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