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ABSITE > 20-22 Pituitary, Adrenal, Thyroid > Flashcards

20-22 Pituitary, Adrenal, Thyroid Flashcards

1
Q

Front (Term)

A

Back (Definition)

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2
Q

What inhibits prolactin secretions?

A

dopamine

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3
Q

What does the posterior pituitary produce?

A

ADH, Oxytocin

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4
Q

What nuclei in the hypothalamus produces ADH? and Oxytocin?

A

supraoptic, paraventricular

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5
Q

What does the anterior pituitary produce?

A

FSH, LH, ACTH, TSH, prolactin, GH

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6
Q

Nonfunctional tumors of the pituitary are almost always what type? what is the tx?

A

macroadenomas, transsphenoid resection

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7
Q

What rx might cause a response in TSH and FSH/LH secreting pituitary tumors?

A

bromocriptine (dopamine agonist)

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8
Q

What is the most common pituitary adenoma?

A

prolactinoma (mostly microadenomas)

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9
Q

Prolactinoma macroadenoma of the pituitary should be resected if hemorrhage, visual loss, CSF leak or if pt wants what?

A

pregnancy

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10
Q

Prolactinoma microadenoma of the pituitary should be resected if ____ unsafe or ineffective (is OK in pregnancy)

A

bromocriptine

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11
Q

Gigantism is a sx of acromegaly. Name 2 more.

A

HTN, DM

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12
Q

Name the acromegaly preoperative rx that inhibits the release of GH.

A

octreotide

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13
Q

How can acromegaly be life-threatening?

A

cardiac sx (valve dysfunction, cardiomyopathy)

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14
Q

Postpartum trouble lactating is usually the 1st sign of what syndrome?

A

Sheehan’s syndrome

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15
Q

Craniopharyngioma is a caclified cyst, remnants of what?

A

Rathke’s pouch

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16
Q

What syndrome occurs after bilateral adrenalectomy; increased CRH causes pituitary enlargement resulting in amenorrhea and visual problems?

A

Nelson’s syndrome

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17
Q

Why is there hyperpigmentation in Nelson’s syndrome?

A

bilateral adrenalectomy causes increased ACTH, beta-MSH (melanocyte-stimulating hormone) is a peptide byproduct of ACTH

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18
Q

What is the tx for Nelson’s syndrome?

A

steroids

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19
Q

What syndrome is caused by adrenal gland hemorrhage that occurs after meningococcal sepsis infection; can lead to adrenal insufficiency.

A

Waterhouse-Friderichsen syndrome

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20
Q

What is the arterial supply of the adrenal gland and what is their origin?

A

Superior adrenal - inferior phrenic artery
Middle adrenal - aorta
Inferior adrenal - renal artery

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21
Q

What is the venous drainage of the adrenal glands?

A

Left adrenal vein goes to left renal vein

Right adrenal vein goes to inferior vena cava

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22
Q

What percentage of abdominal CT scans show adrenal incidentalomas? what percentage are mets or primary adrenal tumors?

A

1-2%, 5%

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23
Q

When is surgery indicated for asymptomatic adrenal mass?

A

ominous characteristics (nonhomongenous),
>4-6 cm,
functioning,
enlarging

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24
Q

How often to follow up for asymptomatic adrenal mass?

A

every 3 mos for first year and yearly after that

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25
Q

What is the most common mets to adrenal?

A

lung CA

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26
Q

What is the workup for asymptomatic adrenal mass with a cancer history?

A

bx

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27
Q

What are the 3 layers of the adrenal cortex and what do they produce?

A

GFR
Glomerulosa - aldosterone (salt)
Fasciculata - glucocorticoids (sugar)
Reticularis - androgens/estrogens (sex)

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28
Q

What is the innervation to the adrenal cortex? and the medulla?

A

none, splanchnic nerves

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29
Q

What does 4 things does aldosterone affect in the kidney?

A

sodium resorption, secretion of potassium, hydrogen ions, and ammonia

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30
Q

What does excess estrogens and androgens by adrenals almost always indicate?

A

CA

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31
Q

What is the most common (90%) congenital adrenal hyperplasia?

A

21 hydroxylase deficiency

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32
Q

In 21 hydroxylase deficiency what hormone is produced in excess and what is the effect on BP?

