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Table of Contents | |
PITUITARY GLAND
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Mayo Clin Proc 1992 Jan;67(1):22-6 |
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The pituitary gland in hyperthyroidism.
Scheithauer BW, Kovacs KT, Young WF Jr, Randall RV
Section of Surgical Pathology, St. Michael's Hospital, Toronto, Ontario,
Canada.
The pituitary glands of 33 patients (24 women and 9 men, 18 to 78 years old)
who died in thyrotoxicosis (18 with Graves' disease and 15 with toxic
multinodular goiter [Plummer's disease]) were examined by histologic and
immunocytologic methods. Thirteen patients (39%) died in "thyroid
storm." The avidin-biotin-peroxidase complex immunostaining method was
used to demonstrate the spectrum of pituitary hormones, including growth
hormone, prolactin, adrenocorticotropic hormone, thyrotropin,
follicle-stimulating hormone, luteinizing hormone, and alpha-subunit. The
most striking finding was a pronounced decrease or loss of immunoreactivity
to thyrotropin in all thyrotoxic cases, a consistent change that allowed
ready distinction of thyrotoxic from euthyroid pituitary glands. When
immunoreactive thyrotrophs were identified, they were sparse and small and
demonstrated only faint thyrotropin reactivity. No morphologic
differences were noted between the pituitary glands of patients with Graves'
disease or Plummer's disease or between sexes. Loss of thyrotropin
immunoreactivity was found to be reversible in that thyrotropic cells in the
pituitary glands of 16 additional concurrently studied patients, who had
thyrotoxicosis but were treated and subsequently had normal thyroid function
or hypothyroidism, appeared normal or even hyperplastic. Other types of
adenohypophysial cells in both the thyrotoxic and the successfully treated
groups exhibited no abnormalities. Pituitary adenomas were incidental
findings in 6 of the 33 patients (18%). Their immunotypic spectrum included
three prolactin-immunoreactive tumors, two growth hormone-containing
adenomas (one of which was plurihormonal), and one tumor with
follicle-stimulating hormone and luteinizing hormone; no thyrotropin-containing
adenomas were noted. No examples of pituitary hyperplasia were encountered
in pituitary glands of thyrotoxic patients, and no hypophysitis or fibrosis
was noted.
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