Endocrine

Question 1

Thyroid gland neoplastic disease

Answer 1

Most thyroid nodules are asymptomatic

RF:

• extremes of age
• h/o head/neck irradiation
• most found in men and children are malignant

Dx:

• FNA w/bx
• radioactive iodine uptake scan
• thyroid US

Mgmt:

• surgery: if CA suspected or indeterminate FNA w/cold thyroid scan [total vs. subtotal thyroidectomy]
• obs: q 6-12mo for suspicious nodules
• suppression therapy w/thyroid hormone in attempt to shrink nodule

Question 2

Types of thyroid nodules

Answer 2

Benign: smooth, firm, irregular, sharply outlined, discrete, painless

Malignant: rapid growth, no movement w/swallow (fixed)

Types of Malignant:

1. Thyroid Papillary (MC - 80%)
   - young Female
   - common after radiation exposure
   - least aggressive
   - good prognosis
2. Follicular (10%)
   - more aggressive but good prognosis
3. Medullary
   - MC w/MEN2
   - more aggressive, requires total thyroidectomy
4. Anaplastic
   - most aggressive, rapid growth
   - compressive sxs by invading trachea
   - poor prognosis

Question 3

Corticoadrenal insufficiency Sxs

Answer 3

1’ 2’ 3’

• weakness
• muscle ache
• myalgias
• fatigue
• anorexia
• NV, abd pain
• HA, salt craving

1’ only

• hyperpigmentation [ACTH stimulates melanocyte stimulating hormone]
• orthostatic hypotension
• hypoNa, hypoK
• dec sex hormones in women

Question 4

Corticoadrenal insufficiency

Answer 4

1’

• autoimmune [industrialized country]
• infection [worldwide]
• vascular: thrombosis or hemorrhage in adrenal gland [waterhouse-freidrichsen]
• met disease
• meds: ketoconazole, rifampin, phenytoin, barbiturates

2’

• pituitary failure of ACTH secretion
• lack of cortisol
• aldosterone intact d/t RAAS
• MC: exogenous steroid use**
• hypopituitarism

Question 5

Corticoadrenal insufficiency dx/tx

Answer 5

High dose ACTH stimulation test:

• screening for adrenal insufficiency
• A.I. = little or no increase in cortisol levels

CRH stimulation test

• 1’ (addison): High ACTH and low cortisol
• 2’ (pituitary): Low ACTH and low cortisol (pituitary cannot produce enough ACTH)

Mgmt
- glucocorticoids (hydrocortisone) + mineralocorticoids (fludrocortisone) for addisons

• only glucocorticoids in 2’