Prolactinoma pathophysiology: Difference between revisions

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*McCune-Albright Syndrome
*McCune-Albright Syndrome
*MEN like syndrome ( CKDN1B loss of function)<ref>http://radiopaedia.org/articles/pituitary-adenoma</ref>
*MEN like syndrome ( CKDN1B loss of function)<ref>http://radiopaedia.org/articles/pituitary-adenoma</ref>
====Familial pituitary adenomas====
A pituitary adenoma may be part of a familial syndrome:<ref name=pmid19564887>{{Cite journal  | last1 = Elston | first1 = MS. | last2 = McDonald | first2 = KL. | last3 = Clifton-Bligh | first3 = RJ. | last4 = Robinson | first4 = BG. | title = Familial pituitary tumor syndromes. | journal = Nat Rev Endocrinol | volume = 5 | issue = 8 | pages = 453-61 | month = Aug | year = 2009 | doi = 10.1038/nrendo.2009.126 | PMID = 19564887 }}</ref><ref name=Ref_PCPBoD8|554>{{Ref PCPBoD8|554}}</ref>
{| class="wikitable sortable" style="margin-left:auto;margin-right:auto"
! Syndrome
! Gene
! Notes
|-
| [[Multiple endocrine neoplasia]] I
| MEN1
| characterized by the 3 Ps: '''p'''ituitary adenoma, [[parathyroid adenoma|'''p'''arathyroid adenoma]], [[pancreatic neuroendocrine tumour|'''p'''ancreatic neuroendocrine tumour]]
|-
| MEN-1-like syndrome
| CDKN1B<ref name=omim600778>{{OMIM|600778}}</ref>
| also known as ''Multiple endocrine neoplasia IV'' <ref name=omim600778>{{OMIM|600778}}</ref>
|-
| [[Carney syndrome]]
| PRKAR1A
| other findings (mnemonic ''NAME''): nevi, [[atrial myxoma]], myxoid neurofibroma, ephelides (freckles)
|-
| Isolated pituitary adenoma<ref name=pmid22612670>{{Cite journal  | last1 = Korbonits | first1 = M. | last2 = Storr | first2 = H. | last3 = Kumar | first3 = AV. | title = Familial pituitary adenomas - Who should be tested for AIP mutations? | journal = Clin Endocrinol (Oxf) | volume =  | issue =  | pages =  | month = May | year = 2012 | doi = 10.1111/j.1365-2265.2012.04445.x | PMID = 22612670 }}</ref>
| AIP
| classically GH-producing adenoma - leads to acromegaly
|}
===Microscopic===
Features:<ref name=Ref_PSNP36>{{Ref PSNP|36}}</ref>
*Loss of fibrous stroma.
**The cells of a normal (anterior) pituitary are nested.
Notes:
*Smears very well.<ref>MUN. 24 November 2010.</ref>
====Images====
<gallery>
Image:Nonfunctioning_pituitary_adenoma_%281%29.jpg | Pituitary adenoma - non-functioning. (WC/KGH)
File:HE fibrosis pituitary adenoma.jpg | Extensive interstitial and perivascular fibrosis in a pituitary adenoma (WC/jensflorian)
File:PRL HE histology.jpg | Pituitary adenoma - PRL producing, HE. Note the basophilic appearance of the cells (WC/jensflorian)
File:PRL adenoma treatment HE.jpg | Pituitary adenoma - PRL producing, HE. Extensive regressive changes after after dopamine agonist treatment (WC/jensflorian)
File:PRL IHC pituitary adenoma.jpg | Pituitary adenoma - PRL producing, Prolactin IHC (WC/jensflorian)
File:Densely granulated HGH producing adenoma.jpg | Pituitary adenoma - HGH producing, HE. The cells have a slightly eosinophilic appearance (WC/jensflorian)
File:Sparsely granulated HGH adenoma.jpg | Sparsely granulated adenoma - HGH producing. Note the numerous fibrous bodies in HE stain (WC/jensflorian)
File:HGH adenoma CK8.jpg | Sparsely granulated adenoma - HGH producing. CK8 IHC highlighting fibrous bodies (WC/jensflorian)
File:TSHoma HE.jpg | Pituitary adenoma - TSH producing. HE stain showing pleomorphism (WC/jensflorian)
File:TSHoma IHC-TSH.jpg |  Pituitary adenoma - TSH producing. TSH IHC can be heterogeneous (WC/jensflorian)
Image:Pituitary_adenoma_%281%29_GH_production.jpg | Pituitary adenoma - GH producing. (WC/KGH)
File:HE-GHoma.jpg | Pituitary adenoma , HE. This gonadotropin producing adenoma has a papillary architecture (WC/jensflorian)
File:FSH-GHoma.jpg | Pituitary adenoma, IHC for FSH (WC/jensflorian)
File:LH-GHoma.jpg | Pituitary adenoma, IHC for LH (WC/jensflorian)
File:ACTHoma-PAS-O-G.jpg | Pituitary adenoma , ACTH producing. PAS-O-G stain showing basophilic adenoma cells (WC/jensflorian)
File:ACTHoma-IHC.jpg | Pituitary adenoma , ACTH producing. Strong ACTH IHC in this basophilic adenoma (WC/jensflorian)
</gallery>
www:
*[http://path.upmc.edu/cases/case6.html Pituitary adenoma - crappy pictures (upmc.edu)].
*[http://path.upmc.edu/cases/case556.html Pituitary adenoma - case 2 - several images (upmc.edu)].
===Stains===
*Reticulin - loss of reticulin between tumour cells.


