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CTC Endocrine Flashcards

1
Q

Blood supply to the adrenal glands

A

Three arteries: superior from the inferior phrenic, middle from the aorta, and inferior from the renal artery.

Venous: Via one major vein. IVC on right, left renal vein

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2
Q

What are the 4 zones of the adrenal glands and what do they make?

A

Zona Glomerulosa: Aldosterone
Zona Fasciculata: Cortisol
Zona Reticularis: Androgens
Medulla: Catecholamines

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3
Q

What does the adrenal gland look like on US in peds?

A

Cortex is hypoechoic and medulla is hyperechoic.

Triple stripe appearance - Dark cortex, bright medulla, dark cortex.

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4
Q

Causes of adrenal hypertrophy?

A

21-hydroxylase deficiency - congenital hypertrophy - genital ambiguity (girls) or some salt losing pathology (boys). Adrenal limb width greater than 4 mm and loss of central hyperechoic stripe.

Cushing Syndrome: Too much cortisol. Pituitary adenoma (75%), or ectopic production from small cell lung cancer. BILATERAL gland hyperplasia. Less commonly (20%) it is from adrenal adenoma.

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5
Q

Waht is 21-hydroxylase deficiency?

A

Congenital adrenal hypertrophy - genital ambiguity (girls) or some salt losing pathology (boys). Adrenal limb width greater than 4 mm and loss of central hyperechoic stripe.

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6
Q

Causes of adrenal hemorrhage?

A

Stress - after breech birth, but can be seen with fetal distress, and congenital syphilis. Imaging changes with stage of hemorrhage - hyperechoic to isoechoic to hypoechoic. Calcification is often the end result. Should be avascular. Can occur bilaterally, but favors the right side (75%). Serial US will differentiate it from cystic neuroblastoma - will get smaller.

Trauma - more common in adults - CT - more common on the right.

Waterhouse-Friderichsen Syndrome - Hemorrhage of adrenal glands in the setting of fulminant meningitis (Neisseria Meningitidis).

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7
Q

What is Waterhouse-Friderichsen Syndrome?

A

Hemorrhage of adrenal glands in the setting of fulminant meningitis (Neisseria Meningitidis).

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8
Q

Characteristics of Pheochromocytoma

A

Usually large at presentation (larger than 3 cm). Usually heterogeneous mass on CT.

T2 BRIGHT.

Both MIBG and octreotide could be used (MIBG is better since Octreotide also uptakes in the kidney)

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9
Q

What is the “Rule of 10s” with Pheochromocytoma?

A 
10% are extra adrenal (organ of Zuckerkandl - T2 bright
10% are bilateral
10% in children
10% hereditary - VHL, MEN IIa and IIb
10% are NOT active (no HTN).
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10
Q

What are the syndromes associated with Pheochromocytoma?

A

VHL
MEN IIa and IIb

NF1
Sturge Weber
TS

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11
Q

What is the Carney Triad?

A

Extra-adrenal Pheochromocytoma
GIST
Pulmonary Chondroma (hamartoma)

Carney Complex = Cardiac myxoma and skin pigmentation)

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12
Q

What endocrine disorders are myelolipomas associated with?

A

Cushings, Congenital adrenal hyperplasa, and Conns

These tumors are NOT functional, they just happen to have associated disorders about 5-10% of the time.

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13
Q

What mets to the adrenal gland?

A

Breast, lung, and melanoma

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14
Q

Findings of Adrenal Cortical Carcinoma

A

Large (4-10 cm)
May be functional (cushings)
Calcify in about 20% of the cases.

Often met everywhere (direct invasion first)
Not likely to be less than 5 cm and often has central necrosis.

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15
Q

Ways to evaluate an adrenal adenoma?

A

Non-con CT: Less than 10 HU

Contrast:
Absolute Washout:: (Enhanced - Delayed)/(Enhanced - Unenhanced) x 100. Greater than 60% = Adenoma
Relative Washout: (Enhanced CT - Delayed CT)/Enhanced x 100. Greater than 40% = Adenoma

MRI: Look for drop out on in and out of phase T1.

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16
Q

How do you measure absolute washout of an adenoma?

A

(Enhanced - Delayed)/(Enhanced - Unenhanced) x 100.

Greater than 60% = Adenoma

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17
Q

How do you measure relative washout of an adenoma?

A

(Enhanced CT - Delayed CT)/Enhanced x 100.

Greater than 40% = Adenoma

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18
Q

What is Conn Syndrome?

A

Excessive aldosterone production.

MC by a benign adenoma (70%)
Cortical carcinoma can do it, but that is much more rare and usually accompanied by hypercortisolism.

19
Q

Causes of adrenal calcifications?