A

increased testosterone causes precocious puberty in males and virilization in females. Is salt wasting so causes hypotension

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33
Q

What are the 2 treatments for 21 hydroxylase deficiency and 11 hydroxylase deficiency?

A

cortisol and genitoplasty

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34
Q

List the 3 types of congenital adrenal hyperplasia and their sexual development and BP sx.

A

21 hydroxylase deficiency causes precocious puberty in males virilization in females. It is salt wasting so it causes hypotension

17 hydroxylase deficience causes ambiguous genitalia in males at birth and is salt saving

11 Hydroxylase deficiency precocious puberty in males, virilization in females. Salt saving so it causes hypertension

21 hypotensive boy, 17 hypertensive girl, 11 hypertensive boy

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35
Q

What is the name of the syndrome with hyperaldosteronism?

A

Conn’s syndrome

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36
Q

What are the two types of Conn’s syndrome and their primary marker?

A

Primary disease has low renin (adenoma),

Secondary disease has high renin (CHF, RAS, liver failure, diuretics, Bartter’s syndrome - renin secreting tumor)

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37
Q

What is more common primary or secondary Conn’s syndrome?

A

secondary

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38
Q

What is the #1 and #2 causes of primary hyperaldosteronism?

A

adenoma, hyperplasia

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39
Q

Localizing studies in hyperaldosteronesim include Localizing studies – MRI, and ___ (shows hyperfunctioning adrenal tissue; differentiates adenoma from hyperplasia; 90% accurate); ___ if others nondiagnostic

A

NP-59 scintigraphy,

adrenal venous sampling

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40
Q

In the tx of hyperaldosteronism, hyperplasia is seldom cured (↑ morbidity with bilateral resection) Try medical therapy first with hyperplasia using ___, calcium channel blockers, and potassium. If bilateral resection is performed (usually done for refractory hypokalemia), patient will need ___ postoperatively

A

spironolactone,

fludrocortisone

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41
Q

What is the number one cause of hypocortisolism?

A

withdrawal of exogenous steroids

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42
Q

What is the number one cause of hypercortisolism?

A

iatrogenic

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43
Q

In the diagnosis of hypercortisolism what is done first (most sensitive test)? What is done 2nd?

A

24 hour urine cortisol, low dose overnight dexamethasone suppression test

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44
Q

What is the dx if low-dose overnight dexamethasone suppression test results in low urinary cortisol?

A

Cushing’s disease (pituitary adenoma)

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45
Q

What is the #1 non-iatrogenic cause of Cushing’s syndrome?

A

Cushing’s disease (pituitary adenoma)

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46
Q

What is the #2 noniatrogenic cause of Cushing’s syndrome? what is its most common cause?

A

Ectopic ACTH, small cell lung CA

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47
Q

Cortisol is not suppressed with either the low-dose or high-dose dexamethasone suppression test, what is the most likely diagnosis?

A

ectopic ACTH

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48
Q

With ectopic ACTH resection of the primary tumor is the tx. What are two alternatives if resection is not possible?

A

medical suppression or bilateral adrenalectomy

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49
Q

Name the drug used for adrenocortical cancer with metastatic disease that is an adrenal-lytic

A

Op-DDD (mitotane)

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50
Q

What is the origin of the adrenal medulla?

A

ectoderm neural crest cells

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51
Q

Catecholamine production starts with tyrosine. What are the next 4?

A

dopa -> dopamine -> norepinephrine -> epinephrine

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52
Q

What is the rate limiting step in the production of catecholamines and what is the enzyme?

A

tyrosine to dopa, tyrosine hydroxylase

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53
Q

PNMT is the enzyme only found in the adrenal medulla. What does it doe?

A

converts norepinephrine to epinephrine

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54
Q

What is the only type of pheochromocytomas that will produce epinephrine?

A

adrenal

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55
Q

What is the most notable location for extra-adrenal neural crest tissue?

A

organ of Zuckerkandl

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56
Q

What are the 5 things in the 10% rule for pheochromocytoma?

A

malignant, bilateral, in children, familial, extra-adrenal

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57
Q

What type(s) of MEN syndrome are associated with pheo?

A

MEN IIA and IIB

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58
Q

Which side are most pheos on?

