Pituitary adenoma differential diagnosis: Difference between revisions

Jump to navigation Jump to search
No edit summary
Line 14: Line 14:
*[[Pituitary cancer|Pituitary carcinoma]]
*[[Pituitary cancer|Pituitary carcinoma]]
*Epidermoid of brain
*Epidermoid of brain
==DIfferentiating Pituitary adenoma from other diseases==
<small>
{| style="border: 0px; font-size: 90%; margin: 3px; width: 600px" align="center"
|+
! rowspan="2" style="background: #4479BA; width: 200px;" | {{fontcolor|#FFF|Disease}}
! rowspan="2" style="background: #4479BA; width: 200px;" | {{fontcolor|#FFF|Gene}}
! rowspan="2" style="background: #4479BA; width: 200px;" | {{fontcolor|#FFF|Chromosome}}
! rowspan="2" style="background: #4479BA; width: 200px;" | {{fontcolor|#FFF|Differentiating Features}}
! colspan="3" style="background: #4479BA; width: 200px;" | {{fontcolor|#FFF|Components of MEN}}
! rowspan="2" style="background: #4479BA; width: 200px;" | {{fontcolor|#FFF|Diagnosis}}
|-
! style="background: #4479BA; width: 200px;" | {{fontcolor|#FFF|Parathyroid}}
! style="background: #4479BA; width: 200px;" | {{fontcolor|#FFF|Pitutary}}
! style="background: #4479BA; width: 200px;" | {{fontcolor|#FFF|Pancreas}}
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |[[von Hippel-Lindau syndrome]]
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |Von Hippel–Lindau tumor suppressor
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |3p25.3
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |
* Angiomatosis, 
* Hemangioblastomas,
* Pheochromocytoma, 
* Renal cell carcinoma,
* Pancreatic cysts (pancreatic serous cystadenoma)
* Endolymphatic sac tumor,
* Bilateral papillary cystadenomas of the epididymis (men) or broad ligament of the uterus (women)
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |<nowiki>-</nowiki>
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |<nowiki>-</nowiki>
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" | +
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |
* Clinical diagnosis
* In hereditary VHL, disease techniques such as Southern blotting and gene sequencing can be used to analyse DNA and identify mutations.
|-
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |[[Carney complex]]
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold"| PRKAR1A
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold"| 17q23-q24
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold"|
* Myxomas of the heart
* Hyperpigmentation of the skin (lentiginosis)
* Endocrine (ACTH-independent Cushing's syndrome due to primary pigmented nodular adrenocortical disease)
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" | -
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" | -
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" | -
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |
* Clinical diagnosis
|-
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |[[Neurofibromatosis type 1]]
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold"|RAS
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold"|17
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold"|
* [[Scoliosis]]
* Learning disabilities
* [[Vision]] disorders
* Cutaneous [[lesion]]s
* [[Epilepsy]].
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" | -
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" | -
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" | -
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |'''<u>Prenatal</u>'''
* Chorionic villus sampling or amniocentesis can be used to detect NF-1 in the fetus.
'''<u>Postnatal</u>'''
Cardinal Clinical Features" are required for positive diagnosis.
* Six or more café-au-lait spots over 5 mm in greatest diameter in pre-pubertal individuals and over 15 mm in greatest diameter in post-pubertal individuals.
* Two or more neurofibromas of any type or 1 plexiform neurofibroma
* Freckling in the axillary (Crowe sign) or inguinal regions
* Optic glioma
* Two or more Lisch nodules (pigmented iris hamartomas)
* A distinctive osseous lesion such as sphenoid dysplasia, or thinning of the long bone cortex with or without pseudarthrosis.
|-
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold"  |[[Li-Fraumeni syndrome]]
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |TP53
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |17
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |Early onset of diverse amount of [[cancer]]s such as
* [[Sarcoma]]
* [[Cancer]]s of 
** [[Breast]]
** [[Brain]]
** [[Adrenal gland]]s
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" | -
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" | -
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" | -
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |
'''<u>Criteria</u>'''
* Sarcoma at a young age (below 45)
* A first-degree relative diagnosed with any cancer at a young age (below 45)
* A first or second degree relative with any cancer diagnosed before age 60.
|-
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold"  |[[Gardner's syndrome]]
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" | APC
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" | 5q21
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |
* Multiple polyps in the colon 
* Osteomas of the skull
* Thyroid cancer,
* Epidermoid cysts,
* Fibromas
* Desmoid tumors
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" | -
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" | -
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |
* Clinical diagnosis
* Colonoscopy
|-
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |[[Multiple endocrine neoplasia type 2]]
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |''RET''
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" | -
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |
* [[Medullary thyroid carcinoma]] (MTC)
* [[Pheochromocytoma]]
* Primary [[hyperparathyroidism]]
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" | +