A

Prior trauma or infection (TB).
Certain tumors (cortical carcinoma, neuroblastoma) can have calcifications.
Melanoma mets are known to calcify.

20
Q

What is Wolman Disease?

A

Bilateral enlarged calcified adrenals.

Fat metabolism error that kills w/in 6 months.

21
Q

What is MEN1?

A

3 Ps

Pituitary Adenoma
Parathyroid Hyperplasia
Pancreatic Tumor (gastrinoma most commonly)

22
Q

What is MEN2?

A

2 Ps and 1 M

Medullary thyroid cancer
Parathyroid hyperplasia
Pheochromocytoma

23
Q

What is MEN2b?

A

2Ms and 1 P

Medullary thyroid cancer
Pheochromocytoma
Mucosal Neuroma/Marfanoid Body Habitus

24
Q

What is Carcinoid Syndrome>

A

Flushing, diarrhea, pain, right heart failure from serotonin manufactured by the carcinoid tumor.

MC in GI tract with the appendix being the overally MC location.

There is an association of GI carcinoids with other GI tumors (GI adenocarcinoma)

25
Q

What is the Zuckerkandl Tubercle of the thyroid?

A

Posterior nodular extension, helps give a location of the recurrent laryngeal nerve - medial to it.

26
Q

Qualities that make a thyroid nodule suspicious?

A 
More solid (cystic is more benign)
Calcifications (especially microcalcifications) - MC buzzword for papillary thyroid cancer.
27
Q

What is associated with a thyroglossal duct cyst?

A

Can get infected

Can have Papillary thyroid cancer - see an enhancing nodule.

28
Q

Clinical features of Graves Orbitopathy?

A

Spares the tendon insertion.
Doesn’t hurt (unlike pseudotumor)
Also has increased intra-orbital fat.

29
Q

What are the two classic findings of Hashimotos Thyroiditis on US?

A

Heterogeneous “giraffe skin” appearance

White knights - uniform hyperechoic nodules - usually regenerative nodules

30
Q

What is Reidels Thyroiditis?

A

IgG4 associated (also orbital pseudotumor, retroperitoneal fibrosis, sclerosing cholangitis)

Women in their 40s-70s.

Thyroid is replaced by fibrous tissue and diffusely enlarges causing compression of adjacent structures (dysphagia, stridor, vocal cord palsy)

Increased vascularity on US.
Decreased uptake.
Dark on all sequences on MRI - like a fibroma)

31
Q

What are the IgG4 associated diseases?

A

Reidels Thyroiditis
Orbital Pseudotumor
Retroperitoneal Fibrosis
Sclerosing Cholangitis

32
Q

What is Acute Suppurative Thyroiditis?

A

Bacterial infection of the thyroid - possible to develop abscess

May start in the 4th branchial cleft anomaly (usually on the left), travel via a pyriform fistula and then infect the thyroid.

33
Q

What is a Thyroid Adenoma?

A

Look like a solid nodule on US

Can be hyperfunctioning (hot uptake)

34
Q

How do Papillary Thyroid cancer metastasize?

A

Lymphatics

Follicular is hematogenous

35
Q

How does Follicular Thyroid cancer metastasize?

A

Hematogenous

Papillary is lymphatic.

36
Q

Which thyroid cancers do and do not respond well to I-131?

A

Papillary and Follicular will respond

Medullary, Anaplastic, and Hurthle Cell will not.

37
Q

Which thyroid cancer will produce calcitonin?

A

Medullary

MENII

Local invasion, LN, and hematogenous

Does not respond to I-131

38
Q

What patients does Anaplastic Thyroid cancer involve?

A

Elderly
Prior radiation treatment

Rapid growth with primarily lymphatic spread

Does not respond to I-131

39
Q

What is Hurthle Cell thyroid cancer?

A

Variant of Follicular
Seen in elderly
Does not take up I-131 as well as follicular

FDG-PET is the way to go for surveillance.

40
Q

What does metastatic thyroid cancer look like?

A

Microcalcifications in a node - with papillary.

Hyperechoic compared to regular nodes, hyperenhancing on CT, and T1 bright on MRI.

Bleed in the brain
“Miliary” pattern to the lungs
Can be occult on cross-sectional imaging in lungs.

41
Q

Development of the parathyroid glands

A

Superior 2 are from the 4th branchial pouch
Inferior 2 are from the 3rd branchial pouch

Inferior are more likely to be ectopic.

42
Q

What does a parathyroid adenoma look like on 4D-CT?

A

Early wash in and early wash out.

43
Q

How can you tell a parathyroid gland is carcinoma?

A

Will look like an adenoma, but will have cervical adenopathy or invasion of adjacent structures.

Body (5 decks)

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