Endocrine Flashcards
What are the indications for adrenalectomy
Adenona/neoplasm >4cm
Radiological suspicion for malignancy
Functional adenoma
Significant growth over 6months
What are the typical exam findings of a thyroglossal cyst?
In the midline
Moves on swallowing and protrusion of the tongue
Histopathology features of papillary thyroid cancer
Papillary architecture: finger-like projections
Cuboidal or columnar tumour cells
Orphan Annie eye nuclei
Psammoma bodies
Components for staging for differentiated thyroid cancer
Age at diagnosis
Size of primary tumour
Tumour histology
Extra-thyroidal spread
Loco-regional metastases (LN and direct extension)
Distant metastases
What are the unfavorable histopathological variants of DTC?
tall cell, columnar cell, and hobnail variants of PTC;
widely invasive FTC; hurtle cell
poorly differentiated carcinoma
High risk patient in DTC (ATA guidelines)
Gross extrathyroidal extension
Incomplete tumour resection
Distant metastases
Inappropriate post-operative serum Tg values
LN >3cm
These patients should be offered RAI
Intermediate risk pts in DTC (ATA guidelines)
Microscopic extrathyroidal cells extension
Cervical LN Mets
RAI-avid disease outside the thyroid bed
Vascular invasion
Aggressive tumour biology
These pts should be considered for RAI
FHH
Familial hypocalcuric hypercalcaemia
Autosomal dominant
Loss of function if CaSR (calcium sensing receptor) gene.
Essential the set point for Ca is abnormal
Typically:
High serum Ca
Normal PTH
Decrease urinary Ca (due to increased resorption)
Test to differentiate from PHPT is urinary ca - both Ca and Ca/creat ratio should be low in FHH
Treatment is reassurance if assymptomatic
Calciemetic if symptoms
No role for surgery
Can do gene testing
Pathogenesis of diffuse goiter
Iodine deficiency
Persistent TSH stimulation
Leads to diffuse follicular epithelial hyperplasia
Tests for adrenal Cushing disease
24 urinary cortisol (>3x upper limit of normal)
Dexamethasone suppression test (cortisol high)
Plasma ACTH (low in adrenal source, high is extra-adrenal problem)
TIRADs components
CES-ME
Composition
Echogenicity
Shape
Margin
Echogenic foci
Indications for index total thyroidectomy in DTC
Tumour >4cm
Gross extra-thyroidal extension
Evidence of metastatic disease
Radiation induced DTC
Familial non-medullary thyroid cancer
Multi-focal bilateral DTC
Adverse effects of RAI
Sialadenitis
Nasolacrimal duct obstruction
Transient tumour/thyroid swelling
Infertility
Development of secondary malignancies (eg leukaemia)
All dose dependent
Which genetic conditions are associated with paraganliomas?
Succinate dehydrogenase (SHD) mutations
VHL - von Hippel-Lindau syndrome
RET - MEN-2a
NF1
Carney-stratakis syndrome/ carney’s triad
Cernea classification
