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| ==Differential Diagnosis==
| | * Zenker's diverticula (ZD) is thought to be as a result of motor abnormalities of the esophagus. |
| Multiple endocrine neoplasia type 1 must be differentiated from the hereditary diseases shown in the table below.
| | * ZD emerge from a defect within the Killian's triangle that's a natural place of weak point of the muscular wall of the hypopharynx. |
| {| style="border: 0px; font-size: 90%; margin: 3px; width: 600px" align=center
| | * Killian's triangle is formed by the oblique fibers of the inferior pharyngeal constrictor muscle and the cricopharyngeal sphincter. |
| |valign=top|
| | * chronic strain on the Killian's triangle leads to an Evagination of the sphincter, which may be because of causes: |
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| ! style="background: #4479BA; width: 200px;" | {{fontcolor|#FFF|Disease}}
| | ●high pressures in the food bolus in the course of swallowing |
| ! style="background: #4479BA; width: 400px;" | {{fontcolor|#FFF|Definition}}
| | ●difficulty in swallowing because of abnormalities of the upper esophageal sphincter (UES) |
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| | style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |[[von Hippel-Lindau syndrome]]
| | The consequences of numerous studies illustrate the kinds of observations made in patients with ZD: |
| | style="padding: 5px 5px; background: #F5F5F5;" |An [[autosomal dominant]] genetic disorder causing abnormal growth of [[blood vessel]]s in different parts of the [[body]].
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| | * a variety of situations predisposing to herniation within Killian's triangle, inclusive of atypical esophageal motility, esophageal shortening, or disorders related to altered u.s.function. |
| | style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |[[Tuberous sclerosis]]
| | * increased intrabolus pressures found in patients with ZD can be secondary to impaired bolus passage in combination with or as a result of gastroesophageal reflux disease. |
| | style="padding: 5px 5px; background: #F5F5F5;" |A rare multi-system genetic disease that causes [[benign]] [[tumor]]s to grow in the [[brain]] and on other vital organs such as the [[kidney]]s, [[heart]], [[eye]]s, [[lung]]s, and [[skin]].
| | * An unanswered question is how spasms of the u.s.provoked by acid reflux should cause improved intrabolus pressures during swallowing, given that swallowing is often distinct from episodes of acid reflux disorder. |
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| | style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |[[Carney complex]]
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| | style="padding: 5px 5px; background: #F5F5F5;" |An [[autosomal dominant]] condition comprising [[myxoma]]s of the [[heart]] and [[skin]], [[hyperpigmentation]] of the [[skin]] (lentiginosis), and [[endocrine]] overactivity.
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| | style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |[[Neurofibromatosis type 1]]
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| | style="padding: 5px 5px; background: #F5F5F5;" | An [[autosomal dominant]] [[tumor]] disorder of [[central nervous system]] due to [[germline]] mutations in [[neurofibromin]] manifesting as [[scoliosis]] (curvature of the [[spine]]), learning disabilities, [[vision]] disorders, cutaneous [[lesion]]s and [[epilepsy]].
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| | style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |[[Li-Fraumeni syndrome]]
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| | style="padding: 5px 5px; background: #F5F5F5;" | An [[autosomal dominant]] rare disorder due to [[germline mutation]]s of the [[TP53]] [[tumor suppressor gene]] characterized by early onset of diverse amount of [[cancer]]s such as [[sarcoma]], [[cancer]]s of the [[breast]], [[brain]] and [[adrenal gland]]s.
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| | style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |[[Gardner's syndrome]]
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| | style="padding: 5px 5px; background: #F5F5F5;" | Familial colorectal polyposis is an [[autosomal dominant]] form of [[polyposis]] characterized by the presence of multiple [[polyp]]s in the [[colon]] together with [[tumor]]s outside the [[colon]] .
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| | style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |[[Multiple endocrine neoplasia type 2]]
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| | style="padding: 5px 5px; background: #F5F5F5;" |An [[autosomal dominant]] disorder characterized by [[medullary thyroid carcinoma]] (MTC), [[pheochromocytoma]] and primary [[hyperparathyroidism]].
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| | style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |[[Cowden syndrome]]
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| | style="padding: 5px 5px; background: #F5F5F5;" |A rare [[autosomal dominant]] disorder due to [[germline mutation]] of [[PTEN]], a [[tumor suppressor gene]] characterized by multiple [[tumor]]-like growths called [[hamartoma]]s.
