Pathology of the Endocrine Organs - I - PowerPoint PPT Presentation

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Pathology of the Endocrine Organs - I

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Pituitary Adrenals Jaroslava Du kov Inst. Pathol. 1st Med. Fac. Charles Univ. Prague https://www1.lf1.cuni.cz/~jdusk/ – PowerPoint PPT presentation

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Title: Pathology of the Endocrine Organs - I


1
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/
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 Rathkes pouch proc.
infundibularis
2. splitting of the Rathkes 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
  • Rathkes 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
  • Neurohypophysis secretion 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.
  • ACTHFSH,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 (Crookes 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
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

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

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

22
Hypopituitarismus
  • Total
  • gt90 AH destroyed
  • Syndromes
  • Simmonds
  • Sheehan
  • Falta
  • Lorain
  • Partial
  • monohormonal
  • combined
  • Regulatory hypofunction
  • peripheral glands
  • ectopic production
  • iatrogenous

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

24
Pituitary Adenomas
9
- most frequent clin. symptomes
9
54
28
  1. chiasma opticum compression 43
  2. acromegaly 23
  3. galactorea-amenorea 7
  4. hypopituitarismus 7

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
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

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
Plurihormonal and PlurifunctionalPituitary
Adenoma with Acromegaly
  • STH
  • Prl
  • ACTH
  • TSH
  • FSH (beta)
  • LH (beta)

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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