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" | -
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" | -
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |
* [[Hypercalcemia]]
* [[Hypophosphatemia]],
* Elevated [[parathyroid hormone]],
* Elevated [[norepinephrine]]
'''<u>Criteria</u>'''
Two or more specific endocrine tumors
* [[Medullary thyroid carcinoma]]
* [[Pheochromocytoma]]
* [[Parathyroid]] hyperplasia
|-
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |[[Cowden syndrome]]
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |PTEN
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" | Hamartomas
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" | -
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |<nowiki>-</nowiki>
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |
* ''PTEN'' mutation probability risk calculator
|-
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |[[Acromegaly]]/[[gigantism]]
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |
* Enlargement of the [[hand]]s, [[feet]], [[nose]], [[lip]]s and [[ear]]s, and a general thickening of the [[skin]]
* [[Hypertrichosis]]
* [[Hyperpigmentation]]
* [[Hyperhidrosis]]
* [[Carpal tunnel syndrome]].
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |<nowiki>-</nowiki>
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |<nowiki>+</nowiki>
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |<nowiki>-</nowiki>
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |
* An elevated concentration of serum [[Growth hormone|growth hormone (GH)]] and [[Insulin-like growth factor|insulin-like growth factor 1(IGF-1)]] levels is diagnostic of acromegaly.
|-
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |[[Pituitary adenoma]]
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" | -
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" | -
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |
* [[Visual field defect]]s classically [[bitemporal hemianopsia]]
* Increased [[intracranial pressure]]
* [[Migraine]]
* [[Lateral rectus]] palsy
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |<nowiki>+</nowiki>
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |
:*Elevated serum level of  [[prolactin]]
:*Elevated or decreased serum level of  [[adrenocorticotropic hormone]] (ACTH)
:*Elevated or decreased serum level of  [[growth hormone]] (GH)
:*Elevated or decreased serum level of  [[thyroid-stimulating hormone]] (TSH)
:*Elevated or decreased serum level of  [[follicle-stimulating hormone]] (FSH)
:*Elevated or decreased serum level of  [[luteinizing hormone]] (LH)
|-
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |[[Hyperparathyroidism]]
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |-
* [[Kidney stone]]s
* [[Hypercalcemia]],
* [[Constipation]]
* [[Peptic ulcer]]s
* [[Depression]]
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |<nowiki>+</nowiki>
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |<nowiki>-</nowiki>
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |<nowiki>-</nowiki>
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |
* An elevated concentration of serum [[calcium]] with elevated [[parathyroid hormone]] level is diagnostic of primary hyperparathyroidism.
* Most consistent laboratory findings associated with the diagnosis of secondary hyperparathyroidism include elevated serum [[parathyroid hormone]] level and low to normal serum [[calcium]].
* An elevated concentration of serum [[calcium]] with elevated [[parathyroid hormone]] level in post [[Kidney transplantation|renal transplant]] patients is diagnostic of tertiary hyperparathyoidism.
|-
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |[[Pheochromocytoma]]/[[paraganglioma]]
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |
''VHL''
''RET''
''NF1''  
''SDHB'' 
''SDHD''
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |Characterized by
* Episodic [[hypertension]]
* [[Palpitation]]s
* [[Anxiety]]
* [[Diaphoresis]]
* [[Weight loss]]
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |<nowiki>-</nowiki>
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |<nowiki>-</nowiki>
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |<nowiki>-</nowiki>
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |
* Increased catecholamines and metanephrines in plasma (blood) or through a 24-hour urine collection.
|-
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |[[Adrenocortical carcinoma]]
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |
*p53
*Retinoblastoma h19
*Insulin-like growth factor II (IGF-II)
*p57<sup>kip2</sup>
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |17p, 13q 
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |
* [[Cushing syndrome]] ([[cortisol]] hypersecretion)
* [[Conn syndrome]] ([[aldosterone]] hypersecretion)
* [[virilization]] ([[testosterone]] hypersecretion)
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |<nowiki>-</nowiki>
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |<nowiki>-</nowiki>
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |<nowiki>-</nowiki>
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |
* Increased serum glucose
* Increased urine cortisol
* Serum androstenedione and dehydroepiandrosterone
* Low serum potassium
* Low plasma renin activity
* High serum aldosterone.
* Excess serum estrogen.
|-
| colspan="8" style="padding: 5px 5px; background: #F5F5F5;" |<small>Adapted from Toledo SP, Lourenço DM, Toledo RA. A differential diagnosis of inherited endocrine tumors and their tumor counterparts, journal=Clinics (Sao Paulo), volume= 68, issue= 7, 07/24/2013<ref name="pmid23917672">{{cite journal| author=Toledo SP, Lourenço DM, Toledo RA| title=A differential diagnosis of inherited endocrine tumors and their tumor counterparts. | journal=Clinics (Sao Paulo) | year= 2013 | volume= 68 | issue= 7 | pages= 1039-56 | pmid=23917672 | doi=10.6061/clinics/2013(07)24 | pmc=PMC3715026 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23917672  }} </ref> </small>
|}
</small>