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| | style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |[[Cushing's syndrome]]
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| | style="padding: 5px 5px; background: #F5F5F5;" | A disorder due to prolonged exposure to [[cortisol]] characterized by [[hypertension]], abdominal [[obesity]] but with thin [[arm]]s and [[leg]]s, purple [[abdominal striae]], [[moon facies]], [[buffalo lump]], weak [[muscle]]s, weak [[bone]]s, [[acne]], and fragile [[skin]] that [[heal]]s poorly.
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| | style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |[[Acromegaly]]/[[gigantism]]
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| | style="padding: 5px 5px; background: #F5F5F5;" |A rare syndrome due to excess [[growth hormone]] characterized by enlargement of the [[hand]]s, [[feet]], [[nose]], [[lip]]s and [[ear]]s, and a general thickening of the [[skin]], [[hypertrichosis]], [[hyperpigmentation]] and [[hyperhidrosis]] and [[carpal tunnel syndrome]].
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| | style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |[[Hyperaldosteronism]]
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| | style="padding: 5px 5px; background: #F5F5F5;" |A [[disorder]] due to excess production of the [[aldosterone]] by the [[adrenal gland]]s characterized by [[hypertension]], muscular weakness, [[muscle]] spasms, tingling sensations and excessive [[urination]].
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| | style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |[[Pituitary adenoma]]
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| | style="padding: 5px 5px; background: #F5F5F5;" |A [[tumor]] in [[pituitary gland]] characterized by [[visual field defect]]s, classically [[bitemporal hemianopsia]], increased [[intracranial pressure]], [[migraine]] and [[lateral rectus]] palsy.
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| | style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |[[Hyperparathyroidism]]
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| | style="padding: 5px 5px; background: #F5F5F5;" |A [[disorder]] due to excess production of [[parathyroid]] hormone characterized by [[kidney stone]]s, [[hypercalcemia]], [[constipation]], [[peptic ulcer]]s and [[depression]].
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| | style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |[[Thyroid carcinoma]]
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| | style="padding: 5px 5px; background: #F5F5F5;" |A [[tumor]] of the [[thyroid gland]] characterized by [[sign]]s and symptoms of [[hyperthryroidism]] or [[hypothyroidism]].
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| | style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |[[Pheochromocytoma]]/[[paraganglioma]]
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| | style="padding: 5px 5px; background: #F5F5F5;" |A [[neuroendocrine tumor]] of the [[medulla]] of the [[adrenal gland]]s characterized by episodic [[hypertension]], [[palpitation]]s, [[anxiety]], [[diaphoresis]] and [[weight loss]].
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| | style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |[[Adrenocortical carcinoma]]
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| | style="padding: 5px 5px; background: #F5F5F5;" |An aggressive [[cancer]] originating in the [[cortex]] of the [[adrenal gland]] that may either by non-secretory (asymptomatic) or secretory with signs and symptoms of [[Cushing syndrome]] ([[cortisol]] hypersecretion), [[Conn syndrome]] ([[aldosterone]] hypersecretion), [[virilization]] ([[testosterone]] hypersecretion)
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| | style="padding: 5px 5px; background: #F5F5F5;" colspan="2"|<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>
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- Zenker's diverticula (ZD) is thought to be as a result of motor abnormalities of the esophagus.
- ZD emerge from a defect within the Killian's triangle that's a natural place of weak point of the muscular wall of the hypopharynx.
- Killian's triangle is formed by the oblique fibers of the inferior pharyngeal constrictor muscle and the cricopharyngeal sphincter.
- chronic strain on the Killian's triangle leads to an Evagination of the sphincter, which may be because of causes:
●high pressures in the food bolus in the course of swallowing
●difficulty in swallowing because of abnormalities of the upper esophageal sphincter (UES)
The consequences of numerous studies illustrate the kinds of observations made in patients with ZD:
- a variety of situations predisposing to herniation within Killian's triangle, inclusive of atypical esophageal motility, esophageal shortening, or disorders related to altered u.s.function.
- increased intrabolus pressures found in patients with ZD can be secondary to impaired bolus passage in combination with or as a result of gastroesophageal reflux disease.
- An unanswered question is how spasms of the u.s.provoked by acid reflux should cause improved intrabolus pressures during swallowing, given that swallowing is often distinct from episodes of acid reflux disorder.