CORE - Endocrine Flashcards by Tom Kesler

Cerebriform adrenal gland(s)

adrenal hyperplasia

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Salt-wasting in a boy

consider 21-hydroxylase deficiency CAH

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Genital ambiguity in a girl

consider 21-hydroxylase deficiency CAH

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Conn syndrome

increased aldosterone => hypertension, hypokalemia; most commonly due to a functional adenoma

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Cushing syndrome

over-production of ACTH due to paraneoplastic syndrome, adrenal adenoma, or primary adrenal hyperplasia

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Cushing disease

ACTH-secreting pituitary adenoma

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Adrenal hemorrhage is most common on which side?

right

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Nuclear medicine studies for diagnosis of pheochromocytoma

MIBG > octreoscan for adrenal pheo; octreoscan > MIBG for extra-adrenal pheo (paraganglioma)

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Post-micturition syncope

bladder paraganglioma

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Adrenal calcification DDx

old hemorrhage, ACC, myelolipoma (25%), neuroblastoma, TB, histoplasmosis, Wegener’s, melanoma mets

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Formula for absolute washout

(enhanced - delayed) / (enhanced - unenhanced) * 100

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Formula for relative washout

(enhanced - delayed) / (enhanced) * 100

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Relative washout % for adrenal adenoma

> 40% washout

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Absolute washout % for adrenal adenoma

> 60% washout

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HU cutoff for adrenal adenoma on NECT

10 HU

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Addison disease

adrenocortical insufficiency; autoimmune or post-infectious

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Bilateral enlarged and calcified adrenal glands (peds)

Wolman disease; often fatal

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Zuckerkandl tubercle

normal variant; projects from posterior aspect of lateral thyroid lobes

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Location of recurrent laryngeal n. relative to thyroid gland

medial to Zuckerkandl tubercle

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Thyroglossal duct cyst with an enhancing nodule + NEXT STEP

consider thyroid cancer; next step is biopsy

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Enlarged thyroid gland DDx

multi-nodular goiter, Graves disease, iodine deficiency

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TSH and T3/T4 in Graves disease

decreased TSH, increased T3/T4

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Grave’s ophthalmopathy

order of involvement = I-M-S-L-O; painless, spares tendon insertions, increased intra-orbital fat

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Dominant hyperechoic thyroid nodule(s)

Hashimoto’s thyroiditis (“white knight”)

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Diffusely coarsened or nodular thyroid gland

Hashimoto's thyroiditis

Delphian lymph nodes

adjacent to thyroid gland, level VI

Metastatic involvement of Delphian nodes

suggestive of metastatic laryngeal cancer

Reidel's thyroiditis

assoc. with IgG-4; women 40-70 y/o; enlarged gland, fibrous replacement (T1/T2 dark)

Enlarged thyroid gland with low T1 and T2 signal

Riedel's thyroiditis (fibrous replacement)

Granulmatous thyroiditis

a.k.a. de Quervain or subacute thyroiditis; due to viral infection, self-limited, painful; Tx is steroids

Lymphocytic thyroiditis

similar to subacute thyroiditis, except occurs post-partum and is painless

Most common type of thyroid cancer + 2nd most common type

papillary > follicular

Microcalcifications are most commonly assoc. with which type of thyroid cancer

papillary; microcalcifications may also be seen in nodal mets

Parathyroid adenoma imaging characteristics

early enhancement with delayed washout, T2 bright

Syndromes with increased risk of thyroid cancer

MEN 2 (medullary), Cowden (follicular), FAP/Gardner (papillary)

Calcitonin-producing type of thyroid cancer

medullary (assoc. with MEN 2)

Thyroid cancer types which respond poorly to I-131 therapy

medullary, anaplastic, Hurthle cell

"Pancake" adrenal gland

congenital absence of the ipsilateral kidney

Adrenal blood supply

superior suprarenal a. (from inferior phrenic a.), middle suprarenal a. (from aorta), inferior suprarenal a. (from renal a.)

Adrenal venous drainage

right suprarenal v. drains to the IVC, left suprarenal v. drains to renal v. or inferior phrenic v.