==References==
==References==

Revision as of 19:10, 18 October 2017

Pituitary adenoma Microchapters

Home

Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Pituitary adenoma from other Diseases

Epidemiology and Demographics

Risk Factors

Natural history, Complications and Prognosis

Diagnosis

Staging

History and Symptoms

Physical Examination

Laboratory Findings

CT

MRI

Other Imaging Findings

Other Diagnostic Studies

Treatment

Medical Therapy

Surgery

Primary Prevention

Secondary Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Case Studies

Case #1

Pituitary adenoma differential diagnosis On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

American Roentgen Ray Society Images of Pituitary adenoma differential diagnosis

All Images
X-rays
Echo & Ultrasound
CT Images
MRI

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Pituitary adenoma differential diagnosis

CDC on Pituitary adenoma differential diagnosis

Pituitary adenoma differential diagnosis in the news

Blogs on Pituitary adenoma differential diagnosis

Directions to Hospitals Treating Pituitary adenoma

Risk calculators and risk factors for Pituitary adenoma differential diagnosis

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

Overview

Pituitary adenoma must be differentiated from other diseases such as craniopharyngioma, meningioma, arachnoid cyst, and pituitary carcinoma.

Differential Diagnosis

Pituitary adenoma should be differentiated from other diseases such as:[1]

