Endocrine Flashcards
Highest sensitivity for detecting pancreatic tumors
Intra-operative US
Pancreatic exocrine function showing normal total volume and enzyme secretion but decreased bicarb
Chronic pancreatitis
Whipple’s Triad
Hypoglycemia symptoms
Associated low measured glucose
Relief after increase in glucose
Insulinoma; medical management prior to sx
Frequent high carb meals and diazoxide
Gastrinoma triangle
Cystic duct, junction of 2nd/3rd part of duodenum, junction neck/body pancreas
Main duct IPMN in head of pancreas; tx
Whipple
Galactorrhea and refractory peptic ulcer disease and hypomagnesemia; dx
MEN; Pancreatic tumors(most common gastrinoma), pituitary adenomas, parathyroid hyperplasia
Young, healthy with hypercalcemia, normal neck exam and normal PTH; next step in workup and likely dx
Urine calcium, Familial hypercalcemic hypocalciuria
Needed to confirm removal of all hyper functioning parathyroid glands
PTH drop of 50% compared to highest pre-excision value
Parathyroid carcinoma tx
Parathyroidectomy and en bloc hemithyroidectomy (mod rad neck if pos nodes)
Hyperparathyroidism, high calcium/PTH, low phosphate
Primary hyperparathyroidism
Parathyroidism, low calcium, high PTH and phosphate
Secondary hyperparathyroidism
Parathyroidism, high calcium and phosphate, VERY high PTH
Tertiary hyperparathyroidism
Very high calcium and palpable neck mass; dx
Parathyroid carcinoma
Most commonly injured nerve during thyroidectomy
Superior laryngeal laryngeal nerve
Child with MEN2A and MEN2B; tx
Prophylactic total thyroidectomy with bilateral central neck dissection by age 5 and age 1
Partial thyroidectomy for papillary thyroid Ca 0.7cm; net step
Thyroid hormone and surveillance US
Well-differentiated thyroid cancer in pregnancy; tx
Thyroidectomy post-partum
Poorly differentiated thyroid cancer in pregnancy; tx
Thyroidectomy in 2nd trimester
Absolute contraindications to radioactive iodine
Pregnancy and breastfeeding
Solitary encapsulated thyroid mass spreads through local extension and hematogenous dissemination
Follicular carcinoma
Indication for total thyroidectomy in follicular carcinoma
> 4cm, extra thyroidal extension, mets
Medullary thyroid cancer; tx
Total thyroidectomy with bilateral level VI LND
Germline mutation leading to medullary thyroid cancer in MENII
RET proto-oncogene
Most common side effect of radioactive iodine
Hypothyroidism
Catecholamines of adrenal medulla are derived from what
Tyrosine
Enzyme Tyrosine to DOPA
Tyrosine hydroxylase
Enzyme DOPA to Dopamine
Dopa decarboxylase
Dopamine to NOE
Dopamine hydroxylase
NE to Epi
PNMT
Phenylehtanolamine-N-methyltransferase; where from
Adrenal medulla organ of Zuckerkandl near aortic bifurcation
Best screening test for pheochromocytoma
Plasma free metanephrines
Chemo for adrenocortical carcinomas
Mitotane
Most common primary tumor to metastasize to adrenals
Lung
First-line test for suspected adrenal insufficiency
Early morning serum cortisol
Deficiency in 21-hydroxylase in the adrenal gland
Congenital adrenal hyperplasia, ambiguous genitalia and salt wasting
Deficiency in 11beta-hydroxylase
CAH, less likely symptomatic than 21-hydroxylase
Glucosylceramidase deficiency
Gaucher disease
Hexosaminidase A deficiency
Tay-Sachs disease
Elevated Cortisol, Low ACTH
Adrenocortical adenoma
Elevated Cortisol and High ACTH; next step
Pituitary or ectopic source, Pituitary MRI and high-dose dexamethasone test
Plasma aldo to renin ratio >25, muscle pain, fatigue, polyuria; dx and metabolic
Conn syndrome, hyperaldo, hypokalemia, hypernatremia and metabolic alkalosis
Hypercortiolism, ACTH low and cortisol high with low dose dexamethasone test; next step
CT to identify adrenal source for Cushings
Hypercortiolism, ACTH high with low dose dexamethasone test; next step and then what
High dose test, if suppressed Pituitary MRI, if unchanged search for ectopic source
Pheo classic triad and rule of 10s
Headache, palpitations, diaphoresis
Bilateral 10%, familial 10%, extra-adrenal 10%, malignant 10%
Most common cause of Cushing’s
Exogenous administration of steroids
Most common cause of endogenous Cushing’s syndrome
Adrenocorticotropic hormone-secreting pituitary adenoma
Pituitary adenoma; tx
Dopamine agonist (Cabergoline)
How to distinguish between unilateral and bilateral adrenal hyperplasia
Adrenal venous sampling
Functional adrenal mass; tx
Lap adrenalectomy
Adrenal mass workup
Adrenal CT protocol
Determine if functional with BMP, Aldo, renin, serum and urine metanephrines
Adrenal vein sampling if needed to localize
Arterial supply and venous drainage of adrenals
Arteries - superior(inf phrenic), middle(aorta), inferior(renal)
Right - IVC
Left - Renal vein
Lowest risk of recurrence for tx of hyperthyroidism due to toxic adenoma or multi nodular goiter
Thyroid lobectomy
Incidentaloma, HTN, Hypokalemia, increased aldo:renin, inability to suppress with sodium load; dx and initial tx
Conn Syndrome (prim hyperaldo), spironolactone preop
Hypoglycemia, confusion, diaphoresis; Neuroendocrine tumor
Insulinoma
Abdominal pain, diarrhea, recurrent peptic ulcer; Neuroendocrine tumor
Gastrinoma
Diabetes, necrotizing migratory erythema, thrombosis; Neuroendocrine tumor
Glucagonoma
Watery diarrhea, hypokalemia, hypochlorydia, NAG met acidosis; Neuroendocrine tumor
VIPoma
Cholelithiasis, steatorrhea, diabetes; Neuroendocrine tumor
Somatistatinoma
