how to print barcode in asp.net c# INTRACRANIAL NEOPLASMS AND PARANEOPLASTIC DISORDERS in Microsoft Office

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INTRACRANIAL NEOPLASMS AND PARANEOPLASTIC DISORDERS
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formation is endocrine end-organ failure, as occurs, for example, with ovarian atrophy that induces a basophilic adenoma Only a small proportion (6 to 8 percent) enlarge the sella, ie, most are microadenomas as discussed below On the basis of conventional hematoxylin-eosin staining methods, cells of the normal pituitary gland were for many years classi ed as chromophobe, acidophil, and basophil, these types being present in a ratio of 5:4:1 Adenomas of the pituitary are most often composed of chromophobe cells (4 to 20 times as common as acidophilcell adenomas); the incidence of basophil-cell adenomas is uncertain Histologic study is now based on immunoperoxidase staining techniques that de ne the nature of the hormones within the pituitary cells both of the normal gland and of pituitary adenomas These methods have shown that either a chromophobe or an acidophil cell may produce prolactin, growth hormone (GH), and thyroid-stimulating hormone (TSH), whereas the basophil cells produce adrenocorticotropic hormone (ACTH), beta-lipotropin, luteinizing hormone (LH), and follicle-stimulating hormone (FSH) The development of sensitive (radioimmunoassay) methods for the measurement of pituitary hormones in the serum has made possible the detection of adenomas at an early stage of their development and the designation of several types of pituitary adenomas on the basis of the endocrine disturbance Hormonal tests for the detection of pituitary adenomas, preferably carried out in an endocrine clinic, are listed in Table 31-3 Between 60 and 70 percent of tumors, in both men and women, are prolactin-secreting About 10 to 15 percent secrete growth hormone, and a smaller number secrete ACTH Tumors that secrete gonadotropins and TSH are quite rare These tumors may be monohormonal or plurihormonal and approximately one-third are composed of nonfunctional (null) cells Pituitary tumors usually arise as discrete nodules in the anterior part of the gland (adenohypophysis) They are reddish gray, soft (almost gelatinous), and often partly cystic, with a rim of calcium in some instances The adenomatous cells are arranged diffusely or in various patterns, with little stroma and few blood vessels; less frequently the architecture is sinusoidal or papillary in type Variability of nuclear structure, hyperchromatism, cellular pleomorphism, and mitotic gures are interpreted as signs of maTable 31-3 Hormonal tests for detection of pituitary adenomas
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Prolactin Somatotropin (GH) Adrenocorticotropin Gonadotropin Thyrotropin Vasopressin
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Serum prolactin level, chlorpromazine- or TRH-provocative tests, L-dopa suppression Serum GH level, glucagon, L-dopa, glucoseGH suppression, somatomicid C Serum cortisol, urinary steroids, metyrapone test, dexamethasone suppression Serum FSH, LH, estradiol, testosterone, GnRH stimulation TSH, T4, TRH Urine and serum osmolality after water restriction for de ciency of hormone; without water restriction for excess of hormone
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Key: FSH, follicle-stimulating hormone; LH, luteinizing hormone; GnRH, gonadotropin-releasing hormone; TRH, thyrotropin-releasing hormone; T4, thyroxine; TSH, thyroid-stimulating hormone; GH, growth hormone
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lignancy, which is exceedingly rare Tumors less than 1 cm in diameter are referred to as microadenomas and are at rst con ned to the sella As the tumor grows, it rst compresses the pituitary gland; then, as it extends upward and out of the sella, it compresses the optic chiasm; later, with continued growth, it may extend into the cavernous sinus, third ventricle, temporal lobes, or posterior fossa Recognition of an adenoma when it is still con ned to the sella is of considerable practical importance, since total removal of the tumor by transsphenoidal excision or some form of stereotactic radiosurgery is possible at this stage, with prevention of further damage to normal glandular structure and the optic chiasm Penetration of the diaphragm sellae by the tumor and invasion of the surrounding structures make treatment more dif cult Pituitary adenomas come to medical attention because of endocrine or visual abnormalities Headaches are present with nearly half of the macroadenomas but are not clearly part of the syndrome The visual disorder usually proves to be a complete or partial bitemporal hemianopia, which has developed gradually and may not be evident to the patient (see the description of the chiasmatic syndromes on page 206) Early on, the upper parts of the visual elds may be affected predominantly A small number of patients will be almost blind in one eye and have a temporal hemianopia in the other Bitemporal central hemianopic scotomata are a less frequent nding A post xed chiasm may be compressed in such a way that there is an interruption of some of the nasal retinal bers, which, as they decussate, project into the base of the opposite optic nerve (Wilbrand s knee) This results in a central scotoma on one or both sides (junctional syndrome) in addition to the classic temporal eld defect (see Fig 13-2) If the visual disorder is of long standing, the optic nerve heads are atrophic In 5 to 10 percent of cases, the pituitary adenoma extends into the cavernous sinus, causing some combination of ocular motor palsies Other neurologic abnormalities, rare to be sure, are seizures from indentation of the temporal lobe, CSF rhinorrhea, and diabetes insipidus, hypothermia, and somnolence from hypothalamic compression With regard to differential diagnosis, bitemporal hemianopia with a normal sella indicates that the causative lesion is probably a saccular aneurysm of the circle of Willis or a meningioma of the tuberculum sellae The major endocrine syndromes associated with pituitary adenomas are described brie y in the following pages Their functional classi cation can be found in the monograph edited by Kovacs and Asa A detailed discussion of the diagnosis and management of hormone-secreting pituitary adenomas can be found in the reviews of Klibanski and Zervas and of Pappas and colleagues; recommended also is an article that details the neurologic features of pituitary tumors by Anderson and colleagues Also worthy of emphasis is the catastrophic syndrome of pituitary apoplexy discussed further on Amenorrhea-Galactorrhea Syndrome As a rule, this syndrome becomes manifest during the childbearing years The history usually discloses that menarche had occurred at the appropriate age; primary amenorrhea is rare A common history is that the patient took birth control pills, only to nd, when she stopped, that the menstrual cycle did not re-establish itself On examination, there may be no abnormalities other than galactorrhea Serum prolactin concentrations are increased (usually in excess of 100 ng/mL) In general, the longer the duration of amenorrhea and the higher the serum prolactin level, the larger the tumor (prolactinoma) The elevated prolactin levels distinguish this disorder from idiopathic galactorrhea, in which the serum prolactin concentration is normal
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