Pathology of the Endocrine Organs - I

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Pathology of the Endocrine Organs - I

• Pituitary

Adrenals
Jaroslava Dušková Inst. Pathol. 1st Med. Fac.
Charles Univ. Prague https//www1.lf1.cuni.cz/jdu
sk/
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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

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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)

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1. formation of the Rathkes pouch proc.
infundibularis
2. splitting of the Rathkes pouch
3. mature formation
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Neuroimunoendocrine regulation
CRF
IL-1 neuronal connections
ACTH
TNF IL-6 IL-1
n.vagus
Glucocorticoids
Adrenals
Immune cells
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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
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Neuroimmunoendocrine Regulation Messengers

• Neurotransmitters
• Interleukins
• Hormons

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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

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Pituitary - architecture

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

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Pituitary - cell inclusions

• squamous epithelium
• Rathkes pouch between AH and NH
• salivary glands - NH, often with
  oncocytes

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Pituitary - parts - function

• Adenohypophysis secretion of tropins
• Pars infundibularis (tuberalis)
• modulation of AH secretion
• Pars intermedia
• Neurohypophysis secretion of neuropeptides
• hypophysis pharyngea evtl. secretion
  of tropins

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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)

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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

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Pituitary - cell population hormonal
production

• Hormonal production mostly mixed
• (e.g.
• ACTHFSH,LH,TSH,PRL)

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Pituitary - cell population hormonal production

• Individual producents able of interconversion
  due to stimulation (e.g. PRL-GH)

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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

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Pituitary - regressive changes

• Dystrophy (Crookes hyaline change)
• Atrophy - in aging increased fibrosis, no
  functional influence
• NECROSIS
• traumatic
• (mostly due to the stalk lesion)
• ischemic

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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

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Pituitary - necrosis

• healing scar
• focal regenerates possible
• meaning
• hypofunction only in case of more than 3/4 of
  volume destruction

• incidence
• 1- 8 large autopt. series
• pathogenesis
• intracranial hypertension
• ischemia
• vasospasmus
• atherosclerosis
• thrombi
• stalk lesion

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Pituitary - inflammation

• non specific
• (peri)hypophysitis
• purulenta
• non purulenta
• septic
• pyemic
• microabscesses
• lymphocytic
• autoimmune

• specific
• tbc
• hematogenous dissemination
• solitary tuberculoma
• lues
• inborn
• acquired

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Pituitary syndromes

• Hypofunctional
• panhypopituitarismus
• selective hypofunction
• Hyperfunctional
• monohormonal
• combined

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Hypopituitarismus

• Total
• gt90 AH destroyed
• Syndromes
• Simmonds
• Sheehan
• Falta
• Lorain

• Partial
• monohormonal
• combined
• Regulatory hypofunction
• peripheral glands
• ectopic production
• iatrogenous

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m. Adisoni centralis

• adrenal atrophy
• vacuolisation of cardiomyocytes
• lack of the skin hyperpigmentation

• hypotension
• weekness
• hyperkalaemia

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Pituitary Adenomas
9
- most frequent clin. symptomes
9
54
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1. chiasma opticum compression 43
2. acromegaly 23
3. galactorea-amenorea 7
4. hypopituitarismus 7

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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

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Pituitary Adenomas

• acidophillic
• basophillic
• chromophobe
• mixed

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Acidophillic adenomas

• somatotroph
• lactotroph
• mixed somatotroph and lactotroph
• somatolactotroph
• densely granulated
• onkocytic

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Basophillic adenomas

• corticotrophic
• thyreotrophic
• gonadotrophic
• densely granulated

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Chromophobe adenomas

• all types of hormonal productions
• scarcely granulated
• null cell

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Hyperpituitarismus

• Monohormonal
• Syndromes
• 1. gigantismus/acromegaly
• 2. hyperprolactinemia
• (galaktorea, amenorea)
• 3. Cushing
• 4. hyperthyreosis
• 5. (hypergonadotropinismus)

• Combined
• 12, 13, 14, 23, 34
• Regulatory hyperfunction
• periph. glands
• ectopic production
• iatrogenous

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Plurihormonal and PlurifunctionalPituitary
Adenoma with Acromegaly Syndroma

• doc. MUDr Jaroslava Dušková, CSc,
• prof. MUDr Josef Marek, DrSc,
• prof. MUDr Ctibor Povýšil,DrSc

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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

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Plurihormonal and PlurifunctionalPituitary
Adenoma with Acromegaly

• STH
• Prl
• ACTH

• TSH
• FSH (beta)
• LH (beta)

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Pituitary INCIDENTALOMA- algorithm of
Investigation and treatment
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Other Pituitary Tumours

• craniopharyngeoma
• metastases

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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

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Adrenals - syndromes

• hypofunction - panhypocorticalism
• acute
• chronic Adison
• peripheral
• central
• hyperfunction
• AGS
• Cushing
• hyperaldosteronismus Conn,Bartter

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norm
hypoplasia congenitalis
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Adrenals - syndromes

• hypofunction - panhypocorticalism
• acute
• chronic Adison
• peripheral
• central
• hyperfunction
• AGS
• Cushing
• hyperaldosteronismus Conn,Bartter

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m Adison peripheral central
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Adrenals - syndromes

• hypofunction - panhypocorticalismus
• acute
• chronic Adison
• periferic
• central
• hyperfunction
• AGS
• Cushing
• hyperaldosteronismus Conn,Bartter

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m. Cushing periph. hypothalamic
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m. Cushing paraneopl. pituitary C.
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Androgen overproduction AGS