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Pituitary gland
pathology
Clinical manifestations
of pituitary disease
Hyperpituitarism
Hypopituitarism
Local mass effects
Most cases of hypofunction
arise from destructive processes directly involving
the anterior pituitary (although other mechanisms
have been identified).
-empty sella syndrome
Infarct of the pituitary
CONGENITAL
AND DEVELOPMENTAL
DISORDERS
Many transcription factors are implicated
in pituitary organogenesis,
and abnormalities of these factors may result
in congenital hypopituitarism.
Idiopathic GH deficiency
CYSTIC LESIONS
Rathke’s cleft cysts
Arachnoid cysts
Dermoid and epidermoid cysts
INFLAMMATORY DISORDERS
Lymphocytic hypophysitis
Granulomatous hypophysitis
Xanthomatous hypophysitis
Secondary hypophysitis
may be due to infectious agents
or may occur as part of a systemic process
such as sarcoidosis,
vasculitis
(Takayasu’s Disease,Wegener’s granulomatosis),
Crohn’s disease,
or Whipple’s disease.
It has been associated with ruptured
Rathke’s cleft cyst,
necrotizing adenoma,
and meningitis.
Infections associated
with AIDS
may also involve the pituitary.
PITUITARY HYPERPLASIA
may mimic adenoma.
Somatotroph hyperplasia
.
Mammosomatotroph hyperplasia
Lactotroph hyperplasia
Corticotroph hyperplasia
Thyrotroph hyperplasia
Gonadotroph hyperplasia
Although hyperplasias may have similar
clinical presentations, a reticulin stain
can reliably distinguish adenohypophysial
hyperplasia from adenoma.
PRIMARY TUMOURS OF
ADENOHYPOPHYSEAL CELLS
The classification of pituitary adenomas
requires correlation between clinical manifestations
of hormone hypersecretion,
radiological determination of size and invasiveness,
and tumour morphology.
Tumour classification has been advanced
by the recognition of three main pathways
of adenohypophysial cytodifferentiation
based on expression of transcription factors
that regulate hormone genes.
The corticotroph pathway
Somatotrophs, lactotrophs,
mammosomatotrophs,
and thyrotrophs
Classification
ADENOMAS
ASSOCIATED WITH
GROWTH HORMONE EXCESS
Adenomas that produce GH excess
with acromegaly or gigantism
represent up to 15% of pituitary adenomas.
ADENOMAS
ASSOCIATED WITH
PROLACTIN EXCESS
THYROTROPH ADENOMAS
ASSOCIATE WITH
TSH EXCESS
CORTICOTROPH ADENOMAS
ASSOCIATED WITH
ACTH EXCESS
GONADOTROPH ADENOMAS
CLINICALLY
NON-FUNCTIONING
PITUITARY ADENOMAS
PLURIHORMONAL
PITUITARY ADENOMAS
PITUITARY CARCINOMA
OTHER
SUPRASELLAR
TUMORS
Neoplasms in this location may induce
hypofunction or hyperfunction of
the anterior pituitary, diabetes insipidus,
or combinations of these manifestations.
Craniopharyngioma
This benign, locally invasive tumour arises from remnants
Neuronal tumours, known as gangliocytomas
are composed of mature neurones that resemble
hypothalamic ganglion cells.
Gliomas of the sellar region
Meningiomas
Granular cell tumours
Chordomas
Schwannomas
UNUSUAL
PRIMARY TUMOURS
Germ cell tumours
Hematologic neoplasms
Mesenchymal tumours
METASTATIC
MALIGNANCIES