DIfferentiating Pituitary adenoma from other diseases

Disease Gene Chromosome Differentiating Features Components of MEN Diagnosis
Parathyroid Pitutary Pancreas
von Hippel-Lindau syndrome Von Hippel–Lindau tumor suppressor 3p25.3
  • Angiomatosis, 
  • Hemangioblastomas,
  • Pheochromocytoma, 
  • Renal cell carcinoma,
  • Pancreatic cysts (pancreatic serous cystadenoma)
  • Endolymphatic sac tumor,
  • Bilateral papillary cystadenomas of the epididymis (men) or broad ligament of the uterus (women)
- - +
  • Clinical diagnosis
  • In hereditary VHL, disease techniques such as Southern blotting and gene sequencing can be used to analyse DNA and identify mutations.
Carney complex  PRKAR1A 17q23-q24
  • Myxomas of the heart
  • Hyperpigmentation of the skin (lentiginosis)
  • Endocrine (ACTH-independent Cushing's syndrome due to primary pigmented nodular adrenocortical disease)
- - -
  • Clinical diagnosis
Neurofibromatosis type 1 RAS 17 - - - Prenatal
  • Chorionic villus sampling or amniocentesis can be used to detect NF-1 in the fetus.

Postnatal Cardinal Clinical Features" are required for positive diagnosis.

  • Six or more café-au-lait spots over 5 mm in greatest diameter in pre-pubertal individuals and over 15 mm in greatest diameter in post-pubertal individuals.
  • Two or more neurofibromas of any type or 1 plexiform neurofibroma
  • Freckling in the axillary (Crowe sign) or inguinal regions
  • Optic glioma
  • Two or more Lisch nodules (pigmented iris hamartomas)
  • A distinctive osseous lesion such as sphenoid dysplasia, or thinning of the long bone cortex with or without pseudarthrosis.
Li-Fraumeni syndrome TP53 17 Early onset of diverse amount of cancers such as - - -

Criteria

  • Sarcoma at a young age (below 45)
  • A first-degree relative diagnosed with any cancer at a young age (below 45)
  • A first or second degree relative with any cancer diagnosed before age 60.
Gardner's syndrome APC  5q21
  • Multiple polyps in the colon 
  • Osteomas of the skull
  • Thyroid cancer,
  • Epidermoid cysts,
  • Fibromas
  • Desmoid tumors
- - -
  • Clinical diagnosis
  • Colonoscopy
Multiple endocrine neoplasia type 2 RET - + - -

Criteria Two or more specific endocrine tumors

Cowden syndrome PTEN -  Hamartomas - - -
  • PTEN mutation probability risk calculator
Acromegaly/gigantism - - - + -
Pituitary adenoma - - - + -
Hyperparathyroidism - - - + - -
  • An elevated concentration of serum calcium with elevated parathyroid hormone level is diagnostic of primary hyperparathyroidism.
  • Most consistent laboratory findings associated with the diagnosis of secondary hyperparathyroidism include elevated serum parathyroid hormone level and low to normal serum calcium.
  • An elevated concentration of serum calcium with elevated parathyroid hormone level in post renal transplant patients is diagnostic of tertiary hyperparathyoidism.
Pheochromocytoma/paraganglioma

VHL RET NF1   SDHB  SDHD

- Characterized by - - -
  • Increased catecholamines and metanephrines in plasma (blood) or through a 24-hour urine collection.
Adrenocortical carcinoma
  • p53
  • Retinoblastoma h19
  • Insulin-like growth factor II (IGF-II)
  • p57kip2
17p, 13q  - - -
  • Increased serum glucose
  • Increased urine cortisol
  • Serum androstenedione and dehydroepiandrosterone
  • Low serum potassium
  • Low plasma renin activity
  • High serum aldosterone.
  • Excess serum estrogen.
Adapted from Toledo SP, Lourenço DM, Toledo RA. A differential diagnosis of inherited endocrine tumors and their tumor counterparts, journal=Clinics (Sao Paulo), volume= 68, issue= 7, 07/24/2013[2]

References

  1. http://librepathology.org/wiki/index.php/Pituitary_gland#Pituitary_adenoma. Pituitary adenoma. Accessed on 09/24/2015
  2. Toledo SP, Lourenço DM, Toledo RA (2013). "A differential diagnosis of inherited endocrine tumors and their tumor counterparts". Clinics (Sao Paulo). 68 (7): 1039–56. doi:10.6061/clinics/2013(07)24. PMC 3715026. PMID 23917672.

Template:WikiDoc Sources