A

right

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59
Q

Extra-adrenal pheos are more likely what?

A

malignant

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60
Q

What type of scan is useful in finding the location of a pheo?

A

MIBG (noepinephrine analogue)

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61
Q

Why don’t you use venography with pheo dx?

A

can cause hypertensive crisis

62
Q

How do you control pressure in a pheo pt preoperatively?

A

alpha blocker (phenoxybenzamine) before beta blocker to prevent a hypertensive crisis from unopposed alpha blockade

63
Q

What drug is used in the tx of pheo, inhibits tyrosine hydroxylase causing decreased synthesis of catecholamines?

A

metyrosine

64
Q

What is an important step in the resection of a pheo?

A

ligate veins before manipulating tumor

65
Q

Name 4 extra adrenal sites for pheo.

A

vertebral bodies, opposite adrenal gland, bladder, aortic bifurcation

66
Q

Name the rare benign, asymptomatic tumor of neural crest origin in the adrenal medulla or sympathetic chain.

A

Ganglioneuroma

67
Q

What is the origin of the thyroid?

A

1st and 2nd pharyngeal pouches

68
Q

What is the blood supply of the thyroid with origins?

A

superior thyroid arter is the 1st branch off the external carotid artery,

inferior thyroid artery is off the thyrocervical trunk

69
Q

What is the blood supply to the parathyroids and how should they be ligated in thyroidectomy?

A

inferior thyroid arteries, ligate close to thyroid to avoid injuring parathyroids

70
Q

What is the blood supply to the thyroid isthmus that is occurs in 1% and its origin?

A

Ima artery arises from the innominate or aorta

71
Q

What is the venous drainage of the thyroid and where do they drain?

A

Superior and middle thyroid veins drain into the internal jugular. The inferior vein drains to the innominate vien

72
Q

Nonrecurrent laryngeal nerve arises directly from the vagus and occurs in 2-3%. Which side is more common?

A

right

73
Q

The superior laryngeal nerve tracks close to what other structure?

A

superior thyroid artery but is variable

74
Q

What is the innervation of the cricothyroid muscle and what does injury result in?

A

superior laryngeal nerve, loss of projection and easy voice fatigability

75
Q

Where does the recurrent laryngeal nerve track?

A

runs posterior to thyroid lobes in the tracheosophageal groove. can track with inferior thyroid artery but is variable

76
Q

What structures do the right and left recurrent laryngeal nerves loop around?

A

right loops around right subclavian, left loops around aorta

77
Q

What does the recurrent laryngeal nerve innervate?

A

motor to all larynx except cricothyroid

78
Q

Injury to recurrent laryngeal nerve results in hoarseness. What additional tx is need for bilateral injury and why?

A

needs emergency trach since bilateral injury can obstruct airway

79
Q

What is the posterior medial suspensory ligament of the thyroid that is close to the RLNs and requires careful dissection?

A

Ligament of Berry

80
Q

What is the molecule that stores T3 and T4 in colloid?

A

thyroglobulin

81
Q

What is the most lateral posterior extension of thyroid tissue called? They can be rotated medially to find what structures? (left behind with subtotal thyroidectomy because of proximity).

A

Tubercles of Zuckerkandl

82
Q

What is the name of the cells that produce calcitonin?

A

Parafollicular C cells

83
Q

What is a long-term side effect of thyroxine treatment?

A

osteoporosis

84
Q

Postthyroidectomy pt develops stridor. What do you do?

A

open neck emergently to remove hematoma, can result in airway compromise

85
Q

Thyroid storm is most common after surgery in pt with undiagnosed ____?

A

Grave’s disease

86
Q

What are the following sx of?:

increased HR, fever, numbness, irritability, vomiting, diarrhea, high-output cardiac failure (most common cause of death)

A

Thyroid storm

87
Q

Describe the Wolf-Chaikoff effect which is very effective for pts in thyroid storm.

A

Patient given high doses of iodine (Lugol’s solution, potassium iodide), which inhibits TSH action on thyroid and inhibits organic coupling of iodide, resulting in less T3 and T4 release

88
Q

What is the first step in dx of asymptomatic thyroid nodule?

A

thyroid function tests

89
Q

Asymptomatic thyroid nodule FNA shows cyst fluid. It is drained and it recurs, what next?