Adrenal zones

glomerulosa (aldosterone), fasciculata (cortisol), reticularis (androgens), medulla (catecholamines)

Triple stripe appearance of adrenal gland

normal in infants; hypoechoic cortex - hyperechoic medulla - hypoechoic cortex

Most common cause of excess cortisol

Cushing disease (pituitary adenoma)

Malignancy assoc. with increased ACTH production

small cell lung cancer

Clinical symptoms of Cushing disease/syndrome

moon facies, buffalo hump, central obesity, striae, thin skin

Causes of neonatal adrenal hemorrhage

breech birth or fetal distress ("stress"), congenital syphillis

Adrenal lesion equivocal for hemorrhage vs. neuroblastoma - NEXT STEP

short-term US follow-up (hemorrhage will get smaller)

Waterhouse-Friderichsen syndrome

post-hemorrhagic adrenal failure in the setting of N. meningitidis

Neuroblastoma typically arises from the adrenal cortex or medulla?

medulla

Pheochromocytoma imaging characteristics

T2 bright, heterogeneous enhancement

Pheochromocytoma assoc. syndromes

VHL, MEN 2 > NF1, tuberous sclerosis, Sturge-Weber, Carney triad

Carney triad

extra-adrenal pheochromocytoma (paraganglioma), pulmonary chondromas, GIST

Carney complex

cardiac myxomas, skin lesions; considered an MEN syndrome

Rule of 10's

for pheochromocytoma; 10% extra-adrenal, 10% bilateral, 10% malignant, 10% in children, 10% familial, 10% not assoc. with hypertension, 10% contain calcification

Myelolipoma associations

Cushing's, CAH, Conn's

Most common mets to adrenal gland

breast, lung, melanoma; same as spleen

Adrenal lesion with signal loss on out-of-phase

adenoma; may be functional or non-functional

MEN 1

parathyroid hyperplasia, pituitary adenoma, pancreatic islet cell tumors

MEN 2a

medullary thyroid cancer, pheochromocytoma, parathyroid hyperplasia

MEN 2b

medullary thyroid cancer, pheochromocytoma, neuromas (mucosal or ganglioneuromas), marfanoid habitus

Flushing, diarrhea, pain, right heart failure, bronchospasm

carcinoid syndrome (liver mets)

Most common location for carcinoid

appendix > ileum

Collision tumor

mets to adrenal gland with a pre-existing adenoma (classically)

Suspicious features of thyroid nodules

solid, calcifications (esp. microcalcifications)

Thyroid nodule with comet tail artifact

colloid nodule

Most common location of ectopic thyroid tissue

lingual thyroid

Most common location for a thyroglossal duct cust

infrahyoid (per Radiopaedia)

RAIU % for Grave's and multi-nodular goiter

>70% for Graves, >40% for multi-nodular goiter

Risk assoc. with Hashimoto's thyroiditis

increased risk of primary thyroid lymphoma

Antibodies assoc. with Hashimoto's thyroiditis

anti-TPO, anti-thyroglobulin

Hyperthyroid => hypothyroid => euthyroid

subacute thyroiditis

Acute suppurative thyroiditis

bacterial infection of thyroid, may develop into an abscess

Cause of acute suppurative thyroiditis (peds)

may start in a 4th branchial cleft anomaly

Thyroid cancer type that mets hematogenously

follicular

Thyroid cancer type assoc. with prior radiation

anaplastic; seen in elderly patients

Papillary thyroid cancer mets

often cystic with microcalcifications

Origin of parathyroid glands

superior glands from 4th branchial pouch, inferior glands from 3rd branchial pouch

Most common cause of hyperparathyroidism

parathyroid adenoma

Typical age for ganglioneuroma

>10 y/o

Laboratory test for pheochromocytoma

urine metanephrines/catecholamines (NE, Epi)

Lipid-poor adenoma

may be >10 HU on NECT and not demonstrate signal loss on out-of-phase MR

Indeterminant adrenal lesion after advanced imaging (CT/MR)

biopsy is indicated

Most common type of adrenal cyst

endothelial (lymphatic or angiomatous origin)

Adrenal cyst with peripheral calcification

pseudocyst (result of prior hemorrhage)

Most common location for an intra-abdominal paraganglioma

organ of Zuckerkandl (aortic bifurcation)

Adrenal cortical carcinoma - functional or non-functional?

may be either; functional ACC may produce excess aldosterone, cortisol, or androgens

Causes of adrenal hemorrhage (adult)

trauma, anticoagulation; may be bilateral; may cause hypotension