Condition
Condition |Morphology |Clinical Course |Additional Notes |Diff Dx | |
|Pituitary adenoma |Well-circumscribed lesion |Endocrine abnormalities & mass FX |Peak incidence 30s-50s |Hyperplasia of pituitary |
| |Often compress optic chiasm |Radiographic abnormalities of sella turcica |Assoc’d w/ MEN 1 |Carcinoma of pituita |
| |If Invasive: foci of hemorrhage & |Visual field abnormalities—bitemporal |Micro < 1 cm in diameter |ry |
| |necrosis |hemianopsia |Macro >1cm in diameter | |
| |Relatively uniform, polygonal cells |Elev’d intracranial pressure—w/ HA, N/V |Acute hemorrhage into an adenoma=pituitary | |
| |arrayed in sheets or cords. Sparse | |apoplexy | |
| |reticulin (CT) | | | |
| |F(x)al status CANNOT be predicted by | | | |
| |histologic appearance | | | |
|Prolactinoma |Weakly acidophilic or chromophobic cells |Hyperprolactinemia—amenorrhea, galactorrhea, |Most frequent hyperf(x)ing pit. Adenoma |HyperPRL: |
| |PRL w/in secretory granules |loss of libido, and infertility |(lactotrophs) |Pregnancy |
| | | |Serum [PRL] proportional to size of adenoma |Lactating ♀ |
| | | |Ages 20-40, more freq Dx in women |Lactotroph hyperplasia |
| | | | |Stalk effect from other masses |
| | | |Tx: bromocriptine—causes lesions to diminish |Drugs: DA receptor antagonists |
| | | |in size |(phenothiazines, haldol), |
| | | | |reserpine, estrogens |
| | | | |Renal failure |
| | | | |Hypothyroidism |
|Growth Hormone Adenoma |Granulated cells, acidophilic or |If in kids b4 epiphysis close: gigantism—gen’d |Mutant GTPase? | |
| |chromophobic |increase in body size, disprop. Long arms and |GH excess correlated w/: gonadal dysf(x), DM, | |
| |Immunohistochemical stains demo GH w/in |legs |gen’d muscle weakness, HTN, arthritis, CHF, & | |
| |cyto of neoplastic cells |If inc’d levels of GH after closure: |inc’d risk of GI cancers. | |
| | |Acromegaly—most conspicuous in skin & soft | | |
| | |tissues, hyperostosis ini spine & hips, |Tx: surgical removal thru transphenoidal | |
| | |prognathism |approach, radiation therapy, or drug therapy | |
|Corticotroph Cell |Small microadenomas |XS ACTH—hypercortisolism (Cushing syndrome) |Nelson syndrome: when large destructive | |
|Adenomas |Basophilic or chromophobic | |adenomas develop after surgical removal of the| |
| |Stain w/ PAS |Hyperpigmentation due to inc’d ACTH |adrenal glands for Tx of Cushing syndrome | |
| |Produce XS ACTH | | | |
|Diabetes Insipidus |ADH deficiency |Polyuria, polydipsia | |Head trauma |
| | |Excretion of large volumes of dilute urine w/ | |Tumors |
| | |low specific gravity | |Inflamm d/o of hypothalamus & |
| | |Inc’d serum Na | |pituitary |
| | |Inc’d serum osmolality | | |
|Syndrome of inappropriate|XS ADH |Hyponatremia | |Secretion of ectopic ADH by SCLC, |
|ADH secretion (SIADH) | |Cerebral edema | |non-neoplastic dz of lung, & local |
| | |Neurologic dysf(x) | |injury to hypothalamus or posterior|
| | |Normal blood volume, but total body water is | |pituitary |
| | |increased | | |
|Hyperthyroidism |Elevated levels of free T3 & T4 |Nervousness |Cardiac manifestations are the earliest & most|Diffuse hyperplasia of thyroid |
| | |Palpitations |consistent features |gland assoc’d w/ Graves dz |
| |Low TSH in primary |Rapid pulse, cardiomegaly |Thyrotoxic cardiomyopathy |Ingestion of exogenous TH |
| | |Fatigability | |Hyperf(x)al multinodular goiter |
| | |Muscular weakness (prox) |A normal rise in TSH after admin’d of TRH |Hyperf(x)al adenoma of the thyroid |
| | |Wt loss w/ good appetite |excludes secondary |Thyroiditis |
| | |Diarrhea | |Ovarian teratoma |
| | |Heat intolerance | | |
| | |Warm skin | | |
| | |XSive perspiration | | |
| | |Emotional lability | | |
| | |Menstrual changes | | |
| | |Fine tremor of the hand | | |
| | |Inability to concentrate | | |
| | |Insomnia, osteoporosis | | |
|Hypothyroidism | |Cretinism | |Radiation injury, Surgical |
| | |myxedema | |ablation, Hashimoto Thyroiditis, |
| | | | |Iodine deficiency |
| | | | |Drugs (Li, P-ASA), Pituitary |
| | | | |lesions reducing TSH secretion, |
| | | | |Hypothalamic lesions, |
| | | | |Hemochromatosis, Amyloidosis, |
| | | | |Sarcoidosis |
|Cretinism |Hypothyroidism in infancy or early |Imprd devmnt skeletal system & CNS—severe MR, | |Dietary iodine deficiency |