A

thyroidectomy or lobectomy

90
Q

Asymptomatic thyroid nodule with normal TFTs what is the next step in dx?

A

FNA

91
Q

Thyroid FNA shows colloid tissue what is the tx?

A

Low chance of malignancy (<1%), thyroidectomy or lobectomy if it enlarges

92
Q

Thyroid FNA shows follicular cells, what next and what is the malignancy rate?

A

thyroidectomy or lobectomy (5-10% malignancy rate)

93
Q

What percentage of thyroid nodules are benign?

A

85%

94
Q

What next if a thyroid nodule FNA is indeterminate?

A

Radionucleotide study

95
Q

Thyroid nodule FNA is indeterminate, radionucleotide study shows hot nodule, what next?

A

Give thyroxine for 6 months, if size does not decrease perform lobectomy

96
Q

Thyroid nodule FNA is indeterminate, radionucleotide study shows cold nodule, what next?

A

thyroidectomy or lobectomy

97
Q

Diffuse enlargement of thyroid without evidence of functional abnormality = nontoxic colloid goiter. What is the tx?

A

Tx: try to suppress with thyroxine; 131I (may be ineffective), thioamides, subtotal thyroidectomy or lobectomy on side of goiter if medical treatment ineffective

98
Q

What is the name of the thyroid lobe that occurs in 10%, extends from the isthmus toward the thymus?

A

pyramidal lobe

99
Q

What is the cyst that classically moves upward with swallowing?

A

thyroglossal duct cyst

100
Q

What is the tx for thyroglossal duct cyst and why?

A

Resection, susceptible to infection and my be premalignant. (Also need to take midportion or all of hyoid bone along with the cyst)

101
Q

What are the two main side effects of PTU and Methimazole?

A

aplastic anemia or agranulocytosis

102
Q

What is the treatment for hyperthyroidism that is good for young pts, small goiters and mild T3 and T4 elevation?

A

PTU and methimazole

103
Q

What is the treatment for hyperthyroidism that is good for pts who are poor surgical candidates or unresponsive to PTU?

A

radioactive iodine (131I)

104
Q

When is the best time to operate in pregnant women with hyperthyroidism?

A

2 trimester due to decreased risk of teratogenic events and premature labor

105
Q

What is the most common cause of hyperthyroidism and what is the pathophys?

A

Graves’ disease, IgG antibodies to TSH receptor

106
Q

What is the recurrence rate for tx of Graves’ disease with thioamides, 131I, and subtotal thyroidectomy?

A

70%, 10%, 10%

107
Q

Suspicious nodule in pt with Graves’ disease, what is the tx?

A

bilateral subtotal or total thyroidectomy

108
Q

What is the preop preparation for a pt with Graves’ disease undergoing a bilateral subtotal or total thyroidectomoy?

A

Preop preparation: PTU or methimazole until euthyroid, β-blocker, 1 week before surgery, Lugol’s solution for 10–15 days to decrease friability and vascularity (start only after euthyroid)

109
Q

What is the most common cause of thyroid enlargement?

A

toxic multinodular goiter

110
Q

Sx of toxic multinodular goiter include:

cardiac symptoms, weight loss, insomnia, airway compromise;

What could precipitate sx?

A

contrast dyes

111
Q

What is the tx for toxic multinodular goiter and single toxic nodule?

A

131I and thioamides; 131I can be less effective in some (inhomogeneous uptake by gland); subtotal thyroidectomy or lobectomy if medical treatment ineffective

112
Q

What is the most common cause of hypothyroidism in adults?

A

hashimoto’s disease

113
Q

Why can a goiter develope in Hashimoto’s disease?

A

lack of organification of trapped iodide inside gland

114
Q

What usually precipitates DeQuervains’s thyroiditis?

A

viral URI

115
Q

What is the tx for De Quervains thyroiditis?

A

steroids, ASA

116
Q

Rare condition of woody, fibrous component to thyroid that can involve adjacent strap muscles and carotid sheath • Can resemble thyroid CA or lymphoma (need biopsy) • Disease frequently results in hypothyroidism and compression. Tx is steroids and thyroxine. May need isthmectomy or trach.

A

Riedel’s fibrous struma

117
Q

What is the most common endocrine malignancy in the US?

