CONTENTS 1. The Normal Pituitary Gland ......................................................................................... 1 Gross Anatomy .......................................................................................................... 1 Vascular Supply ...................................................................................................... 4 Nerve Supply .......................................................................................................... 8 Embryology ................................................................................................................ 8 Microscopic and Functional Anatomy ...................................................................... 10 Hypothalamus and Neurohypophysis ................................................................... 10 Adenohypophysis ................................................................................................... 12 Adenohypophyseal Cells ........................................................................................ 17 Localization of Other Peptides in the Adenohypophysis ...................................... 34 2. Methods in Pituitary Pathology ................................................................................... 41 Gross Examination .................................................................................................... 41 The Autopsy Pituitary ............................................................................................. 41 The Surgical Specimen ............................................................................................ 42 Intraoperative Consultation ...................................................................................... 42 Histology and Immunohistochemistry ..................................................................... 43 Electron Microscopy .................................................................................................. 47 Tissue Culture ............................................................................................................ 47 Flow Cytometry ......................................................................................................... 49 Molecular Analysis ..................................................................................................... 49 A Practical Approach to the Diagnosis of a Pituitary Tumor .................................... 49 3. Pituitary Adenomas ...................................................................................................... 55 Epidemiology ............................................................................................................. 55 Classification Systems ................................................................................................ 58 Functional Classification ........................................................................................ 58 Anatomic or Radiologic Classification ................................................................... 58 Histologic Classification ......................................................................................... 61 Immunohistochemical Classification .................................................................... 61 Ultrastructural Classification .................................................................................. 62 Clinicopathologic Classification ............................................................................ 63 Adenomas Causing Adrenocorticotropic Excess ....................................................... 63 Clinical Features ..................................................................................................... 63 Biochemical Findings ............................................................................................. 65 Radiologic Findings ................................................................................................ 66 Gross Findings ........................................................................................................ 66 Microscopic Findings .............................................................................................. 67 ix Tumors of the Pituitary Gland Differential Diagnosis ............................................................................................. 74 Treatment and Prognosis ........................................................................................ 75 Adenomas Causing Growth Hormone Excess ........................................................... 76 Clinical Features ..................................................................................................... 76 Biochemical Findings ............................................................................................. 77 Radiologic Findings ................................................................................................ 78 Gross Findings ........................................................................................................ 78 Microscopic Findings .............................................................................................. 78 Differential Diagnosis ............................................................................................. 90 Treatment and Prognosis ........................................................................................ 91 Adenomas Causing Prolactin Excess ......................................................................... 93 Clinical Features ..................................................................................................... 93 Biochemical Findings ............................................................................................. 93 Radiologic Findings ................................................................................................ 94 Gross Findings ........................................................................................................ 95 Microscopic Findings .............................................................................................. 95 Differential Diagnosis ............................................................................................. 105 Treatment and Prognosis ........................................................................................ 106 Adenomas Causing Thyrotropin Excess .................................................................... 108 Clinical Features ..................................................................................................... 108 Biochemical Findings ............................................................................................. 109 Radiologic Findings ................................................................................................ 109 Gross Findings ........................................................................................................ 109 Microscopic Findings .............................................................................................. 109 Differential Diagnosis ............................................................................................. 113 Treatment and Prognosis ........................................................................................ 113 Adenomas Causing Gonadotropin Excess ................................................................. 113 Clinical Features ..................................................................................................... 113 Biochemical Findings ............................................................................................. 114 Radiologic Findings ................................................................................................ 114 Gross Findings ........................................................................................................ 114 Microscopic Findings .............................................................................................. 114 Differential Diagnosis ............................................................................................. 117 Treatment and Prognosis ........................................................................................ 118 Clinically Nonfunctioning Adenomas ...................................................................... 120 Clinical Features ..................................................................................................... 120 Biochemical Findings ............................................................................................. 120 Radiologic Findings ................................................................................................ 120 Microscopic Findings .............................................................................................. 120 x Contents Differential Diagnosis ............................................................................................. 135 Treatment and Prognosis ........................................................................................ 136 Plurihormonal and Double Adenomas ..................................................................... 136 Clinical Features ..................................................................................................... 136 Biochemical Findings ............................................................................................. 137 Radiologic Findings ...............................................................................................