| |childhood |short stature, coarse facial features, a | |Maternal thyroid deficiency |
| | |protruding tongue, & umbilical hernia | | |
|Myxedema |Hypothyroidism in older kids and adults |Vary with age of onset |Dec’d serum [T3] & [T4] | |
| | |Slowing of physical & mental activity | | |
| | |Gen’d fatigue, Apathy | | |
| | |Mental sluggishness | | |
| | |Slowed speech & mental f(x)s | | |
| | |Listless, cold intolerance | | |
| | |SOB, dec’d exercise capacity | | |
| | |Constipation | | |
| | |Decreased sweating | | |
| | |Edema | | |
| | |Broadening & coarsening of facial features | | |
| | |Enlargement of the tongue | | |
| | |Deepening of the voice | | |
|Condition |Pathogenesis |Morphology |Clinical Course |Additional Notes |
|Hashimoto Thyroiditis | |Diffusely enlarged gland |Painless enlargement of the gland |Inc’d risk for dev’ing |
| | |Capsule is intact |Hypothyroidism |B-cell lymphomas |
| | |Well-demarcated margins |May be preceded by transient thyrotoxicosis |Most common cause of |
| | |Pale, gray-tan, firm, & somewhat nodular | |hypothyroidism |
| | |Mononuclear infiltrate—small lymphs, PCs |Elev’d free T4 & T3 levels | |
| | |Well-dev’d germinal ctrs |Low TSH |Gradual thyroid failure |
| | |Hurthle cells |Decreased radioactive uptake |Autoimmune destruxn of |
| | |Inc’d interstital CT |Abs to thyroglobulin & thyroid Peroxidase, TSH receptor, |gland |
| | |Fibrosis does NOT extend beyond capsule |possible iodine transporter |Ages: 45-65 |
| | | | |More common in women |
| | | | |HLA-DR5, HLA-DR3 |
| | | | |Primarily a defect in T |
| | | | |cells |
| | | | |Apoptosis med’d by |
| | | | |Fas-FasL system (induced|
| | | | |by IL-1β) |
|Subacute (granulomatous)| |Involved areas are frim & yellow-white and stand out |Hx of URI b4 onset? |Ages:30-50 |
|Thyroiditis | |from more rubbery, normal brown thyroid substance |Sudden or gradual |More common in women |
| | |Changes are patchy |Pain in the neck, which may radiate to the upper neck, |Caused by a viral infexn|
| | |PMNs forming microabscesses |jaw, throat or ears, particularly when swallowing. |or postviral inflamm |
| | |Multinucleate giant cells |Fever, fatige, malaise, anorexia, and myalgia |process |
| | | | |Peaks in summer |
| | | |High serum T3 & T4 |HLA-B35 |
| | | |Low serum TSH | |
| | | |Low radioactive uptake | |
|Subacute | |Thyroid normal on gross inspexn |Painless |Middle-aged women, esp |
|Lymphocytic | |Multifocal inflamm infiltrate—small lymphs, patchy |Mild hyperthyroidism OR goitrous enlargement |postpartum |
|Thryoiditis | |disruption, & collapse of thyroid follicles | |HLA-DR3 & DR5 |
| | | |High serum T3 & T4 | |
| | | |Low serum TSH | |
| | | |Low radioactive uptake | |
| | | |Elev’d levels of Abs to thyroglobulin & thyroid | |
| | | |Peroxidase | |
|Graves Dz |Autoimmune disorder by AutoAbs to the TSH|Symmetrically enlarged |Thyroid enlargement |Most common cause of |
| |receptor or to thyroid-stimulating Igs |Diffuse hypertrophy & hyperplasia of follicle |Audible bruit over thyroid |endogenous |
| | |epithelial cells |Characteristic wide, staring gaze and lid lag |hyperthyroidism |
| | |Too many cells |Exophthalmos |Ages: 20-40 |
| | |Colloid w/in lumen is pale w/ scalloped margins |Proptosis |Women 7X more common |
| | | |Pretibial myxedema—scaly thickening & induration of skin |HLA-B8 & -DR3 |
| | |Tissues of orbit are edematous | | |
| | | |High serum T3 & T4 | |
| | | |Low serum TSH | |
| | | |Increased radioactive uptake | |
|Diffuse Nontoxic |Involves entire gland w/o producing |Hyperplastic stage |Elev’d TSH | |
|(simple) goiter |nodularity |Colloid involution | | |
| |Iodine deficiency | | | |
|Multinodular goiter |Irregular enlargment of thyroid |Multilobulated, asymmetrically enlarged gland |Sx caused by mass FX—may cause airway obstruxn, |Plummer |
| |Produce the most extreme thyroid nodules |Intrathoracic or plunging goiter |dysphagia, and compression of large vessels in the neck |syndrome—hyperthyroidism|
| | |Irregular nodules containing variable amts of brown, |and upper thorax |w/ toxic multinodular |
| | |gelatinous colloid | |goiter |
| | |Colloid rich follicles lined by flattened, inactive | | |
| | |epithelium and areas of follicular epithelial | | |
| | |hypertrophy and hyperplasia | | |
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