A

thyroid CA

118
Q

What is the most common type of thyroid CA?

A

papillary

119
Q

What type of thyroid CA is the least aggressive, slow growing and has the best prognosis?

A

papillary

120
Q

What is the prognosis in papillary thyroid CA based on?

A

local invasion

121
Q

What type of thyroid cancer’s pathology has psammoma bodies and ophan Annie nuclei?

A

papillary

122
Q

Papillary thyroid CA less than what size can have a lobectomy instead of total thyroidectomy?

A

<1 cm

123
Q

Papillary Thyroid CA with clinically positive cervical nodes or extrathyroidal tissue requires what additional tx?

A

ipsilateral MRND

124
Q

Papillary thyroid CA with metastatic disease, residual local disease, positive lymph nodes or capsular invasion requires what addtional tx?

A

131I 6 weeks after surgery

125
Q

When would you give XRT for papillary thyroid CA

A

unresectable or no response to 131I

126
Q

What is the 5 year survival in papillary thyroid CA?

A

95%

127
Q

Enlarged lateral neck lymph node that shows normal appearing tissue. What is it and what is the tx?

A

papillary thyroid CA with lymphatic spread, total thyroidectomy and MRND

128
Q

What percentage of follicular thyroid carcinoma has metastatic disease at the time of presentation?

A

50%

129
Q

What is the route of metastasis and most common site with follicular thyroid carcinoma?

A

hematogenous, bone

130
Q

If thyroid nodule FNA shows just follicular cells, what is the chance of malignancy?

A

10%

131
Q

Lobectomy for follicular cells on thyroid FNA. Pathology shows adenoma or follicular cel hyperplasia. What next?

A

nothing

132
Q

What size thyroid lesions showing follicular CA need total thyroidectomy?

A

> 1 cm

133
Q

Follicular thyroid CA with clinically positive cervical nodes or extrathyroidal tissue involvement. What additional tx is needed?

A

ipsilateral MRND

134
Q

Follicular thyroid CA > 1 cm or extrathyroidal disease need what tx in addition to thyroidectomy?

A

131I 6 weeks after surgery

135
Q

What is the 5 year survival rate with follicular thyroid CA?

A

70%

136
Q

What does the pathology show in medullary thyroid carcinoma?

A

amyloid deposition

137
Q

What can be used to test for medullary thyroid CA? Causes increase in calcitonin?

A

Gastrin

138
Q

From what cells does Medullary thyroid carcinoma arise and what do they secrete?

A

parafollicular C cells, calcitonin

139
Q

What two other conditions should be screened for if medullary thyroid carcinoma is diagnosed?

A

hyperparathyroidism and pheochromocytoma

140
Q

What are two sx of elevated calcitonin?

A

flushing and diarrhea

141
Q

Tx for medullary thyroid carcinoma is total thyroidectomy with what other dissection?

A

central neck

142
Q

Prophylactic thyroidectomy and central node dissection in MEN IIa or IIb patients at what age?

A

2 years

143
Q

What can be monitored for disease recurrence in medullary thyroid carcinoma?

A

calcitonin

144
Q

What is the 5 year survival in medullary thyroid carcinoma?

A

50%

145
Q

What is the 5 year survival for anaplastic thyroid cancer?

A

0%

146
Q

What types of thyroid CA is 131I effective?

A

papillary and follicular only

147
Q

When do you give I 131?

A

4-6 weeks after surgery when TSH levels are highest

148
Q

When are TSH levels highest?

A

4-6 weeks after surgery

149
Q

Should you give thyroid replacement before treatment with I131?

A

No. This would suppress TSH and uptake of I131

150
Q

What are the indications for I131?

A

papillary and follicular only, recurrent CA, primary inoperable tumors due to local invasion, tumors that are >1cm or have extrathyroidal disease (extra-capsular invasion, nodal spread, or mets)

151
Q

What do you do for pts with papillary or follicular cell CA and mets?

A

perform total thyroidectomy to facilitate uptake of I131 to the metastatic lesions (otherwise all gets absorbed by the thyroid gland).

152
Q

What are the side effects of I-131?

A

sialoadenitis, GI sx, infertility, bone marrow suppression, parathyroid dysfunction, leukemia.

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