== References ==
== References ==

Revision as of 17:38, 9 September 2015

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Faizan Sheraz, M.D. [2]

Overview

Prolactinoma may occur as part of a hereditary disorder called multiple endocrine neoplasia type 1 (MEN 1). A minority of prolactinomas are associated with multiple endocrine neoplasia type I (MEN I), Carney complex, McCune-Albright Syndrome, MEN like syndrome ( CKDN1B loss of function).[1]

Pathophysiology

Prolactinoma may occur as part of a hereditary disorder called multiple endocrine neoplasia type 1 (MEN 1). A minority of prolactinomas are associated with:

  • Multiple endocrine neoplasia type I (MEN I)
  • Carney complex
  • McCune-Albright Syndrome
  • MEN like syndrome ( CKDN1B loss of function)[2]

Familial pituitary adenomas

A pituitary adenoma may be part of a familial syndrome:[3][4]

Syndrome Gene Notes
Multiple endocrine neoplasia I MEN1 characterized by the 3 Ps: pituitary adenoma, parathyroid adenoma, pancreatic neuroendocrine tumour
MEN-1-like syndrome CDKN1B[5] also known as Multiple endocrine neoplasia IV [5]
Carney syndrome PRKAR1A other findings (mnemonic NAME): nevi, atrial myxoma, myxoid neurofibroma, ephelides (freckles)
Isolated pituitary adenoma[6] AIP classically GH-producing adenoma - leads to acromegaly

Microscopic

Features:[7]

  • Loss of fibrous stroma.
    • The cells of a normal (anterior) pituitary are nested.

Notes:

  • Smears very well.[8]

Images

www:

Stains

  • Reticulin - loss of reticulin between tumour cells.

References

  1. ↑ http://radiopaedia.org/articles/pituitary-adenoma
  2. ↑ http://radiopaedia.org/articles/pituitary-adenoma
  3. ↑ Elston, MS.; McDonald, KL.; Clifton-Bligh, RJ.; Robinson, BG. (2009). "Familial pituitary tumor syndromes". Nat Rev Endocrinol. 5 (8): 453–61. doi:10.1038/nrendo.2009.126. PMID 19564887. Unknown parameter |month= ignored (help)
  4. ↑ Template:Ref PCPBoD8
  5. ↑ 5.0 5.1 Online Mendelian Inheritance in Man (OMIM) 600778
  6. ↑ Korbonits, M.; Storr, H.; Kumar, AV. (2012). "Familial pituitary adenomas - Who should be tested for AIP mutations?". Clin Endocrinol (Oxf). doi:10.1111/j.1365-2265.2012.04445.x. PMID 22612670. Unknown parameter |month= ignored (help)
  7. ↑ Template:Ref PSNP
  8. ↑ MUN. 24 November 2010.

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