGS