Pituitary adenoma

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Pituitary adenoma

Endocrine system

Adrenal gland disorders

Congenital adrenal hyperplasia

Primary adrenal insufficiency

Waterhouse-Friderichsen syndrome

Hyperaldosteronism

Adrenal cortical carcinoma

Cushing syndrome

Conn syndrome

Thyroid gland disorders

Thyroglossal duct cyst

Hyperthyroidism

Graves disease

Thyroid eye disease (NORD)

Toxic multinodular goiter

Thyroid storm

Hypothyroidism

Euthyroid sick syndrome

Hashimoto thyroiditis

Subacute granulomatous thyroiditis

Riedel thyroiditis

Postpartum thyroiditis

Thyroid cancer

Parathyroid gland disorders

Hyperparathyroidism

Hypoparathyroidism

Hypercalcemia

Hypocalcemia

Pancreatic disorders

Diabetes mellitus

Diabetic retinopathy

Diabetic nephropathy

Pituitary gland disorders

Hyperpituitarism

Pituitary adenoma

Hyperprolactinemia

Prolactinoma

Gigantism

Acromegaly

Hypopituitarism

Growth hormone deficiency

Pituitary apoplexy

Sheehan syndrome

Hypoprolactinemia

Constitutional growth delay

Diabetes insipidus

Syndrome of inappropriate antidiuretic hormone secretion (SIADH)

Gonadal dysfunction

Precocious puberty

Delayed puberty

Premature ovarian failure

Polycystic ovary syndrome

Androgen insensitivity syndrome

Kallmann syndrome

5-alpha-reductase deficiency

Polyglandular syndromes

Autoimmune polyglandular syndrome type 1 (NORD)

Endocrine tumors

Multiple endocrine neoplasia

Pancreatic neuroendocrine neoplasms

Zollinger-Ellison syndrome

Carcinoid syndrome

Pheochromocytoma

Neuroblastoma

Opsoclonus myoclonus syndrome (NORD)

Endocrine system pathology review

Adrenal insufficiency: Pathology review

Adrenal masses: Pathology review

Hyperthyroidism: Pathology review

Hypothyroidism: Pathology review

Thyroid nodules and thyroid cancer: Pathology review

Parathyroid disorders and calcium imbalance: Pathology review

Diabetes mellitus: Pathology review

Cushing syndrome and Cushing disease: Pathology review

Pituitary tumors: Pathology review

Hypopituitarism: Pathology review

Diabetes insipidus and SIADH: Pathology review

Multiple endocrine neoplasia: Pathology review

Neuroendocrine tumors of the gastrointestinal system: Pathology review

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Pituitary adenoma

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Pituitary adenoma

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A 41-year-old woman comes to her outpatient provider because of skin changes that began three-months ago. She has noticed increased bruising and the development of purple-red stretch marks on the abdomen. Past medical history is notable for asthma, for which she intermittently uses a budesonide inhaler. She smokes half-a-pack of cigarettes per day. In the office, her temperature is 37.7°C (99.9°F), pulse is 71/min, respirations are 19/min, and blood pressure is 142/85 mmHg. Physical exam confirms the presence of ecchymoses and abdominal striae. Laboratory testing reveals the following findings:

 Laboratory value  Result 
 Sodium  146 mmol/L 
 Potassium  3.9 mmol/L 
 Bicarbonate  26 mmol/L 
 Fasting glucose  137 mg/dL 
 24-hour urine cortisol 72 µg/day 
 Serum ACTH**  35 pg/mL 

*Normal range: 4-40 µg/day
**Normal range: 5-20 pg/mL

The serum cortisol levels are significantly reduced in response to a high-dose of dexamethasone. Which of the following is the most likely underlying pathophysiology for this patient’s condition?

External References

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Amenorrhea

pituitary adenoma and p. 544

Bitemporal hemianopia p. 562

pituitary adenoma p. 544

Headache p. 536

pituitary adenomas and p. 344, NaN

Pituitary adenoma p. 544

Pituitary adenomas

acromegaly and p. 343

GH and p. 340

goiter and p. 348

hypopituitarism and p. 351

Pituitary tumors

diabetes insipidus p. 344

MEN 1 and p. 358

Transcript

Content Reviewers

Rishi Desai, MD, MPH

Contributors

Antonia Syrnioti, MD

Brittany Norton, MFA

Marisa Pedron

Jake Ryan

Robyn Hughes, MScBMC

Tanner Marshall, MS

Pituitary adenoma can be broken down - “adeno” refers to a gland and “oma” refers to a tumor, so pituitary adenoma is a tumor that develops in the hormone-producing cells of the pituitary gland.

Normally, the pituitary is a pea-sized gland, hanging by a stalk from the base of the brain.

It sits just behind the eyes near the optic chiasm, which is where the optic nerves cross.

The anterior pituitary, which is the front of the pituitary gland, contains a few different types of cells, each of which secretes a different hormone.

The largest group of cells are the somatotropes which secrete growth hormone, or GH for short, which goes on to promote tissue and organ growth.

The second largest cell group are the corticotrophs which secrete adrenocorticotropic hormone, or ACTH for short.

ACTH stimulates the adrenal glands to secrete cortisol, a hormone that controls the stress response and metabolic regulation.

A smaller cell group are the lactotrophs which secrete prolactin.

Prolactin stimulates breast milk production, and also inhibits ovulation, which is when an egg cell is released from the ovary, and inhibits spermatogenesis, which is the development of sperm cells.

There are also thyrotrophs which are cells that secrete thyroid stimulating hormone, or TSH which goes on to stimulate the thyroid gland.

And finally, there are also gonadotrophs which secrete two gonadotropic hormones - luteinizing hormone, or LH, and follicle-stimulating hormone, or FSH, both of which go on to stimulate the ovaries or testes.

In pituitary adenomas, one of these cells mutates and becomes neoplastic, meaning that it starts dividing uncontrollably and over time it forms a tumor.

Summary

Pituitary adenomas are benign tumors that occur in the pituitary gland. They vary depending on their size and the type of hormones they produce. Some pituitary adenomas do not produce any hormones and are referred to as non-functioning adenomas, while others produce hormones that can cause a wide range of symptoms.

Common symptoms include headaches, visual disturbances, fatigue, and changes in sexual function or menstrual cycles. The most common types involve lactotrophs that make prolactin, somatotrophs that make growth hormones, and corticotrophs that make ACTH. They are usually diagnosed by checking hormone levels and obtaining an MRI and are treated with medications or surgery.

Sources

  1. "Robbins Basic Pathology" Elsevier (2017)
  2. "Harrison's Principles of Internal Medicine, Twentieth Edition (Vol.1 & Vol.2)" McGraw-Hill Education / Medical (2018)
  3. "Pathophysiology of Disease: An Introduction to Clinical Medicine 8E" McGraw-Hill Education / Medical (2018)
  4. "CURRENT Medical Diagnosis and Treatment 2020" McGraw-Hill Education / Medical (2019)
  5. "Harrison's Endocrinology, 4E" McGraw-Hill Education / Medical (2016)
  6. "Management of hormone-secreting pituitary adenomas" Neuro-Oncology (2016)
  7. "The prevalence of pituitary adenomas" Cancer (2004)
Elsevier

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